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Inspection on 05/08/08 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 5th August 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 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 manager and staff knew people living at the home very well. This ensured that people`s needs were well met. Although people had very limited communication, staff were very aware of each individual`s ability to communicate with the use of facial expressions and noises. One staff member spoken with said, "Just because they can`t speak it doesn`t mean that we can`t communicate". The environment was of a very good standard with above the National minimum standard of communal and bedroom space. Each bungalow had a Snoezelen facility (sensory room) that provided positive stimulation for people. People had been given the opportunity to go on holiday. This had been arranged in small groups and with staff support. Extensive activities were available for people that had good mobility, although they were less available for people that needed a wheelchair. People`s health care needs were well met, with referrals to specialist health care professionals when required. There was a safe system for recruiting new staff, with all checks undertaken, so that people were protected. Each person`s records that were seen were person centred and individualised. The `expert by experience` thought that staff motivated people living at the home, understood their needs and looked after people well.

What has improved since the last inspection?

New furniture had been purchased since the last inspection visit and improvements to an already pleasant outside area had been made, including a new gazebo. Some bedrooms had been re decorated. All requirements had been met from the previous inspection visit which were concerning medication records, fire drills and records concerning cleaning chemicals. Policies and procedures had been reviewed, although they were not yet available at the home. The service has obtained funding for an additional 30 hours activity organiser, which will improve activities for people living at the home.

What the care home could do better:

The home was at times short of staff. There were three nurse vacancies and the manager was having difficulty recruiting new nurses. Two support workers had recently been appointed although they had not yet started due to awaiting relevant checks. This meant that staff were regularly working overtime. Staff rotas showed that not all shifts had been covered leaving the home at times with reduced staffing. This would make it difficult for staff to meet people`s needs. One staff member wrote in our survey, "Sometimes we have staffing problems and this prevent service users going out on day care". Discussions with staff and checking activities records showed that people reliant on nursing care and requiring a wheelchair for outings went out much less than people with better mobility. There were fewer activities provided at weekends due to deployment of staff.

CARE HOME ADULTS 18-65 Fisher Close Nursing Home Grangewood Farm Estate Walton Chesterfield Derbyshire S40 2UN Lead Inspector Jill Wells Unannounced Inspection 5th August 2008 08:00 Fisher Close Nursing Home DS0000002056.V369502.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.V369502.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.V369502.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) Enable Care & Home Support Limited June Stocking Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The Provider may provide the following category of care only : Care home with nursing - Code N To service users of the following gender: Either Whose Primary care needs on admission to the home are within the following category: Learning Disability - code LD Physical Disability - code PD The maximum number of service users who can be accommodated is: 15 28th September 2007 2. Date of last inspection Brief Description of the Service: Fisher Close is situated in a residential area approximately 2 miles from the centre of Chesterfield. The Home comprises three bungalows, each providing nursing and personal care and support for up to five adults with learning disabilities and physical 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 and three of these have en suite facilities. 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. Fees range from £466.04 to £504.04 depending on assessed needs of individual but excluding any nursing care contribution. Items not included in these fees are hairdressing, outings, and private chiropody. People living at the home receive disability allowance mobility component that is used to pay for the transport provided at the service. Fisher Close Nursing Home DS0000002056.V369502.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 the service is two star. This means the people who use the service experience good quality outcomes. The inspection visit was unannounced and took place over 8 hours. An expert by experience and supporter was used during the inspection visit. This is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what its like to live in or use the service. There were 14 people living at the home on the day of the inspection. Residents, staff and the manager were spoken with during the visit. Most residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 28th September 2007. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. • The previous key inspection report Completed surveys from people living at the home and staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. What the service does well: The manager and staff knew people living at the home very well. This ensured that peoples needs were well met. Although people had very limited communication, staff were very aware of each individuals ability to communicate with the use of facial expressions and noises. One staff member spoken with said, Just because they cant speak it doesnt mean that we cant communicate. The environment was of a very good standard with above the National minimum standard of communal and bedroom space. Each bungalow had a Snoezelen facility (sensory room) that provided positive stimulation for people. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 6 People had been given the opportunity to go on holiday. This had been arranged in small groups and with staff support. Extensive activities were available for people that had good mobility, although they were less available for people that needed a wheelchair. People’s health care needs were well met, with referrals to specialist health care professionals when required. There was a safe system for recruiting new staff, with all checks undertaken, so that people were protected. Each person’s records that were seen were person centred and individualised. The ‘expert by experience’ thought that staff motivated people living at the home, understood their needs and looked after people well. What has improved since the last inspection? What they could do better: The home was at times short of staff. There were three nurse vacancies and the manager was having difficulty recruiting new nurses. Two support workers had recently been appointed although they had not yet started due to awaiting relevant checks. This meant that staff were regularly working overtime. Staff rotas showed that not all shifts had been covered leaving the home at times with reduced staffing. This would make it difficult for staff to meet peoples needs. One staff member wrote in our survey, Sometimes we have staffing problems and this prevent service users going out on day care. Discussions with staff and checking activities records showed that people reliant on nursing care and requiring a wheelchair for outings went out much less than people with better mobility. There were fewer activities provided at weekends due to deployment of staff. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 7 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. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 8 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.V369502.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information that they need in order to make an informed decision about where to live, and needs are fully assessed prior to admission. EVIDENCE: There had been one person admitted to the home since the last inspection visit. A full assessment had been completed, however this person had been admitted ‘ out of category’ which means that the home was not registered to meet their specific needs. As a result of this the provider was contacted and it was agreed that the home could submit a variation to their registration to include the category ‘ physical disability’. We undertook a site visit in May 2008 and assessed that the service could meet the needs of people with physical disability as well as a learning disability and their registration was revised. A support worker completed our survey on behalf of a resident and wrote, My family visited the property. I had tea visits and overnight stay before moving into the home. Each person had been provided with a service user guide although most people at the home would be unable to understand this document. The manager said that alternative formats were not available for example audio format, which may assist prospective people to understand what the service provides. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 10 There was also a statement of purpose available. This has recently been revised and provides all the information required although the document provided at inspection did not have the complaints procedure and name, address and telephone number of the Commission for Social Care Inspection (CSCI) attached as stated. The manager was later contacted and she explained that this was an error on her part when printing the document. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff supported people to make decisions and take responsible risks, promoting each individuals independence as much as possible. EVIDENCE: The care plans and other relevant records of three people (one from each bungalow) were seen. There was a photo in place of each person living at the home. There was a personal profile and social and emotional pen picture. There were also personal planning books in place for each person which included things that the person liked and did not like for example, I dont like to be touched only if I initiate the touch and, I like music, but not noisy instruments . As most people living at the home had little or no verbal communication, staff needed to understand each persons specific communication needs and abilities. The communication care plans were particularly detailed and assisted staff to work in a person centred way with each individual. Staff spoken with were very aware of each persons particular communication abilities, for example what an individuals facial expressions and Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 12 specific noises meant. The ‘expert by experience’ said that staff communicated well with people living at the home and staff had learnt to understand them. There were relevant risk assessments in place for example activities, personal handling and accessing the minibus. There were also clear records of communication with people’s relatives where appropriate. One persons records said, Likes heat and if mobilising on the floor will move towards radiators. The person’s risk assessment said that staff should supervise at all times when mobilising on the floor. This was discussed with the manager and she confirmed that there had not been a risk assessment concerning radiators that were not covered. There were several examples of where people were supported to take risks as part of an independent lifestyle. For example one person had been advised by a specialist not to eat particular foods, however they had expressed their preference to continue to do so and this had been respected and recorded. Staff spoken with were aware of the importance of confidentiality as well as the need to share information, particularly when a persons health and safety was at risk. Staff were very aware of the importance of supporting people to make decisions. One worker said, Just because the person can’t speak, doesnt mean that we cant communicate. They were able to give several examples of giving people a choice by showing them things for example different foods and choices of clothes and asking questions that need yes/no answers. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were provided with stimulation, which included activities inside and outside the home to enable them to maintain fulfilling lives. EVIDENCE: There were a number of vehicles available to enable outings to take place. Each bungalow operated independently in many ways, including activities. It was evident that the people in the bungalow that were more mobile had more trips out using the transport than people that relied on wheelchairs. Staff spoken with said that this was a staffing issue and also as the area was very hilly, taking someone out not using the minibus was difficult. Activities outside the home were less likely to take place at weekends due to staffing. Each person had an activity sheet to record any activities that had taken place. This record also included the outcome and response to the activity. One person’s activity records had very few entries with gaps of up to 12 days where no activities were recorded. Staff spoken with said that activities had taken place but staff did not always record them. Staff also explained that activities Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 14 were less likely to take place at the weekend due to the activities organiser being unavailable. A staff member said that if a person needed a nurse to escort them on a trip, this was often not possible. The service has obtained funding for an additional 30 hours activity organiser, which will improve activities for people living at the home. The ‘expert by experience’ said that staff were observed motivating people living at the home by talking to them and playing games. There was a Snoezelen facility (sensory room) in each bungalow that was seen to be very beneficial to some individuals, providing positive stimulation. Most people attended either Enable’s in-house day care or Ash Green, the local community hospital specialising in people with a learning disability. Various activities there included music, spa and drama. People had also had a holiday supported by staff and people living in one bungalow were due to go on a second holiday to Blackpool for three days to see the lights. One person had requested support to go fishing which is something that they did at a previous service, and also to access more community facilities. This had not yet been arranged although the manager said that staff were looking into this. The ‘expert by experience’ observed the meals that were provided. They said that they had a written and pictorial menu in the home and people pointed to a picture to identify the food that they wanted. They said that the food looked nice and people seemed to like the food as they were seen smiling and giggling during the mealtime. One person living at the home typed the menus using their computer, which they enjoyed doing. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples physical and emotional health needs were met in a sensitive and person centred way. EVIDENCE: Staff were seen providing sensitive personal support to ensure peoples privacy and dignity were respected. Staff said that people’s preferences concerning how often to bathe and times for getting up and going to bed were flexible where possible. Staff described how they would encourage people to make a choice wherever possible by observing peoples non-verbal communication. Most people needed two staff to assist them with moving and handling and personal care. Record showed that most people were supported to bathe every day if this was their wish. The ‘expert by experience’ said that staff respected people’s privacy by providing personal care in their room. There was weight records in place however one-person admitted to the home this year was weighed in April 08, but had not been weighed since then. This was discussed with the manager, who explained that most people were Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 16 weighed whilst they were at day care, but this person did not attend day care and there were not the facilities at the home to weigh them. The weight obtained in April was as a result of taking this person to another care home. Relevant guidance was in place for peoples health needs for example guidance on how staff should respond when a person has a seizure. There were clear records of involvement of GPs and other health professionals, including specialist support and advice from physiotherapists, speech therapists and nutritionalists when required. Preferred routines, likes and dislikes were recorded to assist staff to provide person centred care. At the advice of the specialist consultant, some staff had started to receive training in and use intensive interaction, which is a tool used by staff to improve communication between staff and each individual who has little verbal communication. The manager was aware of the issues of consent, and forms had been completed with involvement from other professionals concerning lack of ability to consent to health care, although care plans did not reflect issues of consent more generally. There were separate medication storage and records in each bungalow. The medication system was inspected in one of the bungalows. A qualified nurse administered medication and a nursing assistant had been trained in medication administration for occasions when medication needed to be administered away from the home. Although the medication was locked in secure cabinets, the room where this was stored was not locked. This room also held some confidential information. The manager explained that they had been advised by the fire officer not to lock the store as there was the fire alarm system within this room that staff may need quick access to. Medication administration records were generally in good order. There was a photograph of each person for easy identification. There were written guidelines concerning prn (as required) medication for each person. Any handwritten medication records were signed and countersigned, which was good practice. One medication had been stored removed from its box. This was not safe practice. There was a clear system for receiving and disposal of medication. The manager had a copy of the guidance, handling medication in social care which was available for staff to read. One resident had recently died. The manager explained how this had been very distressing for staff and some people living at the home. Counselling had been offered to staff and staff had spent time talking with residents and explaining what had occurred, in order to help them with any possible emotional difficulties. Staff had also monitored for any signs of distress. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are aware of the importance of responding positively to any concerns complaints or allegations that may be made to ensure that people are safe. EVIDENCE: Most people living at the home would have difficulty verbalising any concerns or complaints that they had, although one person had used a computer to write their concern about staff hours provided and funding arrangements. Meetings were being held with Social Services about this. The complaints procedure was displayed at the home. Staff spoken with were aware how to respond to an allegation of abuse and their responsibilities under the whistle blowing procedures. At the last inspection visit it was highlighted that the procedure concerning safeguarding adults was not fully clear about the need to immediately contact Social Services, and the whistle blowing policy was not available. This was discussed with the manager during this inspection visit. The manager explained that all policies and procedures were in the process of being reviewed and they were expecting revised copies in September 08. She believed that relevant amendments concerning the above would have been made. Questionnaires were sent out to families to encourage any issues to be raised and dealt with. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 18 Reviews were held with care managers from Social Services and any issues were highlighted in the minutes of these meetings and dealt with accordingly. The manager explained that she and the staff closely observed people living at the home for any non-verbal signs of discomfort, sadness or frustration and tried to find out the source of this whenever possible. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a very comfortable, homely, clean environment, which meets their needs. EVIDENCE: The Home consisted of three adjacent bungalows, each with five bedrooms of which three had en suite showers. Each bungalow also had a bathroom – two with an ‘arjo’ ‘rising bath’ and overhead track with hoist. One bath had recently been changed, including the position of the bath in the bathroom. This meant that the tracking hoist was no longer central to the bath, possibly making entering and leaving the bath more difficult for the person and staff supporting them. This was discussed with the manager who explained that staff had mentioned this and consideration was being given to changing the position of the overhead track. Each bungalow was well furnished and decorated with its own pleasant, accessible outside area. A summerhouse and gazebo were provided. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 20 Bedrooms were very comfortable, with specialist beds where needed. Staff worked hard to ensure that each bedroom reflected each persons personality. There was suitable equipment and adaptations around the home. The manager explained that there were no call systems as none of the people living at the home could use them. There was a well-equipped kitchen in each bungalow. The laundry was off the kitchen. There was a separate door to the laundry from the hallway. The manager said that staff used this door when bringing in dirty laundry, to avoid any possible contamination of food. There were sluicing sinks and high temperature washing machines in each bungalow. Several cupboards had a sign on the door stating, fire door keep locked, but these were not locked. The ‘expert by experience’ thought that it would be good to have photographs up around the home of places that people have been. The manager told us that there had been new lounge furniture in all bungalows some bedrooms had been re decorated since the last inspection visit. There was a large lounge providing facilities to watch TV and listen to music. One person was seen by the expert by experience being supported to choose their own DVD which they enjoyed watching. Communal living space and bedroom space was above the national minimum standards. The service is again commended for the high environmental standards. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although staff at the home were experienced and knowledgeable, staffing levels sometimes meant that they had difficulty meeting peoples needs. EVIDENCE: There was a range of staff working at the service with various roles and responsibilities. Staff spoken with understood their own and others roles and responsibilities. It was evident from observation that staff had developed positive relationships with each person living at the home and were usually able to understand each persons non-verbal communication. Many staff had worked at the home for a number of years and knew residents well. However some staff were reluctant to undertake relevant training and there continued to be a low percentage of staff having undertaken a relevant NVQ (National vocational qualification). The training records were checked. Many staff had not undertaken the required training for refreshers. The manager said that she believed that staff needed to take responsibility for booking themselves on courses advertised, however due to problems with Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 22 staffing it was found that staff often had difficulty fitting in training when shifts needed to be covered. The monthly report from the service manager in May 08 said, “Staff shortages high, staff pulling together to cover”. At the site visit by CSCI in May 2008 concerning the revised registration of physical disability, the inspector advised that staff should receive further training specific to physical disabilities and awareness. This had not been arranged. The staff rotas were seen for two of the three bungalows. These showed that there was always one nurse on duty at night between the three bungalows. There were two nurses on duty in the daytime between the three bungalows. Although the aim of the service was to have three or four workers on duty in the daytime per bungalow, rotas showed that this often was reduced to two workers due to staff holidays and sickness not always being covered. The manager recorded in the AQAA, ‘we need to improve staffing levels due to retirement, death and change of work. Advertisements placed, but poor response. Need to provide a housekeeper to release staff from cleaning tasks’. It was explained that a housekeeper had been found, but was awaiting criminal record bureau (CRB) checks. You were also told that there were 10 residents that needed 2 people to assist with personal care, 14 residents need assistance with eating and all had special communication needs. This means a high level of dependency, and the reduction to 2 support staff on duty per bungalow may not meet the needs of everyone living at the home. A member of staff wrote in our survey, sometimes we have staffing problems and this prevents service users going out on day care Two staff files were seen and it was found that all relevant checks had been made on new staff to ensure that people living at the home are protected. Although the manager said in our AQAA that all staff were regularly supervised, record showed that staff did not always receive regular one-to-one supervision. One member of staff spoken with said that they believe they had received one supervision session in two years. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well managed, with effective quality assurance systems, ensuring that people are listened to and the home continues to develop and improve. EVIDENCE: The manager was a qualified nurse for people with learning disabilities. She was a senior staff nurse at the home before being promoted to manager. She is registered with CSCI. The manager has kept up-to-date with relevant training including Mental Capacity Act, training on disciplinary procedures, managing performance and attending a health and safety workshop. Regular staff meetings within each bungalow were taking place and minutes of these were available showing that the manager enabled staff to voice concerns and make suggestions. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 24 The service manager responsible for the home was visiting regularly and there were written reports available of these visits, showing that they had talked to staff and spent time with people living at the home. Questionnaires were sent out to families, and the ones that were seen showed a high level of satisfaction, although some people commented about low staffing at times. Comments from surveys included, “keep doing what you are doing, care is of a high standard” and “great deal of confidence in staff”. Residents meetings were taking place, and staff explained how they would make suggestions to residents and observe non-verbal communication which showed their interest or not in the suggestion. The manager explained that written policies were in the process of being reviewed and would be available at the home in September 08. The previous requirements identified in the last inspection report had been met. These were concerning medication practices, data sheets being available concerning cleaning chemicals at the home and regular fire drills. Records required by regulation are maintained including records concerning residents and staff. Some confidential records that were kept in the medication room were not secure, as this door was not being kept locked due to fire officer guidance as explained previously. There was an environmental risk assessment, but there was no date or signature on this document. Some but not all radiators were covered. There was no risk assessment concerning uncovered radiators. There were records to show that water tanks had been inspected for risk of legionella. Thermostatic controls had been placed on hot taps to ensure safety of people. Accidents were being recorded and showed that there were a low number of accidents. The gas and electrical safety certificates were inspected and found to be in order. The kitchen was kept unlocked. The manager explained that they did not wish to restrict people living at the home. However the accident record showed that there had been an accident in the past involving two people living at the home in the kitchen when staff had not been around. The manager said that a risk assessment concerning each kitchen had not been completed. Fire records showed that fire drills were undertaken every 4-6 months. The homes record stated that the fire alarm should be tested weekly but this was last done three weeks prior to the inspection visit. The service held money on peoples behalf. The manager explained a system where each person living at the home had their own bank account that was held at head office, and money would be withdrawn on the persons behalf and held at the home. Records showed that staff were sometimes but not always countersigning the initial signature of any transactions undertaken. Receipts were being kept to ensure an audit trail, and checks were made on a weekly basis of the money and records. Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 25 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 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X 2 3 x Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 26 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. YA33 Standard Regulation 18 (1) (a) Requirement There must be sufficient numbers of staff to support people living at the home at all times. Timescale for action 05/09/08 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. Refer to Standard YA1 Good Practice Recommendations The statement of purpose and service user guide should be available in alternative formats e.g. audio format and include the telephone number of the Commission for Social Care Inspection (CSCI). This is to ensure that it is fully accessible and people are informed of how to contact CSCI. There should be a record of activities undertaken by each individual that should be up-to-date and accurate to ensure that people receive appropriate stimulation, community links, social inclusion and leisure activities. All people living at the home, including people that require a wheelchair should have an equal opportunity to be part of the local community and to receive outdoor leisure activities flexibly including weekends. This is to ensure equality of opportunity. DS0000002056.V369502.R01.S.doc Version 5.2 Page 27 2. YA14 3. YA14 Fisher Close Nursing Home 4. 5. 6. 7. 8. 9. 10. 11. 12. YA19 YA27 YA24 YA32 YA36 YA35 YA41 YA41 YA41 There should be suitable equipment at the home to monitor individual’s weight as part of monitoring their overall health. Consideration should be given to repositioning of the tracking hoist over the bath so that it is central, in order to improve access to the bath for people living at the home. Staff should ensure that doors that should be locked due to risk of fire are kept locked when not in use. This is for the safety of everyone at the home. At least 50 of social care staff should hold a National Vocational Qualification (NVQ) to level 2 or above. Staff should have regular, recorded supervision meetings at least six times a year as well as an annual appraisal to review performance. Staff should receive training specific to physical disabilities and awareness to improve their knowledge in this area. All records should be secure at all times including records in the medication room. This is to ensure confidentiality of private information. The environmental risk assessment should be signed and dated by the person completing the document so that it is clear when this should be reviewed. There should be a risk assessment concerning access to the kitchen for people living at the home and concerning radiators that are not covered to ensure peoples health and safety. Where a record of a financial transaction has taken place on behalf of service user, this record should be countersigned by a second person to ensure that peoples money is protected. Records should be consistently made of weekly fire alarm tests to ensure people’s safety. 13. YA41 14. YA42 Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Fisher Close Nursing Home DS0000002056.V369502.R01.S.doc Version 5.2 Page 29 - 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. 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