Inspection on 13/06/08 for Fleetwood Hall

This inspection was carried out on 13th June 2008.

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

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

Other inspections for this house

Fleetwood Hall 10/06/09

Fleetwood Hall 04/09/07

Fleetwood Hall 14/09/06

Fleetwood Hall 22/03/06

Fleetwood Hall 18/08/05

Fleetwood Hall 05/01/05

Fleetwood Hall 22/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN Lead Inspector Mike Perry Unannounced Inspection 13th June 2008 09:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fleetwood Hall Address 100 Fleetwood Road Southport Merseyside PR9 9QN 01704 544242 01704 503956 malcolm@fleetwoodhall.com 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) 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.V362742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may admit four named service users over pensionable age within the category of mental disorder (MD). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social care Inspection. To admit one service user under pensionable age to the elderly care unit (OP). 4th September 2007 [Key Inspection] 24th Jan 2008 and 26th Feb 2008 [pharmacy] 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. The current fees for the service range from £540 - £1,900 weekly Date of last inspection Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 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 3 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 two incidents in the home which required investigation under the local ‘safeguarding’ procedures and some of the detail of these are included in the report along with any relevant findings and action taken by the home in response. A pharmacy inspector on 11/6/08 undertook a separate inspection. This was because the home has had a number of requirements in this area since the last inspection and there have been two other visits by the pharmacist over this period. The pharmacists report and any requirements are also included in this report. Requirements and recommendations are listed at the end of the report. During the site visit the laundry was inspected and standards were found to be poor in that there was a general lack of systems to manage infection appropriately. An ‘immediate requirement’ was made by the inspector and this was dealt with by the management over the next 48 hours. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 7 Medicines handling has improved, records of medicines receipt, administration and disposal were clear and usually accurate. Checks showed that medicines were usually administered correctly and more information about how medicines should be used was in the residents care plans, this helps ensure their health and wellbeing is maintained. There has been a general improvement in the way that staff record information on the care plans for residents. These are generally a lot more detailed and clearer on all units and have therefore improved since the last visit. This was particularly noted on the Andrew mason Unit [AMU] where the documentation was clear and easy to follow. There is also evidence on the AMU that more specific care planning documents are being drawn up with the involvement of residents, which set out daily routines and individual activities over each week so that residents can achieve realistic goals in their care. Following a requirement on the last report there is now a fuller understanding amongst the management of the reporting process for managing any allegations of abuse and more recent incidents occurring since the last inspection have been reported appropriately. There has been more training organised by the manager in dementia care and mental health issues as this had been a recommendation on the last inspection. The evidence from the observations made as well as residents feedback is that the general standard of the accommodation on the AMU has been improved and is being maintained so that residents are accommodated in a cleaner and more comfortable environment. What they could do better: Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. The assessments varied in detail and quality. Some were lacking in any detail and some were not signed or dated appropriately. It is strongly recommended that more complete and detailed assessments be maintained by the home so that a more complete picture of each residents care needs can be gained. Although the general care planning documentation has improved there are recommendations around the need to update care plans for more longstanding care needs on a regular basis so that all aspects of the plan can be seen to be updated and ensuring that the plan reflects current care. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 8 There is a requirement to ensure one of the medication storage cupboards meets standards so that medicines are safely maintained. The general standard of personal care for residents was observed to be good. One resident reviewed was in need of more consistent input and monitoring however and some comments from relatives were that standards are not always maintained. The dementia care unit is being upgraded at present. There are difficulties in accessing green space [shared with ground floor] due to the unit being on the top floor and any development of care here should focus on regular activity off the unit as well as on. Some residents did say that occasionally the suppertime meal [sandwiches, cake, biscuits etc] is sometimes not given. The availability of food in the satellite kitchens is very limited in such eventuality. It would be recommended that food is made available during the evening time on a consistent basis. The training programme for staff highlighted the need for all staff to attend updates in safeguarding procedures and abuse awareness. It was a concern that the laundry area was found to be poorly managed. The laundry was cluttered making it difficult to work in as well as clean. There was no evidence of any ongoing cleaning and the separation of clean and dirty areas was poor with clean linen observed to be stored haphazardly. Unmarked clothing [shoes and slippers] was observed to be stored on windowsills and could not be identified by the laundry worker. An immediate requirement notice was left and the manager responded within the time scale to say that this area was now being managed appropriately. Given the findings around some aspects of the care records and the management of the laundry the manager must ensure that these auditing tools are robust enough to pick up anomalies and maintain consistent standards. 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. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 [standard 6 is not applicable]. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are carried out prior to residents being admitted but the ones completed by the home need to be clearer and in more detail so that a more 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. The assessments varied in detail and quality. For example one assessment seen was fully completed Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 11 and was signed and dated appropriately [on the G/F unit] whilst a care file seen on the dementia care unit was very confusing in that it contained three separate assessments none of which were signed and only two of which was dated. The two dated were following the admission date on the record. The detail on these assessments varied but was generally poor in that some details had not been filled in. The nurse in charge was unaware of the origin of one the dated assessments although made the observation that the resident in question had been admitted initially to the AMU and then transferred to the dementia unit. The assessments were backed up by information and assessments from both health and social care professionals who had referred the resident so that, overall, a reasonable idea of the care needs were apparent. There were also some risk assessments completed which were appropriate. Another residents file was inspected and contained an appropriately signed and dated preadmission assessment but this was again completed with very little detail. Again the professional assessments helped complete the picture of the resident. It is strongly recommended that more complete and detailed assessments be maintained by the home so that a more complete picture of each residents care needs can be gained and that these are signed and dated clearly. [This has been a previous recommendation]. The auditing processes used by the home to help standardise documents should be able to monitor this more consistently. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The general care of residents health and personal care has improved overall but there remain some inconsistencies so that not all residents receive the same standard. EVIDENCE: Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 13 Nursing units [top floor and ground floor] We reviewed two care files on the top floor dementia care unit and observed the care of the residents and spoke with one of them. Both care files of these 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. One of the residents was observed to be nursed in bed. The staff spoken with identified deterioration in this person’s health and said that the family were fully aware and were involved in regular communication. This was not identified on the care planning documentation however [although a fairly new development] and we advised that this should be addressed and the current care needs clearly identified. We observed that the other resident had identified care needs around personal hygiene and continence. The care plan identified a minimum of three baths weekly to maintain good levels of personal hygiene. It was unclear from records however whether this had been carried out. The last recorded bath was in the daily notes over a week previous and the daily personal hygiene / care record completed by care staff was again unclear and some days no entry had been made [e.g. day previous]. Care staff could not identify when the last bath had been given. [There is some difficultly currently due to upgrading on the unit and the lack of a bath on this floor]. Better records need to be maintained however. In this case the resident did have a body odour and the bedroom had some smell of incontinence so consistent monitoring of personal care is important. 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. The care files seen on the ground floor unit were clear and addressed the needs of the residents. Any health care issues are addressed. One care plan identified a resident who had had a pressure sore and this was well monitored. The appropriate treatment and medical aids in terms of pressure relief mattresses were supplied. The care notes seen included reference to medical visits by GP’s and visits by health care professionals such as speech therapists. Some of the relative surveys commented that residents are not always dressed in their own clothes. For example one commented: ‘my relative often looks unkempt and wearing other peoples cloths which are scruffy and often in holes’. This was supported by two other relative comments of a similar nature. This was not observed on the inspection although was discussed with the manager who felt that this had been raised previously and things had improved. However, the inspection of the laundry revealed that not all clothing Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 14 is marked and some, mainly footwear can be unidentified and therefore the risk of this occurring can be evidenced. It is recommended that all clothing including footwear be appropriately labelled. A relative commented: The management are very open and don’t hide things. They said I could look around any time when I first approach the home regarding a place. Father gets good care. Seems happy in the home. They always keep me informed. I saw the care plan in the beginning. Can look at this anytime. I feel involved in the home. My dad is always clean and tidy and well groomed. The comments from residents interviewed were similarly positive and the care generally was identified as being good. Other relatives said that although the care is generally good there could be more consistency around personal care: ‘They do a lot of good work but when we visited last week my father was unshaven and another time he had the wrong slippers on which did not belong to him’. AMU The care planning on the AMU has generally improved over the last two inspection visits. 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. [One care file did contain only very limited evaluations ‘care as plan’ and the manager is aware that there is still some consistency needed]. There were also risk assessments which contained care interventions and actions are included as part of the care planning process. Although up to date in terms of regular evaluations some of the care plans are actually dated 18 months – 2 years ago as the care needs are very long term. It would be a recommendation however that even long term needs are updated at least yearly so that aims and objectives can be perhaps more appropriately reviewed and discussed with the resident. 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 the weekly outings to the pub with a member of staff, which he clearly enjoyed and benefited from. At the same time the standards of personal care of Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 15 residents were observed to be much improved and more consistent from previous inspections. Residents reported good relationships with key workers [care staff] on the unit and felt that they could communicate with them. They generally felt that staff supported them on a daily basis. Staff were seen interacting with residents. 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 one resident 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. 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 a consultant psychiatrist employed on a sessional basis and there is evidence some psychology input on the unit. Residents spoke of the regular reviews undertaken by the psychiatrists and felt reassured about this support. Medications As part of the inspection a specialist pharmacist inspector looked at how medicines were handled because previous inspections had found some serious shortfalls. We carried out checks on a random sample of medicines and found that these usually added up, this is a significant improvement from the last inspection, which showed they had been given to residents correctly. We checked the timings of medicines and found that most medicines were now given at the right time, notably those that need to be given before meals were now being given correctly. 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 but noted several medicines that had not been properly highlighted and some evidence that these medicines were not being given in a consistent way, we told the manager about this and discussed it with the nurses in each unit. Having detailed written care plans is important to help ensure residents receive their medicines correctly. We checked the stocks and records of controlled drugs (medicines that can be misused). Although a secure cupboard was being used for storage it does not meet standards and we gave some advice to the manager on how to put this right. We checked the controlled drug records and noted two recent mistakes that had resulted in a resident having their pain relief patch replaced a day Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 16 late, which means this resident could have suffered unnecessary pain. We told the manager about this and gave some advice on how to improve the recording and administration of controlled drugs. Secure storage and witnessed records help ensure controlled drugs are not mishandled or misused. We saw evidence of regular monthly medicines checks being carried out by the senior managers. These checks had identified some mistakes and action had been taken to help prevent them happening again, we gave some detailed advice to the manager on how to develop these further. Nursing staff had also recently had a competency assessment by the manager to ensure they were following the right procedures. Checks on medicines handling are important because they help ensure medicines are administered as prescribed and help ensure staff are competent. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. 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 Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 18 bedroom that contained enough space for computer, books and other activity / pastimes that complimented the residents lifestyle. Most bedrooms seen displayed a high level of personalisation. The same resident was observed to be enjoying the garden area and spoke about how some of the residents are involved in gardening. Resident 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. The dementia care unit is being upgraded at present and has only a limited number of residents. 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. 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 supportative. 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 discussed the weekly activity plan and this included graded exercise as well as attention to personal care. Some of the residents went on holiday last year and more is being organised this year. 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. The dining arrangements for residents on all floors are sociable and pleasant. One resident reported that that occasionally the suppertime meal [sandwiches, cake, biscuits etc] is sometimes not given. This was supported by comments from the manager and cook who had observed that occasionally the food sent down for supper had not been given out and was still there next morning. The availability of food in the satellite kitchen [fridge on ground floor inspected] is very limited. It would be recommended that the super time food is consistently made available so that residents can be provided with extra sustenance if required out of kitchen times. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. 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 is a complaints procedure in the home and residents feel their concerns are addressed but there needs to be full training of staff so that there is greater awareness of monitoring and reporting processes around safeguarding issues so that 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 notice advertised in the home ‘problem – no problem’ highlights the complaints procedure in more immediate terms and is evidence of a positive attitude to the views of the residents and visitors. Over the last year there have been two concerns that have been investigated under the safeguarding procedures by Social Services. The first was an investigation into the care of a resident on the dementia care unit who sustained a burn and was admitted to hospital. The investigated was inconclusive regarding how the resident had sustained the burns but there were issues raised around the care of people who have continence needs and Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 20 also moving and handling needs. There were also concerns about how care is recorded and incidents reported. In response to requirements made by The Commission for Social Care inspection [CSCI] the manager has produced an action plan, which seeks to address these issues. There is a more recent issue, which is currently under review. The home have acted to alert the authorities and to manage the in house processes appropriately. The family of the resident have been kept informed of any action taken. Staff have received some training around abuse and safeguarding awareness but the records seen indicate that a large proportion of staff have not completed this and been updated appropriately. This needs to be addressed so all staff are updated and aware of the issues involved in identifying and reporting abuse. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. 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 has been improvement to the general environment in the home and the maintenance programme outlined together with the recommendations in this report should ensure that satisfactory standards are maintained and residents live in a wellmaintained environment. EVIDENCE: Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 22 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. 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. Following previous requirements the AMU has been upgraded 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. One bedroom seen was in need of upgrading but this was in hand and the resident concerned said he was moving to another room to accommodate this. The top floor dementia care unit was in the process of being upgraded during the inspection. There was a new fire escape being fitted and new day area, bathroom and shower room is being created. There was some discussion regarding the future of the unit and any planned care for the future should meet the good practise guidelines spoken of including both staffing and access to green space on a regular basis. The bedclothes for one resident on the dementia care unit were observed to be in poor condition. The manager said that bed linen would be replaced as the unit was upgraded. There has been some feedback regarding the management of personal clothing previous to the inspection and the laundry was therefore visited. It was a concern that this area was found to be poorly managed. The laundry was cluttered making it difficult to work in as well as clean. There was no evidence of any ongoing cleaning and the separation of clean and dirty areas was poor with clean linen observed to be stored haphazardly. Unmarked clothing [shoes and slippers] was observed to be stored on windowsills and could not be identified by the laundry worker. An immediate requirement notice was left and the manager responded within the time scale to say that this area was now being managed appropriately. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. 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 For 13 residents on the G/F unit there was one trained and 3 care staff on duty at the time of the inspection. This is reduced to 1 trained and 2 carers for the afternoon shift. The top floor unit had 6 residents and was staffed with 1 trained nurse and 2 care staff. There is a unit manager over both these floors. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 24 These staffing ratios are consistent and staff interviewed stated that staff turn over was minimal and is now settled and consistent. There was some discussion regarding the future development of the top floor dementia care unit and appropriate staffing – both in numbers and qualifications needs o be planned as part of the proposals. Care staff spoken to had had updates or training in dementia care and the qualified nurses spoken with had also been on regular updates and stated that the home were good at providing training and that they felt supported by the management. AMU The AMU had 16 residents. 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 suitable references. Files also contained some training certificates and supervision records. Training was discussed with the staff. Most were pleased with the training offered from induction through to access to NVQ which has been stepped up and there are currently 45 care staff undergoing the training and 65 have achieved this providing a good staff base for the care of residents. All staff spoken to had received statutory updates in manual handling health and safety issues. There remains some training around safeguarding to catch up on [records seen highlight this]. 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.V362742.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. 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 is consistent management in the home and quality systems which evidence continued improvement in standards overall and that the home act in the best interests of residents. EVIDENCE: Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 26 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 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 a relative and resident representative. Some of the requirements and recommendations previously made have been met and the home has generally showed progress over the last year. Given the findings around some aspects of the care records and the management of the laundry the manager must ensure that these auditing tools are robust enough to pick up anomalies and maintain consistent standards. Resident’s monies are managed through the home residents monies account and the records are maintained satisfactorily. Residents interviewed had no problems in terms of the management of finances and were pleased that this was a convenient way of accessing monies. Health and safety issues were reviewed with respect to fire safety and training, which have been addressed. The electrical wiring in the home has now been upgrade. Other maintenance certificates examined were up to date. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 27 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 X 2 X 3 2 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 3 36 X 37 X 38 3 Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement The controlled drugs cupboard on the ground floor nursing unit must be compliant with standards to ensure they are not mishandled or misused. Timescale for action 11/09/08 2 OP26 13(3) The laundry area must be 15/06/08 maintained at all times with respect to basic infection control measures and good practise guidelines and must be clean. Immediate requirement notice served. 3 OP33 10(1) The manager must ensure that the auditing systems in the home are robust enough to monitor standards effectively and can identify clear failings in standards. [This in relation to the laundry procedures and standards and the assessment documentation on residents care files this inspection]. DS0000017279.V362742.R01.S.doc 01/09/08 Fleetwood Hall Version 5.2 Page 29 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 OP3 Good Practice Recommendations All assessments completed by staff either prior to or following admission should be in more detail and be clearly signed and dated. Care plans on all units should be updated on a more regular basis [at least yearly] although long term needs are clearly evaluated. This will enable any changes in aims / objectives to be more clearly reviewed and also any change in care interventions to be more fully considered. The care plan for the resident on the dementia care unit should be updated to include current needs. Although much improved there remain some care plans that contain very brief evaluations / reviews that lack detail [AMU]. Personal care needs need to be consistently met. See comments around resident with continence / bathing needs and also comments around clothing. All clothing needs to be identified including footwear so that the risk is reduced of items being misplaced or lost. Development of the dementia care unit should include more planned activity which accesses fresh air for residents more frequently. The provision of food during the evening should be reviewed to provide choice of out of hours sustenance if needed. All staff should receive necessary updates in identifying and reporting suspected abuse. The upgrading work on the top floor should be completed with reference to the good practice guidance discussed. 2 OP7 YA6 3 OP10 4 5 6 7 OP12 OP15 OP18 OP19 Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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. Fleetwood Hall DS0000017279.V362742.R01.S.doc Version 5.2 Page 31 - 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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