CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN Lead Inspector
Mike Perry Unannounced 18 August 2005
th 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 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 F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Fleetwood Hall Address 100 Fleetwood Road Southport Merseyside PR9 9QN 01704 544242 01704 503956 Telephone number Fax number Email 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 Ltd Mrs Yvette J Oreschnick [ currently applying] N - Care Home with Nursing 53 Category(ies) of MD - Mental Disorder - 21 registration, with number OP - Old Age - 12 of places DE - Dementia - 15 PE - Physical Disability - 5 Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Variation for 4 named service users over pensionable age within MD category. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the CSCI. 3. Variation for 1 named service user within OP category to remain in the home on a residential basis. 4. Variation to admit 1 service user under age 65 to the elderly care unit (OP). Date of last inspection 5th January 2005 Brief Description of the Service: Fleetwood Hall is a large detached building that occupies a position on the outskirts of Southport but within reach of the town centre and promanade. The building was once an NHS hospital and has been converted to provide care over 3 floors. The registration is divided so that the nursing unit cares for generally elderly [situated on the ground floor] and older people with mental health needs are cared for on the top floor. The middle floor is given over to the Andrew Mason Unit [AMU] which is registered to admit younger adults [ below 65 years of age] with mental health needs - specifically those with longer term psychiatric needs. There is also registration for 5 younger adults with physical disability on the ground floor unit. This report is therfore an amalgamation covering 2 sets of National care Standards. the home has been owned and managed by Newco Southport Ltd since 1996 whose directors are Mr and Mrs Oreschnick. Mrs Oreschnick is managing he home and has applied for Registration with The Commission. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over a period of 3 full days. All 3 units were visited. All day and recreation areas were seen and many 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. In total 10 residents in the home were spoken to along with 4 relatives, 12 members of staff and the Manager. 1 relative and a total of 15 of the residents also completed comment cards and comments have been reflected in the overall report. 15 of the 20 Core standards were covered on the inspection. There were many positive aspects to the inspection and the management were responsive and open to comments made. There are areas that need to be developed consistently across all 3 units in the home and these are listed as requirements and recommendations at the end of the report. What the service does well:
Fleetwood hall was found to have good staffing levels on each of the units in the home so that care be carried out well, by experienced staff. Residents are admitted to the home and undergo a series of very thorough assessments, particularly on the older persons units on the top and ground floors of the home. From these assessments care plans are drawn up by the nursing staff and there is good liaison with relatives for this purpose. The home are good at talking to and referring residents, if required, through to other health care professionals such as district nurses or General Practitioner’s. This was particularly evidenced with one resident on the nursing unit who was being treated for leg wounds. The Andrew Mason Unit [AMU] benefits from a consultant psychiatrist employed by the home and regular reviews are carried out. The care plans for the elderly residents are very thorough and address all care needs consistently. There are also good care plans on the AMU, which address aspects of daily living skills such as attention to personal hygiene although the plans are not always inclusive of all needs. Staff were described by residents and relatives as friendly and helpful. Staff understood the importance of maintaining the dignity of residents by, for example, ensuring that residents are clean and appropriately dressed. Residents on the AMU were generally pleased with the staff approach and felt relaxed on the unit.
Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 6 The management of the home are open and constructive with respect to complaints and this was the case when the inspector reported an issue concerning a staff’s inappropriate behaviour towards a resident. The managers took appropriate action. Staff training is good with care staff able to access NVQ training on an ongoing basis. The residents and relatives spoken to consistently praised the food and mealtimes in the home. What has improved since the last inspection? What they could do better:
Pre admission assessments are carried out but it was not possible to assess the quality of these as they were not accessible being filed external to the care notes. It is recommended that these assessments be filed with the other documentation and held centrally. There was some inconstancy on the AMU with respect to care planning for residents. Some were appropriate with agreed targets around care needs such as self care and it was clear that the resident had ‘signed up’ to this and there was ongoing evaluation. Other plans were not up to date and some care needs were missing and had not been included. This was particularly the case with a
Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 7 resident who had been in the home for some months and had mobility problems that had not been assessed properly and care planned effectively, as well as some social needs which also need to be addressed. One resident raised the issue of self-medication when going out on extended trips. There is no drive to develop care plans to include programmes of self medication and this should be looked at in terms of encouraging independence. The need for proper risk assessments and ongoing monitoring is obviously important to consider, as the fact that residents have mental health problems is important. The need for an annual holiday was raised with one particular resident. None of the younger adult residents currently have been offered a holiday and this needs to be addressed, as it will improve the quality of life for some residents in the home. There have been some examples of residents on The AMU attending college or other training courses outside the home. There are difficulties with the enduring nature of the mental health problems of residents on this unit which create barriers in terms of motivation and concentration but the benefits have been demonstrated in the past and perhaps there needs to be more of an emphasis placed on encouraging some residents. One resident on the unit has expressed an interest in art but this has not been formally followed through by staff. The medication administration recording on the elderly unit [ground floor] was looked at, and there are still errors with recording in that blanks in the records could not be explained. This was a requirement on the last inspection and needs attention by the managers in order to ensure medicines are administered properly and safely. All younger adult residents should have a copy of their care plan. Again this has occurred with some residents but is not consistent. Activity plans should also be included rather that merely stored in the office for staff use. The staff files seen were generally complete and necessary checks were in place to ensure that staff employed are suitable. This is not he case in one particular instance however and it is important that all staff employed receive Criminal Records Bureau [CRB] checks prior to working unsupervised. 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. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 8 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 Standards 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 F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 9 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 [OP], 2,5 [YA] The assessments carried out by the home following admission are good and help ensure that the home can meet the needs of residents admitted. Preadmission assessments need to be accessible in the care notes and are important as part of the admission process so that judgements can be made regarding appropriate admission. Not all care needs on the AMU were assessed leading to the possibility of some needs not being addressed as part of the care plan. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 10 EVIDENCE: The resident’s contracts for care in the home could not be reviewed, as they were not available due to being with the homes accountant. This requirement from the previous inspection is therefore left on and will be reviewed at the next visit. Both staff and residents interviewed stated that assessments are carried out prior to residents being admitted to the home so that needs can be ascertained. The quality of these assessments could not be reviewed however as they are not filed in the care files and were not immediately obtainable. It is recommended that these assessments be filed in the care notes along with the other assessments carried out. All residents admitted on the nursing units [Top and ground floor] undergo a series of nursing assessments once admitted and those seen [6 files in total] were very detailed. They are based on a model whereby residents abilities to carry out daily activities of living are assessed. These assessments are also backed up by social worker or health assessments were necessary. It was also observed that relatives are asked for their input into the assessments and signatures were seen on documents evidencing good practice. Relative’s interviewed confirmed this process. Other assessments carried out include manual handling, nutrition and risk assessments including risk of pressure sores. Records also include a social profile. From these assessments a care plan is devised. Residents admitted to the AMU undergo a ‘global needs’ assessment, which outline a profile of the care needs. Those files seen [4] also contained assessments and care plans from mental health professional’s external to the home in the form of the Care Programme Approach [CPA] so that continuity of care can be promoted and ongoing reviews with external and referring services can continue. One comment in the care notes from a referring social worker was that the resident was being admitted to a unit specialising in ‘physical [as well as mental] disability’. The AMU does not specialise in physical disability [5 beds are registered on the ground floor unit only] and admissions to the AMU need to be on the basis of mental health need and this must be made explicit to any referring agency and potential resident. [The Statement of Purpose for the Unit is clear on this]. Overall the admission to the unit of this resident is appropriate however with respect to overall needs. Given this residents mobility needs it was a concern that a manual handling assessment could not be found and had not been carried out.
Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 11 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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 [OP] and 6,9,18,20 [YA] The care planning on the older persons units is well devised and includes input from the residents or representatives so that care needs are addressed appropriately. The care plans on the AMU are not consistent in that all care needs are not addressed or kept updated so that there is a risk that problems and care needs are missed. Liaison with health care support services is good throughout the home so that health care needs are fully met. Issues around the recording of medicines and encouraging residents to self medicate need to be addressed so that both safety factors and promoting the independence of residents are met. Residents in the home reported good staff / resident interactions so that issues of privacy and dignity for residents are maintained. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 12 EVIDENCE: On the older persons units there was some evidence that plans of care were being drawn up and reviewed with the input from residents and relatives with more consistency. This following a requirement on the last inspection. Relatives spoken to say that they had been consulted as part of the process and that they were kept informed about any changes in care. Relatives signed some of the care plans seen. There was discussion with staff about the importance of this and that it should continue to be developed. Some relatives expressed a wish to have a copy of the care plan and this should be actioned. The care plans seen were very well written and comprehensive giving a good record of how the care is carried out. Some parts of the care plan are written in a standardised format and there are problems with this as stated interventions or aims do not always relate to the individual and can lead to residents being labelled with needs they have not got. An example of this was one resident’s care plan, which aimed to ‘prevent aggression to self and others’ but this had not been assessed as a need. If standardised plans are to be used careful attention must be paid to tailor them to meet individual needs. One care plan concerned a resident whose leg wound was being treated and the records clearly indicated how this was to be managed and any progress being made. There had also been liaison with the tissue viability nurses who had advised on the care. Care records listed input and reviews by visiting GP’s and health professionals. Following requirements made on the previous inspection the management of medicines was reviewed. An audit trail for medicines is available and this is to be further standardised in the home with key nurses being responsible for each area. Medication administration records [MAR] were seen and all had unexplained gaps in the recording with no note of why these omissions had occurred. This was noted on the last inspection report and still needs addressing so that a correct record is available of residents medicines given or refused or omitted. The recording of the temperatures in the drug fridge is not consistently monitored with perhaps some confusion over how to read the min – max thermometer. Residents interviewed felt comfortable in the home and stated that staff were respectful of their privacy and were supportative. Residents were observed to be appropriately dressed and attention to maintaining personal hygiene was good. This was also the case on the dementia care unit [T/F] were some residents are resistive to personal care. Staff interviewed displayed an understanding of the need to maintain dignity for residents and gave examples of how people with dementia, for example, had to be closely monitored if they displayed behaviour that compromised their dignity.
Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 13 The care plans on the AMU were not as consistent. There was examples of good care planning where, for example, agreed targets for daily living skills were clearly described and the resident had signed up to this. The resident in question did not have a copy of the care plan however. Another resident with very difficult needs around certain risk factors had care plan that was being kept under regular review and the staff were also liaising closely with social worker and probation officer and the family. Although reviews have been led by the external care team the social worker was pleased with the way staff had adapted the care plan to meet safety needs. One resident interviewed had needs around restricted mobility and a need for clear goals around self care to be agreed. The care plan had not been developed to include these however. The named nurse for this resident had left some weeks prior and a new nurse had not been identified. Goals agreed at the previous care assessment meeting with the social worker had not been care planned affectively. The risk here is that care needs are not being addressed. Residents interviewed on the unit were generally settled and felt that the staff had their interests at heart. The general interactions seen were positive and supportative and staff were appropriate in how they reinforced positive behaviours with residents. The inspector observed one incident that was extremely inappropriate involving a member of the care staff and this was dealt with appropriately when reported to the management. One resident raised the question of self-medication. This in relation to leaving the unit for a weekend holiday. There are currently no residents selfmedicating on the AMU although there is a self-medication procedure and policy including assessment for risk. There was some discussion with staff with respect to this individual and how self-medication should be encouraged where appropriate. The residents on the AMU have the benefit of regular reviews by a consultant psychiatrist [in house] and care review meetings under the Care Programme Approach [CPA] are held. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 14 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 asssistance 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 [OP] and ,12,13,14,17 [YA] There has been an improvement from the previous inspection in that a planned, though flexible, approach to the organisation of social activities and programmes in the home, which encourages personal development for residents. Education and training opportunities for younger adult residents need further developing so that residents can achieve greater potential. Social and personal development programmes also need to include the provision of a planned annual holiday so that quality of life for residents can be improved. Meals are well managed and provide opportunities for residents to develop social and domestic skills. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 15 EVIDENCE: Activities for residents are arranged on all units with some activities being shared across units. The home is keen to provide regular trips out and a list of outings is drawn up monthly and includes both local outings as well as trips further a field such a the Lake district. Residents spoken to clearly enjoyed these trips. Those on the AMU stated that the amount of trips available had been reduced due to the mini bus being out of action for some time but this has now been addressed with a new bus available in the next few weeks to compliment the existing taxi type vehicle. The home employs a driver who also involves himself in the organisation of activities. The elderly care unit on the ground floor hosts a regular coffee mornings and the local community and other care homes are invited and this provides a valuable socialising experience for residents in the home. Staff spoken to stated that they found time for 1:1 interactions and socialisation with residents. For example one staff member targets 4 of the younger adults on the ground floor on a weekly basis and provides opportunities for socialisation either in the home or externally with trips to town including the pub or cinema. Other staff have planned intervention at certain times with frailer residents either talking or activities such as attention to nails and hair. The provision of activities here has generally improved since the last inspection and there is a commitment to improve things further. The meal time on this ground floor unit was relaxed and sociable. Staff were observed to be offering a choice of meal for the residents. Residents can either take meals in the dining room or in their bedrooms. Residents and relatives interviewed were pleased wit the food in the home. Of the 15 residents completing comment cards 12 of them were positive about the food only 3 commenting ‘sometimes’ when asked whether they liked the food. There were no negative comments. On the AMU there remains the opportunities for regular trips out into town and during the inspection residents were observed to take these opportunities [both planned and unplanned]. Social activities such as a barbeque are organised regularly. 4 of the residents were also involved in a fishing trip and one of the residents who went on this was able to describe a very positive experience. Another resident showed the inspector a green house where he was growing tomatoes. Each resident does have an activities programme and this also includes reference to personal care activities. Residents spoken to did not have a copy of this however and this should be standard along with the provision of a written care plan. Due to the nature of the enduring mental health needs of residents it has been difficult to promote ongoing opportunities for further education / training
Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 16 external to the AMU. Staff cited examples of residents attending local college courses and this should continue to be promoted. One resident had been reviewed some time previously regarding possible art classes but staff had not followed this up. One resident had wanted to go on holiday for a weekend but reported difficulties due to self-administration of medicines [see previous comments]. The provision of a holiday for long stay residents on the AMU and younger adult in the home has not been considered and this must now be planned. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 [OP] and 22 [YA] The home has a complaints procedure and residents and relatives feel that their concerns are listed to. EVIDENCE: The home has a complaints procedure and this is displayed in the home and is also included in the resident’s information. Relatives interviewed stated that they were aware of the complaints process. The Commission has received two complaints since the last inspection. One anonymous complaint was received in April 2005 and was discussed with the manager on a visit to the home. The complaint centred on training issues and staff recruitment. The manager reviewed the complaint and dealt with the issues. The manager was open and constructive when discussing the complaint. The second complaint was also received anonymously. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 18 The complaint had 3 elements: • • • Alleged poor management of a resident who sustained a fall and then 6 days later was found to have a fracture. Alleged poor management of another resident in similar circumstances. The employment of a member of staff who was alleged to be not fit on account of a criminal record and lack of qualifications. The first 2 elements of the complaint were not founded although recommendations were made around the recording of accidents and first aid management. The last part of the complaint was founded. Requirements were issued around the need for thorough recruitment checks for staff including Criminal Records Checks [CRB]. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 [OP] and 24,30 [YA] There has been improvement to the general environment on the nursing unit and the maintenance programme for the home should ensure that satisfactory standards are maintained and residents live in a well-maintained environment. The standards of cleanliness vary from being satisfactory on the nursing unit to inconsistent and poor on the AMU. The AMU is not consistently clean and hygienic. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 20 EVIDENCE: Both nursing units have been in receipt of some upgrading since the last inspection. The top floor unit in particular following requirements previously issued. The general environment is now brighter and more attractive and visitors and staff commented on this. The planned maintenance programme for the home leading up to Christmas was seen and includes more upgrading of areas both external and internal. The programme does not include attention to the remainder of the external windows on the upper floors, which still need to be painted or replaced in some instances [this therefore stays as a recommendation from previously]. Some areas on the AMU are in need of upgrading and these are planned on the maintenance schedule. The level of cleanliness on both nursing units was good with regular cleaning staff employed [a cleaner is needed for the top floor nursing unit for Sundays and this was discussed]. The AMU was not of the same standard. Toilet/bathroom areas were observed to be dirty and some resident’s bedrooms needed cleaning. There was a lack of an organised rota for cleaning staff on this floor. Cleaning staff on the AMU need to link in with self help programmes for residents so that they are aware of which rooms need which degree of cleaning. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 21 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, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood and met. The recruitment processes in the home are generally robust and do provide sufficient protection for residents although this must be consistent in all instances. Training standards have improved over recent inspections so that staff are better able to meet the needs of residents in the home. EVIDENCE: The nursing and care staff numbers on all 3 units was maintained throughout the inspection and duty rotas confirm that these numbers are maintained. Extra staff are provided for the purposes of activities. Traditionally the home has had a high turn over of staff although the evidence from this visit is that this process has slowed down a little. There is reduced numbers of agency staff from previous inspections and relatives and residents commented that they have been able to build some relationships with more regular staff. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 22 6 staff files were reviewed with regard to recruitment practice. All but one had the necessary recruitment details and required checks in place including Protection of Vulnerable Adults [POVA] and Criminal Records Bureau [CRB] checks so that residents are protected. The outstanding CRB check has still to be completed on a member of staff who has worked in the home for over 6 months. Staff spoken to report that the training in the home has improved overall. There is a standard induction programme for staff and those spoken to report that this had been useful. It covers most issues but there is a need to cover service specific issues such as: • • • • Dementia care Mental Health [Staff inducted to the AMU] Principals of care [privacy, dignity, rights, independence, etc] Abuse awareness These should be included on the ‘checklist’. NVQ training for care staff covers ongoing foundation training in the home. There is also some evidence of ongoing training for nursing staff. For example staff have attended a course in dementia and 2 staff are booked on a course in palliative care in the near future. Other trained staff interviewed have completed training in teaching and assessing and diabetic nursing. Staff on the AMU displayed some practical understanding of reinforcing behaviour and would possibly benefit from some theoretical training around this area. Training records were seen for manual handling and fire training. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 23 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 polies 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 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36,38 All staff in the home need regular supervision sessions so that they are supported in their work with residents. The management of Health and Safety needs to take into consideration the comments in the report around clear recording so that residents are protected at all times.
Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 24 EVIDENCE: Staff are given supervision on a formal basis. This was well evidenced on the AMU with records available but staff reported that this is less consistent on the nursing units and needs to be addressed so that staff feel regularly supported. The home employs a health and safety officer / maintenance manager. Records were available and these were seen but there needs to be better organisation of these so that they are clearer and this was discussed. Specifically: • Fire records were inconsistent and did not show regular checks for emergency lighting, maintenance of clear fire exits, presence of fire extinguishers. Advice was given to check schedules with the fire schedules recommended by the fire brigade [listed in the standard fire log book]. There are fire marshals on each unit and checks need to be made consistently in liaison with these. The electrical system in the home together with the gas safety and fire alarm system are receiving upgrading and the Health and Safety officer agreed to forward copies of certificates to The Commissions once work is complete. Routine risk assessments are recorded. The depth of these needs to be reviewed as hazards such as bedroom doors not closing to their rebates were found throughout the home. The accident recording was reviewed on the AMU. The current accident book is not the standard issue and should be replaced. The requirements under the Data Protection Act for the recording of accidents were discussed. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 25 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 ENVIRONMENT Standard No 19 20 21 22 23 24 25 26
STAFFING Score 3 x x x x x x 2
Score Standard No 7 8 9 10 11 Score 2 3 2 3 x Standard No 27 28 29 30 3 x 2 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 x 36 2 37 x 38 2 Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 26 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 [YA] Regulation 14 Requirement All care needs for residents addmitted AMU must be assessed [ including mobility needs] Each person is supplied with a written and costed contract / of terms and conditions at the point of moving into the home. all residents on the AMU must have a copy of the care plan. All care plans on the AMU must be developed consistently so that all care needs are addressed and are reviewed regularly. The mediaction reording sheets on the nursing unit had blank boxes where medication had not been recorded. This must be addressed with reference to correct recording proccedure. [Requirment date 25.2.05 from last inspection not met]. The resident on the AMU discussed must be reviewed with respect to self medication. Residents in longterm placements have the opportunity of an annual holiday provided by the home. The general environment and
F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Timescale for action ongoing. Review 30.1.06 30.1.06 [review] 30.9.05 30.9.05 2. 2 [OP] 5 [YA] 6 [YA] 6 [YA] 5 3. 4. 15 15 5. 9 [OP] 13 30.9.05 6. 7. 9 [20 YA] 14 [YA] 13 16 30.9.05 30.1.05 8. 26 [30[YA] 23 30.9.05
Page 27 Fleetwood Hall Version 1.40 9. 29 19 10. 11. 12. 36 38 38 18 23 23 bedrooms on the AMU must be maintained to a consistent level of cleanliness and hygiene. All staff employed in the home must have the appropiate CRB check and satisfactory references prior to be allowed to work unsupervised. All staff must regular and ongoing supervision sessions at least 6 times per year. Fire records must be maintained and include the saftey checks listed in the report. A check must be made of all fire doors in the home and particularly bedoroms to ensure closure against rebates. ongoing. Review 30.9.05 30.1.05 30.1.05 6.9.05 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. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard 3 [OP] 2 [YA] 7 7 10 [18 YA] 12 [YA] 19 19 30 38 Good Practice Recommendations Preadmission assessments should be filed in the care notes for ease of access. The process of involving relatives in the care planning should continue on the nursing units. Care should be taken with the standardised care planning format on the nursing unit so that residents are not labelled with needs that they may not have. management should take the opportunity to reinforce appropiate staff interactions with residents following the incident reported. The younger adult residents should be encourage to attend for further education and training if appropiate. The programme of maintainance for the external windows should be completed to the upper floors The maintanance programme seen should be actioned. The additions to the induction programme should be made as discussed and oulined in the report. The home should aquire the new accident reoprting book issued by the HSE.
F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 28 Fleetwood Hall 10. 38 The outstanding saftey certificates discussed and listed in the report should be forwarded to the inspector when work is complete. Fleetwood Hall F53 F03 Fleetwood Hall S17279 V245348 18.08.05 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Burlington House, 2nd Floor, South Wing Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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