Inspection on 03/02/06 for Fisher Close Nursing Home

This inspection was carried out on 3rd February 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fisher Close Nursing Home 05/08/08

Fisher Close Nursing Home 28/09/07

Fisher Close Nursing Home 28/11/06

Fisher Close Nursing Home 13/09/05

Fisher Close Nursing Home 21/02/05

Fisher Close Nursing Home 23/09/04

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 Fisher Close Nursing Home Grangewood Farm Estate Walton Chesterfield Derbyshire S40 2UN Lead Inspector Rose Veale Unannounced Inspection 3rd February 2006 11:30 Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 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.V282586.R01.S.doc Version 5.1 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.V282586.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fisher Close Nursing Home Address Grangewood Farm Estate Walton Chesterfield Derbyshire S40 2UN 01246 200138 01246 200140 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 Mrs Kathleen Wood Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2005 Brief Description of the Service: Fisher Close is situated in a residential area approximately 2 miles form the centre of Chesterfield. The home comprises of three bungalows, each providing nursing and personal care and support for up to 5 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 care park to the front of the bungalows. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The main part of this inspection was unannounced. The inspection was concluded on a second day so that the manager could be involved. There were 14 residents accommodated in the home. Staff were spoken with, a brief tour of each bungalow was undertaken, and records were examined relating to the care of residents, staffing, and health and safety issues. A visit was made to the home on 07/11/05 to follow up the issues of serious concern raised following the last inspection on 13/09/05. It was found that three of the four issues raised had been addressed and one outstanding issue was resolved in December 2005. What the service does well: What has improved since the last inspection? What they could do better: Although residents’ care plans were generally good, some care plans did not cover all the assessed needs of residents. The home did not have suitable working weighing scales available to use for residents with mobility problems. There were not always sufficient staff available to meet the specific needs of one resident regarding taking part in activities outside the home. An Immediate Requirement was made at this inspection for the providers to address this issue urgently. Three requirements were made at the last inspection regarding the bathrooms in two of the bungalows. These requirements had not been met and have been carried forward in this report. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 6 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.V282586.R01.S.doc Version 5.1 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.V282586.R01.S.doc Version 5.1 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): The information provided to residents and the assessment of residents’ needs had improved since the last inspection. EVIDENCE: These standards were not assessed fully at this inspection. Requirements made at the last inspection regarding standards 1 and 2 were followed up. There was a requirement that the Service User Guide must contain all the information in accordance with National Minimum Standard 1.2. At this inspection it was seen that each resident had a copy of the Service User Guide and Statement of Purpose in their individual files and that these two documents included all the required information. There was a requirement that assessments must cover all the needs of residents, (including continence assessments). Continence assessments were seen in all the care records examined. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 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 and 7 Generally, care plans were good, ensuring that staff were fully aware of the action needed to meet residents needs. However, some work was needed to ensure all assessed needs were included and that care plans were reviewed regularly. EVIDENCE: The care records of six residents were examined. The assessment information was detailed and comprehensive, including continence, moving and handling, and activities of daily living. In five of the six records seen the assessment information had been reviewed and updated in the last 12 months. In one record the assessment of activities of daily living and the moving and handling assessment had not been reviewed since 2004. All the care records seen had care plans produced from the assessment of needs. All of the care plans had been reviewed in 2005, all of them more than six months before the inspection. Current good practice guidelines are that care plans should be reviewed at least every six months. One care plan seen did not cover all of the assessed needs of the resident – there were no care plans regarding the resident’s communication, mobility and continence needs. Some of the records showed that the weight of residents had not been recorded since May or June 2005. It was said that this was because there were no suitable weighing Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 10 scales available after this date. It was reported that one resident’s weight was monitored by using the scales at another home. Because of the nature of their disabilities, residents at the home were unable to participate fully in making choices about their lives. Residents’ preferences were included in the care records. It was observed that staff offered choices to residents, such as choices of food and drink and of activities. One care record noted that a resident was unhappy attending a day service and so alternatives were being looked into. Staff spoken with were well-informed about and very familiar with the care needs of the residents. It was observed that there were good relationships between residents and staff. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 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, 16 and 17 There was a good range of activities available inside and outside the home to meet the social and developmental needs of residents. However, as at previous inspections, this was sometimes compromised by lack of staff. Residents’ rights were promoted by staff, ensuring that their choices and preferences were respected. Residents were offered varied and appetising meals in pleasant surroundings. EVIDENCE: The care records seen included details of the day services attended by residents, and other activities, such as shopping, trips out, bowling, and meals out. Activities included using local facilities, such as local parks, pubs and shops. Two residents had separate records of daily activities. These records were detailed and informative. One resident was assessed as needing two staff when being taken out of the home. However, it was noted that this was not always possible due to lack of staff. The resident was still taken out of the home, but with another resident Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 12 sharing the two staff. There was concern that this situation compromised the safety and welfare of the resident, other residents and staff. The issue of insufficient staff to enable residents to take part in activities had been raised at the previous two inspections. Some progress had been made since the last inspection as the home had employed new staff, (see standard 33), but the specific situation with this resident did not appear to have been addressed. An Immediate Requirement was made for sufficient staff to be available to meet the needs of this resident. There was evidence in the care records and from discussion with staff that residents rights and choices were recognised and promoted. For example, using residents’ preferred names, ensuring privacy by knocking on doors before entering, recognition that residents sometimes needed time alone, and respecting residents choices regarding day care activities. The menus seen in each bungalow were varied and appeared well balanced. There were good stocks of food in each bungalow, including fresh fruit. The dining areas were bright and pleasant. Staff were observed offering choices to residents and assisting residents to eat as required. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 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): 20 Residents were protected by the systems in place for the safe handling and administration of medication. EVIDENCE: Medication in the home was stored securely in each bungalow. Records were seen of the ordering, receipt, disposal and administration of medication. There were no residents assessed as able to administer their own medication. The medication policy / procedure for the home was seen. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 14 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): 23 Residents were protected by the systems in place in the home and by staff awareness. However, staff needed more regular training to fully ensure residents’ safety. EVIDENCE: The home’s policy and procedures for the protection of vulnerable adults was seen and this included the Derbyshire County Council multi-agency guidelines. Training records were seen and showed that nearly all staff had received training in adult protection, although most of this training had taken place more than 2 years previously. Staff spoken with were clearly aware of adult protection issues and the correct procedures to follow. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 15 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, 27 and 29 Improvements had been made to the environment for residents, although further work was needed to ensure safe and suitable facilities were available. EVIDENCE: These standards were not fully assessed, but requirements made at the previous inspection were followed up. There was a requirement that the redecoration of bungalow one must be completed. This had been done and the bungalow was bright and pleasant. There were three requirements regarding the baths in bungalow one and two. No changes had been made in either bungalow and so the requirements had not been met. As at the previous inspection, the bath in bungalow one was leaking from the taps and the jacuzzi function was not working. The acting manager said that assessments had been made of the bathrooms and that they were due to be refurbished, but there were no definite plans in place. A requirement was made at the last inspection to review the beds in use and to provide adjustable height beds where needed. A review of the beds had taken place, new beds were in use in bungalow one with more new beds ordered for bungalows one and two. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 16 A requirement made to repair or replace the hoist in bungalow one had been met as the hoist had been repaired. A requirement to provide sluicing disinfectors had been met. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 17 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, 33 and 35 Although staffing levels had improved since the last inspection, one issue remained where residents’ needs were not always properly met because of insufficient staff. Generally, staff had received appropriate training. However, regular updates were necessary to ensure staff were fully competent to meet residents’ needs. EVIDENCE: The staff rotas were seen for each bungalow. Staffing levels had improved since the last inspection with three care assistants during the day on each bungalow on most days. Three new staff had been employed and a member of staff had returned to the home after working in another home. Staff spoken with confirmed that staffing levels had improved and said this had helped to improve staff morale at the home. There was one issue with staffing in bungalow three which had not been resolved. One resident was assessed as requiring two staff when going out of the home. However, it was noted that this was not always possible due to lack of staff. The resident was still taken out of the home, but with another resident sharing the two staff. There was concern that this situation compromised the safety and welfare of the resident, other residents and staff. (See standard 12). Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 18 The staff training records were seen. Staff had received training in all the required areas, such as manual handling, first aid, food hygiene, adult protection, and fire safety. However, some staff had not received updates for two or more years, (except for fire safety training which had been carried out every year for all staff and twice per year for night staff). Other training relevant to the needs of residents had been carried out, such as dealing with challenging behaviour and epilepsy. Approximately a third of the care staff had achieved or were working towards NVQs. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 19 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 and 42 The residents and staff had benefited from the acting manager having more supernumerary time to ensure the better organisation of the home. There were satisfactory systems in place to ensure the health and safety of residents and staff. EVIDENCE: The acting manager of the home had the appropriate qualifications and experience for the role. Staffing rotas showed that the acting manager was working nearly all her hours as supernumerary. This was an improvement since the last inspection. The acting manager said this had helped with carrying out her role and responsibilities. Staff spoken with agreed this change had helped with the smooth running of the home. Records relating to health and safety matters in the home were examined. These included: maintenance and servicing of equipment and systems; fire risk assessments of each bungalow; electrical and gas safety certificates; records Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 20 of testing of the water system, including tests for Legionella; and accident records. The records seen were up to date. Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 21 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 3 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 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X 3 X X X X 3 X Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 22 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. 2. Standard YA6 YA12 Regulation 15(1) 16(n) Requirement Care plans must include all the assessed needs of residents. Access to activities for residents must be facilitated by adequate provision of staff. Original timescale 31/10/05 Appropriate weighing scales must be provided The position of the rise and fall bath in bungalow 2 must be reviewed and positioned appropriately to ensure residents and staff can access this safely. Original timescale 31/01/04 The rise and fall bath in bungalow 1 must be repaired or replaced. Original timescale 31/12/05 Staff must receive training appropriate to their work roles Timescale for action 31/03/06 31/03/06 3. 4. YA19 YA27 12(1) 13(4)(b) 23(2)(n) 31/03/06 30/06/06 5. YA27 23(2)(c) 30/06/06 6. YA35 18(1)(c) 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000002056.V282586.R01.S.doc Version 5.1 Page 23 Fisher Close Nursing Home 1. Standard YA6 Care plans should be reviewed at least every six months Fisher Close Nursing Home DS0000002056.V282586.R01.S.doc Version 5.1 Page 24 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. 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