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Inspection on 28/11/06 for Fisher Close Nursing Home

Also see our care home review for Fisher Close Nursing Home for more information

This inspection was carried out on 28th November 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff group work well together and strive to make Fisher Close as homely as possible. A high standard of accommodation is provided, The building is very well maintained with the needs of individual residents being taken into account. Residents appear contented and good relationships are demonstrated between staff and residents. One resident commented that `my carers understand me, and how I communicate with the world`.

What has improved since the last inspection?

Appropriate weighing scales have been provided. The baths in bungalows 1 and 2 have been replaced with bathing facilities that are appropriate to the needs of residents. Increased staffing levels have enabled further access to activities to be facilitated.

What the care home could do better:

It is expected that care plans are reviewed more regularly in accordance with recommended guidance particularly in the areas of skin integrity, weight, nutrition and moving and handling.Staff are expected to receive training appropriate to their work roles, particularly in the mandatory areas of moving and handling and infection control. The acting manager is expected to make an application to register with the CSCI.

CARE HOME ADULTS 18-65 Fisher Close Nursing Home Grangewood Farm Estate Walton Chesterfield Derbyshire S40 2UN Lead Inspector Marie Bonynge Key Unannounced Inspection 28th November 2006 10:30 Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 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 Fisher Close Nursing Home DS0000002056.V313349.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 Adults 18-65. 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. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fisher Close Nursing Home Address Grangewood Farm Estate Walton Chesterfield Derbyshire S40 2UN 01246 200138 01246 202667 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) Derbyshire Care & Home Support Limited Vacant Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 Brief Description of the Service: Fisher Close is situated in a residential area approximately 2 miles from the centre of Chesterfield. The home comprises of three bungalows, each providing nursing and personal care and support for up to five adults with learning disabilities. Although the home is registered and managed as one establishment, each bungalow has its own separate nursing and care staff group and dedicated facilities including aids and adaptations. All residents are accommodated in single bedrooms. Each bungalow has its own garden area, accessible to residents. Transport is provided for residents. There is a car park to the front of the bungalows. The fees for this home range from £1095 to £1143. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in November 2006 and lasted for five and a half hours. There were 14 residents accommodated on this visit many of whom were at home today. Discussions were held with staff and the acting manager. A brief tour of the bungalows was made. Records were examined relating to the care of residents, staffing and training. 10 CSCI resident surveys were sent to the home and 10 were returned. 2 residents were unable to understand the questions asked due to their communication needs. 8 respondents were assisted by staff – usually their key worker – to complete the surveys with the proviso that many of the residents have limited communication skills. 6 requirements were made at the last inspection visit, 5 of these have now been met and 1 has been carried forward. The good practice recommendation has also been met. What the service does well: What has improved since the last inspection? What they could do better: It is expected that care plans are reviewed more regularly in accordance with recommended guidance particularly in the areas of skin integrity, weight, nutrition and moving and handling. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 6 Staff are expected to receive training appropriate to their work roles, particularly in the mandatory areas of moving and handling and infection control. The acting manager is expected to make an application to register with the CSCI. 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. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that full assessment information is obtained in order to provide a basis for care planning. EVIDENCE: Most of the residents at Fisher Close have lived in the home for many years and some residents have lived here since it opened. There have not been any new admissions since the last inspection. Assessments were completed for these residents prior to their admission to the home and have been updated when the persons needs have changed. An admissons procedure is in place for new and prospective residents that takes into account the needs of the existing residents and the skill mix of staff. 8 residents responded (in completed CSCI resident surveys) that they had received enough information about the home before they moved in so that they could decide if it was the right place for them. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are generally good and underpin the care that is given. Residents are supported to participate as much as they are able to in making choices about their lives. EVIDENCE: Care plans are in place for each resident. Three of these that were looked at in detail indicate that the home uses person centred planning principles and involves residents in the development of care plans where possible. Staff are fully aware of the action that is needed to meet residents needs and use the care plan as a working document to implement their care. Information includes the people and things that are important to each person, this helps to ensure the well being of residents is promoted. For example it is noted on one care plan that the resident does not like storms, staff are therefore aware of circumstances that may upset this person and can respond accordingly. A personal planning book indicates what the person likes to do, how they see their life now and what they would like to do in the future. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 10 Because of the nature of their disabilities many of the residents living in this home are unable to fully participate in making choices about their lives, however staff encourage participation and support this. Choices are offered for example with menus, activities and daily routines. Reviews take place regularly that involve the resident and their family or representative. Care plans include all the assessed needs of residents and a requirement made at the last inspection visit in respect of this is therefore met. Risk assessments are made regarding personal safety, moving and handling and holidays for example. These enable residents to take risks as part of an independent lifestyle within the parameters of the care plan. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to access appropriate recreational pursuits that meet with their recorded preferences and interests. Daily routines are flexible and are organised around the individuals preferences. EVIDENCE: Many residents attend day centres where access is provided for educational and recreational pursuits. Age appropriate activities are actively encouraged such as dancing, bowling, shopping, going for meals out and socialising. One resident who was case tracked had been supported to attend a music concert of a group that they particularly liked. The needs of individuals are taken into account in organising group activities and staff try to meet both group interests and those of the individual. It is acknowledged that sometimes this can be constrained by the availability of minibus drivers and escorts. However consultation takes place at residents meetings and by way of review meetings. Additional staff cover is said to have improved the access to activities for Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 12 residents and this requirement made at the last inspection visit is therefore met. Staff are observed to speak respectfully to residents, being mindful to promote privacy and dignity. Family and friends are encouraged to visit the home. Daily records indicate that residents are also supported to visit the people that are important to them. Some residents go home for weekend visits or for overnight stays. Meals are taken in the dining area of each bungalow which are comfortably furnished. Where assistance is needed to eat there are individual guidelines provided for each person from the speech and language therapist and appropriate and sensitive assisstance is given. Meals are varied and balanced with dietary needs being taken into account. Meal times are said to be flexible so as to accommodate the needs of people who may be out or do not want to eat at set times. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and healthcare support is provided in the way in which residents prefer and is determined by the care plan. Residents health may be compromised where there are deficits in the monitoring of potential problems. The medication systems in place assist in safeguarding residents in respect of the safe handling and administration of medication. EVIDENCE: Detailed care plans provide the basis for the way in which each persons personal and healthcare needs are met. Daily records indicate that preferences are respected and that changes are recorded and communicated to those staff responsible for caring for the person. A key worker system is in operation that assists in supporting this. Each bungalow is staffed seperately. Access to professions allied to medicine such as chiropody, dental services and optical services is provided. Support is also given by way of the local specialist hospital for learning disabilities where links are established. Technical aids and equipment are provided such as specialist mattresses and profile beds, a snoozelan facility is also provided in each bungalow. Although risk Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 14 assessments are completed regarding nutrition, skin integrity, moving and handling and weight these are not always reviewed in accordance with recommended guidelines or with the guidance in the risk scores. For example where a very high risk was indicated with regard to skin integrity there was a gap of 5 months before the next review of this indicator. The manager was aware that a system of auditing the care plans needed to be put in place to ensure that deficits were identified and addressed. Residents healthcare needs could be put at risk where monitoring is not consistent. A requirement is made in respect of this. The medication systems are generally in good order with each bungalow having a separate lockable storage area for medicines. Regular visits are made by the local pharmacist. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures in the home serve to assist in the promotion and protection of residents right, however updates in training will underpin these. EVIDENCE: A complaints procedure is in place that is displayed in the home and one has been developed in pictorial form that is said to have been explained to each resident individually and is kept in the care plan. The complaints procedure does not indicate that people can contact the home manager in the first instance and does not say who the home manager is. A recommendation is made in respect of this. Following a relative / representative survey at this service some changes are being made by way of introducing a compliments and suggestions book and raising the area of complaints at review meetings. No complaints have been received by the home or by the CSCI regarding this service. The home has a policy and procedure in place regarding safeguarding adults and staff have accessed training in this area, however in some cases this is more than 3 years old and updates are recommended. The manager has requested a place to access a course regarding Derbyshires training for safeguarding adults. A recommendation is made in respect of this. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A homely, comfortable and personalised environment is provided with aids and adaptations that meet the needs and lifestyles of those residents accommodated. EVIDENCE: Fisher Close Nursing Home consists of 3 adjacent bungalows that are individually decorated and furnished. All 3 bungalows are clean, homely, safe and comfortable. It is very well maintained and is accessible to community facilities and services. Residents’ bedrooms are highly personalised with belongings of residents and the things that are important to them. Specialist equipment is provided to meet the needs of individuals such as profile beds, mattresses, electric hoists and wheelchairs. A snoozelan facility is provided in each dwelling (although 1 is being refurbished) that is designed to meet the needs of the residents in that setting. Two residents were enjoying using this facility during this visit. Small group living is promoted with all the personal accommodation being single, some of which provide en suite facilities. Each bungalow has a well Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 17 equipped kitchen that is domestic in style, although no residents are able to use these independently. A summer house and gazebo are provided to enable residents to sit outside in the gardens. One of the gardens is paved to provide access for a resident who is a wheelchair user. New adapted baths are now in situ that are suitable to meet the needs of those residents accommodated. Two requirements that have been outstanding in a number of inspection reports are now met. The home is therefore considered to provide an excellent level of accommodation Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are deployed in sufficient numbers to meet the assessed needs of residents and staff are experienced in the delivery of their care. A comprehensive training programme is provided, however there are significant gaps in the training of some staff that does not serve to ensure that staff have the necessary skills to meet the needs of residents. EVIDENCE: 14 residents were accommodated on this visit. Staffing rotas indicate that there are 3 members of staff on duty in each bungalow although this is reviewed depending on activities that are arranged or if residents go home for the weekend or home visits. Staffing numbers are in accordance with the needs of those residents accommodated. Staff vacancies have now been filled with 2 trained staff having commenced employment and 3 care staff being in position. Discussion with staff indicate that they know the needs of residents well and many of the staff are experienced in the care of those residents living in the home. A comprehensive training programme is provided by the company although some gaps in the training of staff are still evident. This includes moving and Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 19 handling, some of which is 3 or more years out of date. The training profiles are not up to date and do not support some of the training that staff have accessed. The manager is aware of the need to review these and dates for training are arranged. However, residents may be put at risk where staff may not always have the skills necessary for the tasks they are expected to do. A requirement was made at the last inspection regarding this area and is carried forward in respect of this. The timescale is extended to take into account the training that is arranged. Fire training records indicate that this is carried out in accordance with the recommended guidance. Records indicate that the homes recruitment policy and practices are followed and that 2 written references and CRB check are obtained prior to new staff commencing employment. This serves to assist in safeguarding residents. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of residents and staff is generally promoted, although gaps in some areas of mandatory training may compromise this. EVIDENCE: The acting manager has been in post for some time, however an application has not been received by the CSCI for her to become the registered manager. A requirement is made in respect of this. The acting manager has the appropriate qualifications and experience for the role and has reviewed many of the systems in place such as streamlining the care plans and improving communications systems. A quality assurance system is established that includes resident and relative / representative questionnaires, the results of which are analysed and acted upon. Staff meetings are held and staff say that they are listened to and can make suggestions or raise concerns within these meetings. A service manager Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 21 provides guidance and development and visits the home on a monthly basis for quality assurance purposes. Maintenance and health and safety issues are addressed and information provided in the pre inspection questionnaire supports that systems are in place to identify maintenance issues. Gaps in mandatory training however cannot ensure safe working practices in the areas of moving and handling and infection control. (See previous comments regarding training). Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 3 X X 2 X Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 23 YES Are there any outstanding requirements from the last inspection? 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 YA19 Regulation 14 2 a b Requirement The care plan must be kept under review in accordance with recommended guidance with reference to the following: skin integrity, weight, nutrition and moving and handling. Staff must receive training appropriate to their work roles with reference to the following: moving and handling and infection control. Previous timescale 30/04/06 The acting manager must make an application to register with the CSCI. Timescale for action 01/02/07 2. YA35 18(1)(c) 01/04/07 3. YA37 912 01/03/07 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. Refer to Standard YA22 Good Practice Recommendations The complaints procedure should indicate who the home manager is. DS0000002056.V313349.R01.S.doc Version 5.2 Page 24 Fisher Close Nursing Home 2. YA23 Safeguarding adults refresher training should be completed for all staff. Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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 Fisher Close Nursing Home DS0000002056.V313349.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!