Inspection on 03/04/08 for Finch Manor

This inspection was carried out on 3rd April 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Finch Manor 21/01/09

Finch Manor 25/10/07

Finch Manor 02/11/06

Finch Manor 08/05/06

Finch Manor 02/02/06

Finch Manor 27/07/05

Finch Manor 21/01/05

Finch Manor 19/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Finch Manor Finch Lea Drive Dovecot Liverpool Merseyside L14 9QN Lead Inspector Jeanette Fielding Key Unannounced Inspection 3rd April 2008 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Finch Manor Address Finch Lea Drive Dovecot Liverpool Merseyside L14 9QN 0151 259 0617 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) finchmanor@bmlhealthcare.co.uk Moorshield Ltd ** Post Vacant *** Care Home 89 Category(ies) of Dementia - over 65 years of age (75), Old age, registration, with number not falling within any other category (14) of places Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate four service users aged 55 to 65 years old on DE (E) unit To accommodate one named service user under the age of 55 years To accommodate one named service user under the age of 65 years for short term respite care 25th October 2007 Date of last inspection Brief Description of the Service: Finch Manor is a purpose built, single storey home situated in the Dovecot area of Liverpool. It is set in its own grounds with gardens to the front and rear and with two internal courtyard-sitting areas. The home provides care and support in four units. One with 14 places is for the general care and support of older people. Another has 21 places for older people with dementia who require personal care only and the remaining 54 places are across 2 units provide nursing care and support to older people with dementia. All of the residents accommodation is provided in single bedrooms with en-suite WC and wash hand-basin. A full range of aids and equipment is available providing assisted showers and baths and all areas of the home are accessible by wheelchair. Lounge and dining areas are located in each of the units and a central kitchen prepares food that is delivered in heated trolleys for care staff to serve to residents. An internal security system of keypads on connecting doors prevents residents from wandering out of the home or between units. Fees at the home range from £357 to £495 depending upon category. The home is within walking distance of local shops and there are public transport routes nearby. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use the service experience poor quality outcomes. This key unannounced inspection took place as a result of concerns raised to CSCI by the Safeguarding Adults Team following an investigation by them. The inspection was conducted over two days by Mrs J Fielding who was accompanied by Mrs J Adam on the first day. The site visit part of the inspection involved speaking with service users, visitors, staff and management. Records relating to the care of service users were viewed to evaluate the level of care required by and afforded to them. Staff files were viewed to ensure that all safety checks had been made on staff prior to their employment at the home and to evaluate the training that they had undertaken. Safety certificates were viewed to ensure that all equipment and facilities within the home assured the health, safety and welfare of the staff. A full tour of the building was undertaken, including most bedrooms to assess the environment in which service users lived. In every outcome area, evidence includes feedback from people who use the service, or where people have communication difficulties, direct observation, case tracking or from relatives are included. This information may be verbal or from surveys. The Regional Manager submitted a speedy action plan to address the shortfalls identified during the inspection. Remedial action has been taken to address some of the issues and timescales were given to address others. What the service does well: The Regional Manager submitted a speedy action plan to address the shortfalls identified during the inspection. Remedial action has been taken to address some of the issues and timescales were given to address others. The staff team have undertaken a high level of training and were supportive of the new manager and said that they were committed to providing a high level of care to service users. Staff files were detailed and included all necessary pre-employment checks together with evidence of staff training. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 6 Bedrooms are homely and personalised and reflect the lifestyle of the service users prior to their admission by the provision of photographs and items of memorabilia. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments provide the home with full information regarding service users health and social needs but do not provide sufficient detail regarding the mental health history of those who are accommodated for care due to their dementia. This has the potential for impacting on the care afforded to those service users. EVIDENCE: The home has produced a detailed Statement of Purpose and Service user Guide to give full information to prospective service users regarding the services and facilities offered by the home. Arrangements are in place to update the documents to reflect recent changes in the management of the home. One service user spoken to confirmed that her relative had obtained a Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 9 copy of the Service User Guide when they were considering which care home would be most suitable for her. Pre-admission assessments are undertaken on all prospective service users prior to their admission to the home. All assessments inspected provided details of the service users health and social care needs. A history of all medical interventions was recorded and information was gathered from the service user, their family and the hospital records. These forms provided sufficient information regarding the care needs of service users accommodated for general residential care and enabled the staff to prepare a plan of care to enable their needs to be met. For those service users who were accommodated due to their dementia, little information was recorded regarding the dementia. No details of how long the service user had had the condition or how it had progressed was recorded. No details were recorded in relation to how the dementia was displayed i.e. confusion, aggression or mood swings. This information would provide staff with an insight into the individual and their condition and enable them to meet the service users needs in a more effective way. Discussion took place with the manager regarding these omissions from the pre-admission assessment form. She stated that this information would be of benefit from the information being gathered at this early stage and would make arrangements for the assessment form to be reviewed and updated to include this information for new service users. The home does not offer intermediate care. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans require review and updated to make them person centred and to inform staff of their current needs to ensure that their needs and preferences are met and thereby provide them with a quality life. Risk assessments are poor and risk management plans are not suitable which has the potential for placing service users at risk. EVIDENCE: Service users are accommodated in four units, each being overseen by a care manager. Qualified nurses manage the units for service users accommodated for nursing care and trained senior care staff manage the units for service users who are accommodated for personal care. The nursing units and one of the personal care units are for service users who have dementia and a general unit provides personal care for elderly persons. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 11 Care files were inspected on each of the units. The care plans are standardised and have been typed for each potential problem within the activities of daily living, such as breathing, washing and dressing. The care plans and risk assessments that require more urgent review are those relating to moving and handling, mobility and nutrition. Confirmation has been received from the manager that these issues were addressed in the week following the inspection and assurances given that regular audits and reviews will ensure they remain accurate and effective. There is a need for care plans to be more person centred to ensure that the specific needs of each service user are detailed to enable the staff to meet those needs together with individual preferences. Little information is recorded with regard to individual choices and preferences. The manager has now advised that she will work with relatives to gather information in order that individual lifestyle details are recorded on the files to further enable staff to meet those choices and preferences. This will include work and social history and will give details about hobbies, relatives, pets and home life. General Unit. Elderly persons. The care files for service users on this unit were organised and contained individual plans relating to the needs of the service users. Care needs were identified and care plans provided staff with full information regarding the specific care that each service user needs. The unit manager was eager to improve the plans and discussion took place regarding additional information that could be included in the care plans. It was evident that the services of GP’s and other healthcare professionals had been sought where concerns had been identified and the care plans included details of changes where necessary. As in all units, some of the information that would be required to be included on the front of a care plan had been recorded within the review. It is necessary that where changes are made to a care plan, the care plans is rewritten to ensure that the information is clearly available to staff. In this unit, the number of plans that require rewriting is small and did not impact on the service users. The bed rail in one bedroom requires to be changed as it is not sufficiently high due to the use of an overlay mattress. Staff spoken to during the inspection were fully aware of each service users individual needs and demonstrated their commitment to providing a high level of care. In view of this, and from discussion with service users, the staff are meeting the individual health needs of the service users. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 12 Unit 3. Personal Care - dementia. The care files of four service users were inspected. The care files were detailed and informative regarding the service users personal care needs. The files would benefit from additional information being recorded regarding service users dementia, how it was progressing, the time frame of the progression of the dementia and any specific problems that could be encountered together with the action to be taken to resolve those problems. The file of one service user showed that some health issues had been identified by the staff at the home as an area of concern. The unit manager had contacted the GP and the dietician with a request for a visit to be made. The service users family had also been updated with regard to the changes in condition and this information had been clearly recorded. The care file of another service user showed that appropriate action had been taken when concerns for their health were identified. The unit manager explained that there were some difficulties in arranging for GP’s to visit the home and that often, service users were taken by taxi to the GP surgery. This had occasionally caused problems as the service users became disorientated by these visits and was not conducive to their care. This was later discussed with the new home manager who said that she will review this practice. The daily records completed by the staff were detailed and provided evidence of the actual care given on a daily basis. It was observed that the staff in this unit were enthusiastic and committed and did all they could to meet the service users needs. Unit 2. Nursing Care – Dementia. The care files on this unit require considerable improvement and updates. The majority of service users had been accommodated at the home for a number of years and their care plans were written in 2006. Each plan had been evaluated monthly and this was evidenced by a comment written by the staff which was dated and signed. It was identified that changes to care needs for some service users was recorded within the reviews, but the actual plan, to identify the changing needs of the service user was not recorded on the front page of the plan. This presents as a problem when trying to find the actual care needs of service user which may have changed considerably since the original plan was written. Some of the necessary information had not been recorded. Some risk assessments were not in place and a number had not been updated to provide accurate information, particularly in relation to moving and handling. The failure to prepare appropriate risk assessments, and risk management plans has the potential for placing service users and staff at risk. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 13 One care plan identified that a service user needed help with oral hygiene. There was no information recorded as to the kind of help that the service user needed or if they had dentures or their own teeth. Little information was recorded to assist staff in meeting service users continence needs. Some files required that the service user be taken to the toilet every two hours, but observation of service users for a period of over three hours showed that none were taken to the toilet, particularly prior to lunch being served. No details were recorded of the type of aids necessary to meet the service users needs. Risk assessments and risk management plans in relation to mobility and moving and handling were generally poor. One care file stated that the service user requires supervision when mobilising and later identifies that a hoist is to be used for transferring. No details are recorded as to the type of hoist to be used or the size of the sling, appropriate to the needs of the service user. No details were recorded in relation to the number of staff required to assist the service user when being hoisted or moved in bed. The service user was recorded as having lost weight and taking a soft diet. There was no record of intervention by the GP or dietician with regard to the weight loss. The service user also had a small pressure sore but the plan in place with regard to the treatment was poor and contained insufficient information for staff. The notes from the District Nurse stated that, in view of the pressure sore, the service user should be cared for in bed but sat in an armchair for meals. The service user was observed to be in the lounge for a period of three hours which contravenes the advise of the District Nurse and has the potential for causing further skin damage. There is some evidence that staff at the home have failed to contact a GP at the appropriate time or when requested to do so by a relative. It is essential that doctors or other healthcare professionals are contacted in a timely manner or on the request of service users or relatives. Unit 1. Nursing Care – dementia. The care files on this unit, again, need considerable update and improvement. The file for one service user identifies that the service user may be verbally and physically aggressive and violent. No details are recorded of whether it is staff, service users or both that may be placed at risk. The care plan states ‘to engage de-escalation techniques’ but not details of this are recorded. No information is recorded as to the events that lead up to the service users aggression or of what interventions are appropriate to diffuse situations. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 14 Care plans were seen that are unnecessary in relation to breathing. These are held on the files of all service users although no problems have ever been encountered and the service user has no history of chest infections. The monthly review records completed by the nurses for some of these service users includes ‘continues to have no problems with breathing’ but the plan remains in place. Written entries by some of the staff proved extremely difficult to read due to the handwriting. All records must be clear and accurate to ensure that all staff can read them. There is some evidence that staff have failed to follow the home’s procedure for moving and handling. The Commission for Social Care Inspection has, subsequent to the inspection, been advised that immediate action has been taken to undertake manual handling assessments on all service users and specific plans put in place to ensure that all service users are moved safely and without risk of injury. Two new hoists have been ordered to supplement the equipment already provided and it is necessary for staff to be given training on the use of this equipment on delivery. Evidence of this training is to be recorded. The inspectors observed the clothing worn by service users, together with clothing in their bedrooms. All clothing is clearly labelled and folded neatly in their drawers and wardrobes. There is no suggestion that the condition of the clothing is a result of the laundering process as this was seen to be attended to with care and consideration. The quality of the clothing is poor and it was evident that some service users were wearing clothes that was unfit for purpose due to the size or poor quality due to it being ‘worn out’. The manager has advised that contact will be made with relatives of service users who require new clothing to request that this is provided. Staff showed a positive attitude towards service users and spoke politely to them. They engaged well with those who were able to communicate verbally. Service users who were unable to communicate verbally were only acknowledged when they were given a morning drink or lunch. Medications. The home has a detailed medications policy and procedure and it is advised that a copy of this is held in each of the unit manager’s offices to give all staff full access. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. Records are held on staff files to confirm that they have been given training on medications and that Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 15 their competency has been assessed. The manager has arranged for detailed medications audits to take place on a monthly basis. Some handwritten entries on the Medication Administration Record (MAR) sheets were illegible. All handwritten entries must be clearly written and include all information as detailed on the label printed by the pharmacist. Some entries in the MAR sheets did not include the signatures of two staff to verify the accuracy of the entries and some did not include the amount of medication received into the home. It is essential that the amount of medication received is recorded to enable an accurate audit to take place. Some shortfalls in medication supplies were identified and one of the unit managers explained the reason for this. All medications are ordered from the GP using the repeat prescription form. The prescriptions are collected by the pharmacist who then dispenses the medication and delivers it to the home. It was established that the staff at the home do not have sight of the original prescriptions prior to them being sent to the pharmacist. Arrangements have been made for this system to be changed. The staff explained that they ordered the medications three weeks prior to them being required but that they were sometimes late being delivered. It was evident that staff had made every effort to ensure that service users received their medication in a timely way but that this could not be guaranteed due to circumstances beyond their control. The manager had not been made aware of this problem, in that she had only been at the home for two days, and so immediately made arrangements to meet with the pharmacist to try to resolve this problem. The manager also stated that she will arrange to meet with representatives of the GP’s if necessary. The unit manager on the General Unit had prepared a chart for care staff to sign when they have applied creams to service users skin. This is good practice and provides evidence that the individual needs of the service users are being met. Care staff spoken to confirmed that personal care was given to service users in the privacy of their own bedroom or in the bathroom as appropriate and staff were observed to take service users to their bedrooms or bathrooms for personal care. The majority of service users at the home were unable to express their views of the home or of the care given due to their cognitive impairment. Service users who were able to express their views spoke highly of the staff and said that they were kind and caring. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The provision of activities and social stimulation is insufficient to meet the varied needs of service users. The home fails to provide a lifestyle that meets service users expectations, preferences or recreational needs. EVIDENCE: The home employs two activity co-ordinators for a total of 56 hours per week but one of the co-ordinators was not available on the day of the inspection or for some weeks previously. The new manager said that there was an activities programme in place but this was not observed during the inspection. There was little stimulation for the residents and some of the more able people looked bored. The television was on but not many people could see it due to the layout of the seating within the room and no-one seemed to be watching it. Resident may benefit from having Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 17 books and magazines around, objects that they could pick up and touch or music playing at times. None of the residents spoken to during the inspection were able to confirm that they had participated in activities and none were observed to chat with staff on a one to one basis. The manager has confirmed, subsequent to the inspection, that the company has provided an increased budget for provisions for activities with an initial sum provided for the purchase of appropriate equipment. On the second day of the inspection, the manager made arrangements for the seating in lounges to be reviewed to provide a more homely environment, giving service users the opportunity to see the television or to communicate more easily with others. Staff members spoken to during the inspection confirmed that they had previously been instructed to ensure that service users remained within the lounge and to prevent them from walking around the home due to the risk of falls. The manager spoke with staff regarding this and immediately made arrangements for service users to have freedom of movement within the home as they wished. Additional social activities, use of the garden and more fresh air within the home by the opening of windows rather than the use of air fresheners was included in survey forms that had been completed by relatives as being necessary to improve the home and the service. Lunch was observed on two units on the first day of the inspection and on the other two units on the second day. No alternative meal was provided for service users, with the exception of having meatballs with or without gravy on the first day, although one member of staff requested that the kitchen prepare a sandwich for one service user who did not like the meal on offer. On the second day, the meal was fish and again, no alternative meal was provided. The staff appeared to know which service users required small meals. The manager stated that the lack of choice was due to the lack of catering staff at the home and had arranged interviews for a new chef. Subsequent to the inspection, the action plan provided by the company confirms that a new chef will commence work at the home on 13th April 2008. On appointment, the chef will be responsible, in conjunction with the manager, for a review of the menus, which will then offer a choice of meals. Individual preference details will be obtained from service users or their families, as appropriate, to ensure that individual preferences can be met. On one unit, the tables used for dining were placed in a long row and plastic table clothes were used. There were no condiments on the table. Not all residents could sit at then table but staff were heard to ask if they wanted to sit at the table or stay in their seat with a bed table in front of them to eat. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 18 On another unit within the home meals were observed and plastic tablecloths and plastic crockery was used. The new manager was unhappy with this and had ordered alternative crockery. Service users were offered cold drinks with their meal. Service users who required assistance with their meals were observed to be assisted in a dignified manner by care assistants who sat beside them at the table, with the exception of one member of staff who was observed to stand over the service user. This was reported to the manager who said that she would speak to this member of staff to ensure that this poor practice did not re-occur. The main kitchen was generally clean, although window frames and high areas would benefit from a programme of deep cleaning. The majority of food stocks within the kitchen were frozen with potatoes and onions being the only fresh vegetables available. Fresh fruit was available in the kitchen and the cook stated that fruit is sent to each unit regularly. Meals are transported to the individual units in heated trolleys. Two of these trolleys had been cleaned but one required a thorough cleaning to remove stains and food debris. The temperatures on the refrigerators and freezers could not be verified and the home is advised to provide independent thermometers for these items to enable and accurate record of temperatures to be maintained. Relatives are welcome to visit the home at any time and the manager was observed to be meeting with relatives on a one to one basis during the inspection. Service users may meet with their visitors in one of the communal areas or in the privacy of their own bedroom as they wish. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not been able to demonstrate that service users were adequately protected through the actions and inactions of staff which has the potential for placing service users at risk or harm. EVIDENCE: The home has a detailed complaints procedure that is displayed on the wall in the foyer and is also documented in the Service User Guide and Statement of Purpose. The records held in the home are incomplete in respect of a complaint made to the home. The inspectors have been advised that the complaint was dealt with in accordance with the home’s policy and procedure but the documentation had not been placed on the file. The majority of staff have been given training on the Protection of Vulnerable Adults (POVA). Further POVA training has been arranged for 16th April 2008. Staff spoken to during the inspection were able to confirm that they had been given training on the different types of abuse and were aware of the action to be taken in the event of it being suspected. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 20 It is evident that the owners and manager of the home have taken immediate remedial action to ensure that service users are protected, it is essential that all staff follow the home’s policies and procedures to ensure that service users are protected. As detailed earlier in this report, there is some evidence that staff have failed to contact GP’s when necessary or on the request of a relative. This constitutes an abuse practice and can result at placing service users at risk. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The communal areas of Finch Manor do not provide a comfortable or attractive environment for residents to live in, resulting in service users not benefiting from an environment that meets their needs and aspirations. EVIDENCE: Finch Manor is a purpose built care home. All bedrooms and facilities are located on the ground floor to give full access to those who require the use of wheelchairs or who have mobility difficulties. Service users are accommodated in single bedrooms, each having en-suite WC and washbasin. Bedrooms were personalised with televisions, pictures, photographs and items of memorabilia. It is evident that staff and relatives have strived to provide a Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 22 homely and pleasant bedroom for service users. All bedrooms were found to be extremely clean and free from odour. The lounges and dining rooms lacked the homely environment necessary for communal living and appeared un-cared for. A smoking room has been installed within one of the lounges since the last inspection. The area used for this was previously a large alcove room where service users could sit quietly. This room lacked adequate ventilation as it was not possible to open windows as the windows overlooked the fire escape. CSCI had not been informed of this change. Armchairs in one lounge had been placed in rows resulting service users being denied the opportunity to interact with each other as they had to lean forward to see the person next to them. Many service users had been seated along walls, out of sight of the television, with no other stimulus provided. No ornaments, appropriate pictures, orientation or stimulation was provided within the lounges which gave an institutional atmosphere. No flowers were seen in any of the lounges. Staff spoken to said that they had previously been told that service users may remove or break any ornaments that were in the lounge and had been discouraged from providing them. Curtains were found to be coming away from the rails in some areas and window frames required to be thoroughly cleaned as they were stained and dirty. One conservatory was fitted with faded, dark green, blinds which did little to enhance the environment. At present, a handyman is employed on a part time basis. Subsequent to the inspection, the handyman’s hours have been increased to full time to address the issues with in the building. At the last inspection, the inspector was advised that cross-corridor doors were left open during the day to allow service users to have access to other areas of the home. At this inspection, cross-corridor doors were closed, denying service users choice in respect of which area of the home they use. Service users who have dementia are therefore denied the opportunity to walk around the home and staff were observed to repeatedly sit service users in armchairs when it was evident that they wished to walk at get some exercise. Service users should be risk assessed in relation to them walking around the home and appropriate risk management plans put in place to ensure that they are safe. The dining tables in one unit were placed in a row and not all service users could sit round them. The use of plastic tablecloths and crockery further detracted from a homely environment. The new manager had identified with some of these issues and had made arrangements for them to be addressed. No condiments were seen on tables to enable service users to choose how they liked their meal to taste and no ketchup or sauces were seen to be available. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 23 No appropriate orientation is provided in relation to toilets and bathrooms to assist service users who have dementia or to promote independence. Discussion took place with the manager regarding signage and colour identification systems that could be considered. Some extractors were found to be not working in bathrooms and toilets which had resulted in malodour in these areas. These extractors require repair or replacement as necessary. Some extractors were seen to be dirty with dust and fluff and require to be cleaned. The manager explained that consideration was being given to converting two bathrooms into shower rooms to provide service users with more appropriate bathing facilities. Plans for this work are currently being prepared. The kitchen requires to have the window frames and many of the high areas deep cleaned to ensure that any risk of cross contamination is removed. One garden area had access through an unused car parking area and could be seen from the window in the lounge. No flowers or shrubs were in the garden and the area was bordered by a fence. Staff confirmed that garden furniture was available for use in the summer months and that they would assist service users to use the space. The gardens surrounding the home provide lawns but there is no colour to brighten the areas. The entrance area to the home provides a ramp to allow full access to service users who have mobility difficulties or require a wheelchair. Grab rails are provided along corridors to assist service users. The home provides two ‘Standaid’ hoists and three hoists for use with slings to assist with moving service users. Two of the hoists were seen to be stored in a sluice. This is unacceptable and presents as a contamination risk. All sluices must be cleared of unnecessary equipment and made suitable for purpose. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home employs a staff team who have received a high number of training opportunities to provide care for the service users to ensure that their needs are met. The competency of the staff has not been assessed in relation to care practice to ensure that procedures are followed to ensure the protection of service users. The policy and procedure for moving and handling requires to be reinforced for all staff to ensure that service users are protected. EVIDENCE: The staff rota within the home indicates that the home employs staff in sufficient numbers to meet the needs of the service users. The unit manager on the General Unit has requested that the manager provide one additional member of staff on the 8am to 2pm shift and this has been agreed. At present, the new manager is reviewing the dependency level of the service users to further evaluate the staffing levels in the home. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 25 The home employs qualified nurses on those units which provide nursing care and care staff throughout the home. Each unit is managed individually and the unit manager is responsible for their staff team and overseeing the care given to the service users. A selection of staff files were inspected which included staff new to the home since the last inspection and staff who had worked at the home for some years. The home has a robust recruitment procedure for the employment of staff. All prospective staff are required to complete an application form prior to being called for interview. A record of the interview is held. Two references are taken and checks are made through the Criminal Record Bureau and Protection of Vulnerable Adults register. All staff are required to undertake induction training when they commence at the home and evidence of this was seen on their files. All files inspected were found to contain all documentation as required. Training records are held on files or in a separate file where in house training has been given. All staff have been given training on moving and handling and a record of the date of this training is held. Further training has been arranged and the dates of this were displayed on the notice board in the office. Planned training includes dealing with challenging behaviour, dementia care, first aid, medications and fire awareness. Training on the protection of vulnerable adults has been given to all staff and the records held in the home provide evidence that this training is given every three months to ensure that staff are aware of the action to be taken to ensure that service users are protected. All nurses and senior carers, together with many of the care assistants, have had training in dementia care and this is recorded on their individual files. A recent incident at the home showed that some staff had failed to follow procedures appropriately and this matter is currently being investigated. The manager confirmed that training on moving and handling is being arranged for all staff and will take place as soon as possible. This issue impacts on the competency of the staff, despite a high level of training being given. Staff spoken to during the inspection said that they enjoyed their work and were committed to providing a high level of care for the service users. They said that they would like to provide a more homely environment for the service users but were not fully aware of the safety aspect of the use of ornaments and other items within the lounges. Two carers said that they were aware that service users were at risk of falling and required continuous supervision, sometimes ensuring that those at risk remained in the lounge so that they could be observed. The manager confirmed that she will discuss risks with the staff and ensure that all staff are made aware of appropriate risk management Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 26 strategies. Care staff confirmed that they were encouraged to read the care files so that they knew exactly what the service users care needs were. One carer said that they would like to use name badges so that service users, visitors and other people knew their names and could communicate more effectively with them. The home employs qualified nurses, senior care assistants, care assistants, laundry, domestic staff and an administrator. The number of catering staff will be increased by the employment of a qualified chef to improve the catering services and to offer choice of meals and utilise more fresh foods in the meal preparation. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent changes in the management of the home has identified the need for considerable change in the ethos of the home to ensure that service users are provided with a quality lifestyle within a safe and homely environment. EVIDENCE: Since the last inspection, there has been a change to the manager of the home. The new manager had only commenced working at the home two days prior to the inspection. The previous manager had left the home the previous week. An application to register the manager is required to be submitted to CSCI. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 28 The new manager is a qualified nurse who has considerable experience in the management of care homes. The owners are currently looking to recruit a deputy manager to assist the manager and this post is to be advertised in the local press. The manager had already identified a number of shortfalls within the service during her two days at the home and had already put systems in place to address them. She confirmed that staff were supportive and had been open with her in discussions and had demonstrated that they wished to improve the service. Since the last inspection, a new Operations Manager and Regional Manager have been appointed. Written confirmation was received from the Regional Manager, subsequent to the inspection, that many issues raised during the inspection had been addressed or systems put in place to address them. The Operations Manager is to work closely with the manager to ensure that service users are protected and shortfalls addressed. A high number of staff spoke with inspections and all said that although the new manager had been in post for only a few days, they found her approachable and willing to listen to them. They confirmed that many issues had been dealt with and felt confident that she would be supportive and give direction to improve the home. Service users financial dealings are generally dealt with by their relatives or advocates. A separate bank account is held for service users who do not have relatives and detailed accounts are held of all monies in the account. This account is audited regularly and records held in the home show that the accounts are accurate. The records held in the home provide evidence that all staff are given regular supervision. The records show that supervision is given to care staff by the unit managers and that the unit managers are given supervision by the manager. The new manager is to review the supervision process to include greater identification of skills and abilities with a view to identifying training needs and thereby develop their knowledge and understanding. The supervision process will require that care practices are monitored to assess staff competence following the relevant training. Questionnaires are sent to service users and their families every six months to obtain their views and opinions of the home. The new manager is to arrange a meeting with relatives to introduce herself, to explain the changes in the home and to give them the opportunity to give their views. This meeting will also provide the opportunity to inform relatives of the items of clothing, toiletries Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 29 and personal items that service users need. The relatives meeting has been planned for 22nd April 2008. The home has detailed policies and procedures. As part of the staff development programme, staff will be required to become familiar with all policies and procedures. Safety certificates were inspected and found to be well maintained and up to date. Checks on fire detection equipment are made as required and are duly recorded. Fire drills are held on a regular basis to ensure that all staff are aware of the procedure to be followed in the event of fire being suspected. The home has failed to notify CSCI of significant events in the home as required under Regulation 37 of the Care Homes Regulations 2001. Incidents such as injuries to service users where hospitalisation is required, the change of manager or changes that take place within the home are required to be notified to CSCI. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 1 X 3 X 3 2 2 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 3 2 Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Timescale for action 23/05/08 2. OP7 15 3. OP8 13 4. OP9 13 The registered person must ensure that full information regarding the service users is recorded in the preadmission assessment to ensure that the home can meet their needs. This is specifically in relation to service users who have dementia. The registered person must 20/06/08 ensure that person centred and individualised care plans are prepared and regularly reviewed and updated to inform staff of the level of care required by service users. Plans are to include risk assessments and risk management plans. The registered person must 23/05/08 ensure that doctors and other health care professionals are contacted in a timely manner or on request to ensure that service users health care needs are met. The registered person must 23/05/08 ensure that medications are received into the home in a timely manner, two signatures are recorded on handwritten DS0000048861.V362045.R01.S.doc Version 5.2 Finch Manor Page 32 5. OP12 12 6. OP14 12 7. OP15 16 8. OP18 13 9. OP19 23 10. OP19 23 11. OP26 23 12. OP25 23 entries, the amount of medication received is accurate and all handwritten entries are clearly written to ensure that service users are protected from lack of medication or misadministration. The registered person must ensure that sufficient and appropriate activities are provided for service users to promote social interaction and stimulation. The registered person must ensure that choices in all aspects of daily life are offered to service users to promote their independence. The registered person must ensure that service users are served a nutritious choice of meals within a congenial setting with appropriate crockery and condiments to meet their assessed nutritional needs. The registered person must ensure that service users are protected from abuse through staff training and monitoring care practices to ensure their safety. The registered person must ensure that the layout of the lounges is conducive to social interaction. The registered person must ensure that faulty extractors are repaired or replaced to prevent malodour. The registered person must ensure that window frames and the kitchen are cleaned to provide a pleasant environment for the service users. The registered person must ensure that all extractors are clean and maintained in a working condition to prevent DS0000048861.V362045.R01.S.doc 23/05/08 23/05/08 23/05/08 23/05/08 23/05/08 23/05/08 23/05/08 23/05/08 Finch Manor Version 5.2 Page 33 13. OP28 OP30 OP36 18 14. OP31 8 15. OP38 37 16. OP38 13 malodour. The registered person must ensure that staff are given appropriate training and supervision to ensure that service users are in safe hands at all times. The registered person must ensure that an application to register a manager of the home is submitted to CSCI to manage the staff team and supervise the care of service users. The registered person must ensure that deaths, illnesses and other events are reported to CSCI. The registered person must ensure the health and welfare of staff and service users through monitoring and supervision of the facilities and services. 23/05/08 20/06/08 23/05/08 23/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP15 OP16 OP19 OP20 Good Practice Recommendations Independent thermometers should be provided for all refrigerators and freezers to ensure that their temperatures can be accurately monitored. Up to date records should be held within the home of all complaint responses to provide evidence that these have been dealt with appropriately. A means of identification of bathrooms and WC’s should be considered to provide orientation and promote independence. Consideration should be given to improving the gardens by the provision of flowers and plants to give colour and thereby improve the environment for service users. DS0000048861.V362045.R01.S.doc Version 5.2 Page 34 Finch Manor 5. OP33 Effective quality monitoring systems, based on seeking the view of service users will ensure that the home is run in the best interest of the service users. Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Finch Manor DS0000048861.V362045.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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