Key inspection report CARE HOMES FOR OLDER PEOPLE
Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN Lead Inspector
Mike Perry Key Unannounced Inspection 09:00 10th and 11th June 2009
DS0000017279.V375986.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Fleetwood Hall Address 100 Fleetwood Road Southport Merseyside PR9 9QN 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) 01704 544242 01704 503956 malcolm@fleetwoodhall.com Newco Southport Limited Mr Malcolm George Francis Rugen Care Home 53 Category(ies) of Dementia (15), Mental disorder, excluding registration, with number learning disability or dementia (21), Old age, of places not falling within any other category (12), Physical disability (5) Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service 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 categories: Old age, not falling within any other category - Code OP (maximum places - 12) Dementia - Code DE (maximum places - 15) Mental disorder, excluding learning disability or dementia - Code MD (maximum places - 21) Physical disability - Code PD (maximum places - 5) The maximum number of service users who can be accommodated is: 53 Date of last inspection 26th March 2003 Brief Description of the Service: Fleetwood Hall is a large detached building that occupies a position on the outskirts of Southport but within easy distance of the Town Centre and promenade. It was once an NHS hospital and has been converted to provide care over 3 floors. The registration is divided so that the nursing units on the ground and top floor care for older persons, older persons with dementia and also younger adults with physical disability. The middle floor is given over to the Andrew Mason Unit [AMU], which admits younger adults with longer term and enduring mental health needs. This report therefore covers both sets of National Minimum Standards. The home has been owned and managed by Newco Southport Ltd since 1996. The responsible Person is Mr R. Oreschnick. The Registered Manager is Mr Malcolm Rugan. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 5 The current fees for the service range from £550 - £1,900 weekly Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
The inspection was unannounced and was conducted over a period of 2 days. All 3 units were visited. All day and recreation areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. Residents in the home were spoken to along with members of staff and the Manager. A relative was interviewed. Prior to the inspection survey forms were sent out to residents in the home and relatives as well as staff. Some of these were returned and comments have been used in the report. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the visit, which is a detailed document that gives us a lot of information and update about the home and assists in focussing the inspection. The home has had three incidents since the last inspection which required investigation under the local ‘safeguarding’ procedures and some of the details of these are included in the report. We met a social worker during the inspection and looked at the care of one person in the home who is currently the subject of an ongoing safeguarding investigation. We also had some assistance on the inspection from an ‘expert by experience’ This is a person who has had some previous experience of care services and assists the inspector by focusing on quality of life issues for people in the home and providing feedback for the inspector. During the visit the expert visited the Andrew mason unit and spent two hours talking to residents and care staff. During the inspection we made some specific observations on the dementia care unit using a special observation tool called SOFI [Short Observational Framework for Inspection] developed to look at how staff interact with people and how this may affect their level of well being. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 7 What the service does well:
The care files in all areas were clear and addressed the needs of the residents. Any health care issues are addressed. Care plans identified residents who have had some specialised needs such as one resident who needed all personal care to be carried out and found communication difficult as well as being at risk from choking and injury due to a medical condition. The care records clearly identified these needs and were personalised to a high degree so that it was clear how to communicate with the person and the best ways to provide support. The appropriate treatment and medical aids in terms of pressure relief mattresses and a specialised chair were supplied. Care notes seen included reference to medical visits by GP’s and visits by health care professionals such as speech therapists. The person lacks family support so that the home have been careful to organise an independent advocate who has input into the care planning. We found the home to have a relaxed atmosphere and to encourage people to live daily lives involving active choice. One resident commented: ‘It’s not institutional here. Other homes tend to be all the same; rooms and so on. This is different. My rooms been decorated recently. Staff have supported me to give up smoking. I go out regularly and can do what I want. I can get involved in activities’. Another resident on the Andrew Mason unit said: ‘I’m able to do my own cooking. Staff take me out shopping. I go on trips. Everything is alright. I am getting a new TV, bed and curtains and stereo. I like my room since it has been decorated. I picked my own colour for both walls and carpet.’ A relative commented: ‘The home genuinely cares for all residents. Staff show a sincere commitment and form excellent interpersonal relationships and treat people as individuals’. On the AMU one resident who has cultural needs around a Muslim faith had these needs addressed in the context of her overall mental and physical condition and there was clearly an understanding of the individual needs of this resident being addressed. This was evidenced in the care plan as well as the key workers understanding.
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 8 There was an understanding of the importance of facilitating good communication with residents and allowing them the time to develop their lifestyles. All bedrooms seen displayed a high level of personalisation. One resident spoke about enjoying the garden area and about how some of the residents are involved in gardening. Another is involved in producing the homes magazine. Residents spoken with advised of the various activities that are undertaken in the home. There are staff members coordinating some of these events and the home also employ a driver who also contributes a lot in terms of working with some residents and ‘getting them out and about’. The period of observation conducted on the dementia care unit evidenced very high levels of staff interaction and we observed support which helped provide a good level of resident wellbeing. Likewise on the AMU some of the residents are limited in their ability to make some specific life choices but interviews were consistent in that residents are listened to and choices made on a daily basis are respected. Staffing levels are good on the unit, which allows for one to one input for some of the more needy residents with respect to physical care and the importance of using this time for positive social interaction was a feature of the staff interviews conducted. One resident who has previously not ventured out of the home has been able to develop skills in this area with the support of his key worker. This shows that the home is willing to meet a diversity of care needs and respect people as individuals. Staff reported that training in the home is good. Nearly all staff, including ancillary staff, have some form of qualification. For example nearly all care staff have completed NVQ to at least level 2 standard. Those spoken with had clearly been attending training and this helps to ensure that staff are updated and competent to carry out the care work needed. What has improved since the last inspection?
The home continues to improve and develop in many areas. All of the requirements made during the last inspection have been met. This includes the provision of a controlled medicines cabinet on the ground floor nursing unit, The maintaining of standards in the laundry so that infection control measures are now more consistent, and the auditing tools used by the manager are now more robust and able monitor and improve standards in all areas.
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 9 This shows that the homes managers can meet statutory requirements and can develop the service in line with good practice. The assessments that staff carry out for people living in the home both prior to and following admission are much better developed and more consistent in standard. This ensures that people being admitted have their care needs clearly highlighted and a care plan can be devised. Care plans for each of the people in the home are of a much more consistent standard. The manager has introduced a standardised format for recording care and this has improved the amount of detail and personalisation so that each residents care needs are better described and understood. We found that these plans are known to the residents and that they are involved in their care. We found that people living in the home were receiving a good standard of personal care. People told us that staff were supportive and helpful in giving personal care so that they could maintain daily living activities and dignity in their personal dress and cleanliness. There had been some inconsistency in this respect during the last inspection. The training of staff with respect to ‘safeguarding’ and abuse awareness is upto-date. This follows a requirement made previously. Staff spoken to and training records seen indicate that staff have attended training over the past year. This helps ensure that staff have a good level of understanding of how to identify and report abuse and so protect people in the home. There continues to be various upgrading work in terms of the general environment. Work has been competed in all areas and the home has been able to maintain more consistent standards so that people can live in comfortable surroundings. The level of individualisation in people’s bedrooms is very high indeed and shows a commitment by managers and staff to ensuring that people can identify Fleetwood Hall as their ‘home’. What they could do better:
There have been three incidents on the dementia care unit which are currently under investigation under the locally agreed safeguarding procedures. Both Social Services and police are involved. One of these incidents was picked up and reported through effectively to Social Services by the managers in the home. This helps ensure peoples rights and
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 10 safety are protected. The other two incidents, although identified by the service were not reported through appropriately. This failure can have serious implications as peoples right to be safe in the home can be jeopardised if concerns and allegations are not appropriately and correctly investigated through agreed procedures. Managers must, as a priority, report any allegations of abuse through the agreed protocols and involve the local social service safeguarding team. We found the toilet/ shower room on the Andrew mason unit to be in need of upgrading. Both extractor and shower are not working and staff reported difficulties in maintain this area due to flooding of the floor on occasions. The flooring outside this facility needs repairing / replacing as it is split exposing the wooden floor below. A requirement has been made to ensure that this facility can be used by people on the unit. We also had reports from staff about the failure of some locks on toilets and bathrooms. This needs to be checked as it seriously impinges on the privacy of people using these facilities. The management of medications is safe but we have made some good practice recommendations around the recording of the application of creams as well as ensuring any handwritten entries on medication records [Mar charts] are signed by two staff. This ensures all medications are recorded and monitored accurately. We found the social care to be developing well. We would make a good practice recommendation for more attention to be paid to ensuring people with dementia on the top floor unit have improved access to fresh air and outings. Also those people on the Andrew Mason Unit need to have yearly holidays considered. People we spoke with identified this. This would help ensure further improvements to the quality of life for people. We have made some further good practise recommendations around social activity based on conversations we had with people on the AMU. We had some reports on the Andrew Mason Unit [AMU] of staff failing to serve food hygienically. We had some discussion with the manager of the unit who will monitor this so that standards at meal times are preserved. We looked at staff records and found one staff who had been employed following concerns raised, as part of the recruitment process, which may have raised doubts about the persons ‘fitness’ to care for vulnerable people. Records indicated there had been no risk assessment made at the time to clarify these issues and whether the person may have presented a continuing risk to residents. We spoke with the manager about the need to develop an assessment tool for use as part of the recruitment process. This will help ensure that risks are highlighted which can assist in management decision making and ensure that people in the home are kept safe. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 11 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 12 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 13 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 [standard 6 is not applicable]. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out prior to residents being admitted and these are clear so that a completed picture of care needs can be obtained. EVIDENCE: Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. We saw assessments on the top floor dementia care unit and the ground floor nursing unit and also the younger adult mental health unit [Andrew Mason Unit - AMU]. The assessments were consistent in detail and quality and clearly identified care needs. The assessments were backed up by information and assessments from both health and social care professionals who had referred the resident so that a
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 14 good idea of the care needs were apparent. There were also some risk assessments completed which were appropriate. The assessments completed also showed evidence of the people using the service being involved so that care needs can be personalised and people can feel more involved in the process. Initial assessments for one resident seen on the AMU were followed up by a social worker review a week following admission which shows good practice and monitoring. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 15 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care is well monitored so that residents are receiving individualised care that promotes their dignity and maintains their health. EVIDENCE: Nursing units [top floor and ground floor] We reviewed care files on the top floor dementia care and the ground floor nursing unit and observed the care of the residents and spoke with a number of them. Care files contained care plans, which outlined the care needs of the residents concerned. Generally these were detailed and the progress of the care could be followed by the regular written evaluations. This ensures that care is well monitored and staff can be kept up to date with care needs.
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 16 An example of the care provided involved one resident who had very complicated medical needs which resulted in all personal care needs being carried out by staff. We found this person to be well cared for and despite severe communication difficulties staff were seen to be supporting him well and understanding of the care required. We observed good standards of personal hygiene and choice of clothing so that individuality and dignity were preserved. The person was supported by a range of aids and adaptations including specialised chairs and mattresses to maintain comfort and skin integrity. There was reference for example to a specialised toothbrush to ensure good oral hygiene as well as dental input. The care plan included input by an advocate form outside the home as the resident lacked immediate family support. This helps ensure that peoples rights are maintained by somebody being able to speak for them and advocate on their behalf. We saw that the care records were very personalised and included reference to any risk factors associated with the care. For example a risk of choking highlighted due to swallowing problems. Appropriate diet had been organised and medical appointments listed. There has also been speech therapy input. Another person on the dementia unit was reviewed and again the staff were knowledgeable about the needs of the person concerned. The person experienced periods of agitation and the care plan outlined ways support could be given which made reference to the person’s likes and dislikes. There had been regular review by medical staff and this was recorded. We observed the person over a two hour period to see the kind of staff support and we found the support offered to be both appropriate and personalised and staff were able to maintain a very positive relationship which enhanced the persons feelings of well being. Other residents seen on the nursing units were clean and appropriately dressed. There are a proportion of residents nursed in bed and these were observed to be comfortable and regularly attended to. One person spoken with said: ‘The staff are very good and look after me well’. A relative commented; ‘The home genuinely cares for all residents. Staff show a sincere commitment and form excellent interpersonal relationships and treat people as individuals’. The comments from residents interviewed were similarly positive and the care generally was identified as being good. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 17 We found the care standards on both units to be much more consistent than on our last inspection particularly around care planning and personal care. AMU The care planning on the AMU has also been standardised and is now more consistent. The care files seen were organised and easier to follow. Each care need was addressed in some detail on those seen and these were evaluated appropriately. There were also risk assessments which contained care interventions and actions are included as part of the care planning process. We saw that the care files seen contained evidence that people living on the unit had been involved in drawing up care plans and each bedroom contained a copy of the care plan so that people could reference it if they wished. One resident was able to discuss her care plan. This was in the form of a weekly activity plan and it included going out for daily walks with staff and weekly trips to town. The weekly activity plans are basic routines that residents have agreed to and are easy to follow. They include aspects of personal care and work with key workers. Another resident discussed how he was now going out regularly off the unit and this had been achieved with support from his key worker. We were also able to see how support from staff had enabled the person to improve personal hygiene and appearance so that dignity was being maintained and the person was more independent. Residents reported good relationships with key workers [care staff] on the unit and felt that they could communicate with them. Some reported that they felt on their own sometimes and that staff could ignore them at times and not interact. This was variable on the day of the inspection. For example one person was very disturbed on the day but staff response varied. One staff reported that they had had little training in how to communicate with people who are disturbed and for some of this period the person was not approached or supported by staff. The trained nurse on the unit was, however observed to be supporting the person well and offered some reassurance which seemed effective. We would recommend that care staff attend more training around managing aggression and communication strategies so that all are confident to approach and talk to residents openly. There were less diverse needs apparent than on previous inspections in that most of the residents were clearly long term and have enduring mental health needs although there were some who have a physical component to their disability [for example two residents with Huntingdon’s disease]. One resident who has cultural needs around a Muslim faith had these needs addressed in the context of their overall mental and physical condition and there was clearly an understanding of the individual needs of this resident being addressed. This was evidenced in the care plan as well as the key workers understanding. This
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 18 person had completed and returned a survey form stating that the care staff gave was very good and well personalised. The unit has had some review in terms of GP allocation and there is now more choice available for people who are resident on the unit. There is also consultant psychiatrist input so that medical reviews are carried out consistently. Residents spoke of the regular reviews undertaken by the psychiatrists and felt reassured about this support. Medications We looked at the care plans of several residents that had been prescribed medicines on a ‘when required’ basis. We found some good information to support their use clearly highlighted in ‘care plans’ in the medication records. Having detailed written care plans is important to help ensure residents receive their medicines correctly. We checked the storage of controlled drugs (medicines that can be misused) and the previous requirement made for an appropriate secure cupboard has been carried out and now meets standards so drugs are kept safe. We saw evidence of regular monthly medicines checks being carried out by the senior managers. These checks can ensure good monitoring and pick up any mistakes or improvements needed. We spoke to staff about how creams applied to the skin are recorded and found that currently care staff responsible for administering these are not recording their input. We discussed ways this should be recorded so that it is clear which staff applies and when. We were advised that currently no people in the home are self medicating. [This was assessed on the AMU]. Staff spoken with had clearly not considered this as a way of assisting people to become more independent. We discussed this and would recommend that managers of the units consider assessing people to encourage more independence and autonomy in this area. The home has policies and procedures to support this. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The attention to the social needs of the residents in the home helps ensure that they have a good quality of life. EVIDENCE: There was an understanding on the nursing units of the importance of facilitating good communication with residents and allowing them the time to develop their lifestyles. One resident spoken with had a very personalised bedroom that contained enough space for computer, books and other activity / pastimes that complimented the residents lifestyle. All bedrooms seen displayed a high level of personalisation. One resident was observed to be enjoying the garden area and spoke about how some of the residents are involved in gardening. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 20 Residents spoken with advised of the various activities that are undertaken in the home. There is a staff member coordinating some of these events and the home also employ a driver who also contributes a lot in terms of working with some residents and ‘getting them out and about’. Care notes include a note of any activities that residents partake in including the dementia unit on the top floor. There are difficulties in accessing green space [shared with ground floor] due to the unit being on the top floor and therefore more geographically removed so that people with dementia are reliant on care staff support for accessing the garden. Any development of care here should focus on regular activity off the unit as well as on. Staff did report that some residents went out on a weekly basis on the minibus but felt that this could be made more regular. We conducted a two hour observation of the social interactions of staff and residents on the dementia unit. This was positive with staff providing appropriate and supportive interactions which clearly enhanced the wellbeing of people on the unit. Other residents on the ground floor unit spoke about trips out twice weekly in the mini bus and also frequent trips to town. The interactions between residents and staff were observed to be very supportive. Residents spoken with were very relaxed and clearly enjoyed the daily life of the care home. One person said: ‘It’s not institutional here. Other homes tend to be all the same; rooms and so on. This is different. My rooms been decorated recently. Staff have supported me to give up smoking. I go out regularly and can do what I want. I can get involved in activities’. AMU Another resident on the Andrew Mason unit said: ‘I’m able to do my own cooking. Staff take me out shopping. I go on trips. Everything is alright. I am getting a new TV, bed and curtains and stereo. I like my room since it has been decorated. I picked my own colour for both walls and carpet.’ On the AMU some of the residents are limited in their ability to make some specific life choices but interviews were consistent in that residents are listened to and choices made on a daily basis are respected. Staffing levels are good on the unit, which allows for one to one input for some of the more needy residents with respect to physical care and the importance of using this time for positive social interaction was a feature of the staff interviews conducted. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 21 Some of the residents went on holiday last year but others did not. Those spoken with said they would enjoy a holiday if they could be supported to organise one. This was discussed with the manager as a possible aim. We spoke to residents about the diversity of activity on the unit and found this to be limited. We asked whether people from the community, e.g. the local college, ever come in to run courses or activities, but were told that this never happens. Some residents said that they would be interested in this, perhaps a series of taster sessions where they could try things out to see what they liked. Generally all residents praised the meals. There is good choice and residents said that they look forward to the choice of a cooked breakfast each morning. We observed the dinner time meal on the Andrew mason Unit. We observed that tables were not laid prior to meals. Some residents reported that staff do not always wear protective aprons and that standards of hygiene are not always consistent. One service user had missed lunch, and staff did not appear to have noticed that this service user had not come for lunch. She was offered food from the leftovers, but declined. We gave some feedback to the nurse in charge regarding this so that standards could be monitored. We would recommend that this area of care is audited to ensure any improvements needed are introduced and monitored. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 22 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There needs to be more consistency in the recognition and reporting of any incidents of alleged abuse so that these are properly investigated and residents are fully protected. EVIDENCE: There is a complaints procedure in the home and the manager has recorded in-house concerns and complaints since the last inspection. The complaints procedure is displayed in the home in more immediate terms and is evidence of a positive attitude to the views of the residents and visitors. We spoke to residents about how they would complain or raise a concern and they were confident that they could approach the staff who they felt would listen. The pre inspection information completed by the manager lists areas of good practice: ‘There has been increased senior management review of every area of service. Standard format for dealing with all complaints with step by step procedures. All staff have attended protection of vulnerable adults training, managers have
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 23 attended specialized course in protection of adults, Mental Capacity Act and at present waiting for DOLS [derivation of liberty] training’. Over the last year there have been three concerns that have been investigated under the safeguarding procedures by Social Services. All three involve allegations of mistreatment on the dementia care unit involving physical abuse allegations. The investigations remain on going at present. All three were picked up and reported by staff in the home. Only one of the incidents was reported through to social service safeguarding team at the initial stages however. In the other two incidents [including the latest] the homes management have initiated their own investigation and only reported through the appropriate channels at a later stage. In the most recent incident this was not reported through until staff informed the Care Quality Commission. The importance of following the correct [and agreed] procedures in these instances is that each allegation can be investigated by a multidisciplinary approach that is seen to uphold the rights of people living in the home and ensure that investigations are thorough and objective by the inclusion of external bodies such as social service and the police. A requirement is made in this report to ensure that managers in the home ensure future consistency in this area. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 24 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: 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 ongoing improvements to the home ensure that residents live in a well maintained and comfortable environment. EVIDENCE: The ground floor nursing unit and the Andrew mason Unit were both clean and well maintained in general. Both provide personalised accommodation for residents and the bedrooms seen clearly displayed this [to a high standard]. There is access to green space [garden] on the ground floor unit and this is well maintained and some of the residents are involved in assisting in the garden.
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 25 The AMU has been upgraded over the past 2 years with new flooring in various areas, décor to bedrooms and the female day area. There have also been new furnishings for other day areas. Residents were generally pleased with the standard of the accommodation and commented on this. The top floor dementia care unit has also been upgraded with new bath and shower facilities as well as having the existing day area decorated and refurnished and a new lounge area created. Again bedrooms in this area were highly personalised and comfortable. This shows that the staff on the unit are concerned to promote individual aspects of peoples personality and make bedrooms as ‘homely’ as possible. We spoke about the need to develop the area in terms of more orientation aids such as signage etc which would enable people to find their way around more easily. The laundry was visited as this had been the focus of a previous inspection requirement for improved management. The laundry was seen to be well organised and clean. There were no issues or concerns expressed around the management of laundry for people. We inspected the toilet facilities on the AMU and found one facility to be in need of upgrading. Both extractor and shower are not working and staff reported difficulties in maintain this area due to flooding of the floor on occasions. He flooring outside this facility needs repairing / replacing as it is split exposing the wooden floor below. A requirement has been made to ensure that this facility can be used by people on the unit. We also received comments from staff members that although bathrooms are fitted with locks ‘not all of them work’. We feel it is not acceptable that service users’ dignity and privacy is not provided for in this way. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 26 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood. EVIDENCE: Nursing We visited and spoke with staff on both the ground floor nursing and top floor dementia care unit. There were appropriate staff for residents needs. Staffing ratios are consistent and staff interviewed stated that staff turn over was minimal and is now settled and consistent. The top floor dementia unit has had some experienced staff employed and a new clinical lead from the previous inspection. This has helped ensure more consistency and raise standards. Care staff spoken to have had updates or training in dementia care and the qualified nurses spoken with had also been on regular updates and stated that
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 27 the home were good at providing training and that they felt supported by the management. AMU Staffing is consistent and there is generally a 1:3 ratio maintained. The figure also includes the unit manager. Residents reported that staff are always available and that they felt supported by the care team. There are trained staff who are appropriately qualified and experienced with regard to nursing this client group. Again the rate of turnover of staff is currently fairly low and there are therefore consistent personal on the unit. General. Staff records were viewed [3 in total] and all were comprehensive in that staff information available and the required Criminal Records [CRB] and vulnerable adult checks [POVA] were recorded along with references. Files also contained some training certificates and supervision records. We did find one staff who had been employed following concerns raised, as part of the recruitment process, which may have raised doubts about the persons ‘fitness’ to care for vulnerable people. Records indicated there had been no risk assessment made at the time to clarify these issues and whether the person may have presented a continuing risk to residents. We spoke with the manager about the need to develop an assessment tool for use as part of the recruitment process. This will help ensure that risks are highlighted which can assist in management decision making and ensure that people in the home are kept safe. Training was discussed with the staff. Staff were pleased with the training offered from induction through to access to NVQ which has been stepped up over the last few years and now all but 2 care staff have achieved an National Vocational qualification [NVQ] which provides a good staff base for the care of residents. All staff spoken to had received statutory updates in manual handling and health and safety issues. Since the last inspection all staff have undergone training in safeguarding of adults and abuse. Other training planned includes areas specific to mental health care and has been planned in response to staff supervision. Staff are well thought of by residents and visitors alike and there were many positive comments recorded through out the inspection and the support observed was appropriate and genuine. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 28 Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 29 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: 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. There is consistent management in the home and quality systems which evidence continued improvement in standards so that the home acts in the best interests of residents. EVIDENCE: Malcolm Rugan is the Registered Manager for the. He has worked in the home for a number of years and prior to appointment as manager was employed in a deputy management role. He has an NVQ course in management and has an RMN [Registered Mental Nurse qualification]. Feedback from staff, residents
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DS0000017279.V375986.R01.S.doc Version 5.2 Page 30 and visitors generally is that he is consistent in approach and is easy to communicate and talk to. The manager was able to discuss developments in terms of quality issues in the home. There is a yearly external audit that accesses both staff, resident and relative views of the home and provides feedback to the managers. There are various audits conducted regularly including health and safety audits, which are reported through the health and safety management team. There is also a clinical governance team consisting of management, staff and relative and resident representatives. We spoke to one of the resident representatives who valued this inclusion. The manager also reports that resident’s representatives are included in the staff recruitment process which shows commitment to including residents in the general running of the home. The requirements and recommendations previously made have been met and the home has generally showed progress over the last year in further improving standards in the home which are now managed more consistently. The one area of inconsistency is around the adherence to and reporting of safeguarding incidents which are commented on previously and must be addressed. Health and safety issues were reviewed with respect to fire safety and training, which have been addressed. We looked at how the home had managed an outbreak of infection and the response and systems in place had been more than adequate. We saw an environmental health inspection report which scored the home well in terms of management of infection. This ensures there are systems in place to maintain a safe environment in the home. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 32 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 OP18 Regulation 12(1)a Requirement Timescale for action 01/07/09 2 OP19 23(2)b All incidents and allegations of abuse must be reported through to the local safeguarding team so that they can be investigated appropriately. This ensures that people’s rights are upheld and people are fully protected. The toilet / shower room 01/08/09 identified on the AMU must be upgraded and made fit for purpose so that people on the unit can use this facility. 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 OP9 Good Practice Recommendations We were advised that currently no people in the home are self medicating. [This was assessed on the AMU]. Staff spoken with had clearly not considered this as a way of assisting people to become more independent. We discussed this and would recommend that managers of the units consider assessing people to encourage more
DS0000017279.V375986.R01.S.doc Version 5.2 Page 33 Fleetwood Hall independence and autonomy in this area. We spoke to staff about how creams applied to the skin are recorded and found that currently care staff responsible for administering these are not recording their input. We discussed ways this should be recorded so that it is clear which staff applies and when. 2 OP12 Development of the dementia care unit should include more planned activity which accesses fresh air for residents more frequently. On the AMU Some of the residents went on holiday last year but others did not. Those spoken with said they would enjoy a holiday if they could be supported to organise one. On the AMU Residents said that they would be interested in more varied activities organised with support from outside agencies such as colleges. Perhaps a series of taster sessions where they could try things out to see what they liked. 3 OP15 On the AMU we had varying standards of meal time experience reported. We would strongly recommend that the managers monitor this aspect of care to ensure consistent standards. We spoke about the need to develop the dementia care unit in terms of more orientation aids such as signage etc which would enable people to find their way around more easily. The managers need to check the locks on toilets and bathrooms on the AMU to ensure that they all work effectively. 5 OP29 We did find one staff who had been employed following concerns raised on recruitment checks. Records indicated there had been no risk assessment made at the time to clarify these issues and whether the person may have presented a continuing risk to residents. We spoke with the manager about the need to develop an assessment tool for use as part of the recruitment process. We would recommend that care staff attend more training around managing aggression and communication strategies so that all are confident to approach and talk to
DS0000017279.V375986.R01.S.doc Version 5.2 Page 34 4 OP19 6 OP30 Fleetwood Hall residents openly. Fleetwood Hall DS0000017279.V375986.R01.S.doc Version 5.2 Page 35 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
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