Inspection on 22/03/06 for Fleetwood Hall

This inspection was carried out on 22nd March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fleetwood Hall 10/06/09

Fleetwood Hall 13/06/08

Fleetwood Hall 04/09/07

Fleetwood Hall 14/09/06

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 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN Lead Inspector Mr Mike Perry Unannounced Inspection 22nd March 2006 10:00 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.V287554.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V287554.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fleetwood Hall Address 100 Fleetwood Road Southport Merseyside PR9 9QN 01704 544242 01704 503956 yoyoearsden.karoo.co.uk 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 Mrs Yvette J Oreschnick 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.V287554.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Variation for 4 named service users over pensionable age within MD category The service should at all times employ a suitably qualified and experienced manager who is registered with the NCSC Variation for 1 named service user within OP category to remain in the home on a residential basis Variation to admit 1 service user under age 65 to the elderly care unit (OP) 18th August 2005 Date of last inspection 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 present Manager, Mr Malcolm Rugan has applied for Registration with the Commission. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 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 although the inspector spent most time [2 days] on the Andrew Mason Unit [AMU]. 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. In total 13 residents in the home were spoken to along with 12 members of staff and the Manager as well as 2 student nurses on placement at the home. A visiting social worker was interviewed and another spoken with by phone. 2 relatives were interviewed by phone. 14 of the 20 Core standards were covered on the inspection. For a more complete picture of the home this report should be read alongside the inspection report completed in August 2005. There were many positive aspects to the inspection and the management were responsive and open to comments made. There are areas of care that need to be developed consistently, particularly on the AMU. The nursing floors have benefited from more consistent staffing and generally standards were good. Requirements and recommendations are listed at the end of the report. What the service does well: Contracts are drawn up so that residents and their representatives are aware of the terms and conditions of the residency in the home. The care planning on the older persons units is good and includes input from the residents or representatives so that care needs are addressed appropriately. An example of this is one resident who has multiple disabilities and communication difficulties whose needs were comprehensively covered with appropriate care interventions by staff planned. There are good links with health care support services. This is the case throughout the home so that health care needs are fully met. Personal care for residents on the older persons units is good so that resident’s dignity is preserved. Those residents seen were clean and appropriately dressed. Residents nursed in bed were observed to be comfortable and regularly attended to. Staff on the older persons units understood the need for residents to exercise choice within the limits of their individual disability and identified choice of Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 6 activity, clothing and food as daily examples of how this can be achieved for residents. Comments received from residents on the elderly units were: “Glad I moved here, I feel I can live my life” “ It might look a bit tatty sometimes but there’s nowhere better”. On the Andrew Mason Unit [AMU] some of the residents are limited in their ability to make life choices but when spoken to say they are listened to and choices made on a daily basis are respected. A visiting social worker was aware that staff on the unit did well in getting a practical balance in this respect with one resident under review. All Relatives and residents interviewed felt that the staff approach to care is supportative and respectful throughout the home. There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood and met. 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 and a clinical governance team consisting of management, staff and a relative and resident representative so that residents’ views can be heard. Resident’s monies are managed through the home residents monies account and the records are maintained satisfactorily. What has improved since the last inspection? The medication records were reviewed on the nursing unit following requirements on the last report and these were clear and medicines are administered safely. All residents on the AMU now have a copy of their care plan and stated that staff speak to them about their care needs. Relatives interviewed also stated that staff communicate well and kept them up to date with events. The general maintenance of the home has consistently been an issue in past inspection reports [and there remains a constant need to budget and plan effectively if standards are to be both maintained and improved]. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 7 The manager was able to demonstrate an ongoing programme, however, which has included some décor and general upgrading. The AMU has seen a raising of the general consistency of cleanliness on the unit and this must continue to be a priority for both domestic and care staff. The creation of the women’s unit has been a good achievement and female residents spoken to felt they had privacy and felt safe. Following requirements on the previous inspection residents are protected by the homes recruitment processes, which include appropriate checks for all staff. Health and safety issues were reviewed with respect to requirements made on the previous inspection around fire safety and training which have now been addressed. What they could do better: Some of the residents on the AMU require more intensive input to maintain their personal care satisfactorily. The care plans on the AMU are not as 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. The home provides a protective and caring environment but there needs to be more awareness amongst the management and staff regarding the local adult protection procedures so that residents are fully protected from abuse. There are requirements and recommendations in the report to maintain and improve some of the general environment in the home. These include: • • • Some of the windows on the top floor are in need of attention [this has been a feature of past inspections]. There are no curtains on windows in the day room and some bedrooms on the top floor and this must be addressed. Some flooring in bedrooms on top floor is poor and carpeting should be looked at as replacement [practicalities allowing] in some bedrooms rather than a continual programme of hard flooring. There are still areas on the AMU such as the toilets and some bedrooms that must receive greater staff vigilance in terms of maintaining DS0000017279.V287554.R01.S.doc Version 5.1 Page 8 • Fleetwood Hall cleanliness. 2 bedrooms seen in particular were unacceptable with standards of hygiene poor. Toilet areas have charts pinned to walls for staff signatures so that regular monitoring can be recorded but these were not in use on the inspection. • The toilet / shower room at the rear of the AMU is in poor condition. The manager states that the shower facility needs to be upgraded before use and this should be made a priority. The home has suffered in the past due to a history of constant management changes over the past 5 -6 years and the aim of the management team at present should be the development of a more consistent approach. The manager has commenced some staff supervision in the home but this needs to be built on so that all staff receives supervision at least 6 times yearly. 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 DS0000017279.V287554.R01.S.doc Version 5.1 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.V287554.R01.S.doc Version 5.1 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Contracts are drawn up so that residents and their representatives are aware of the terms and conditions of the residency in the home. EVIDENCE: The issuing of contracts was reviewed with respect to a requirement made on the last inspection. The financial director manages contracts. 2 contracts for private residents were seen. These are given to residents or their representatives together with terms and conditions of residency. Relatives spoken to had received contracts and information following admission. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 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 the following standard(s): OP7, OP8, OP9, OP10, YA6, YA18, YA19 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 as 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. The medication records on the nursing unit were clear and medicines are administered appropriately. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 12 Personal care for residents on the older persons units is good so that resident’s dignity is preserved. Some of the residents on the AMU require more intensive input to maintain their personal care satisfactorily. EVIDENCE: OP / YPD Care plans were reviewed on the ground floor nursing unit and these were clear and easy to follow and covered all of the areas of care for individual residents. One resident reviewed has multiple disabilities and communication difficulties and these were comprehensively covered with appropriate care interventions planned. The resident was observed to be receiving regular attention from staff that were comfortable in carrying out the care and clearly understood the residents needs. Reviews of the care plans were recorded. Another resident who has mobility needs had received an assessment for wheelchair use. The tissue viability nurse has assessed a resident who has developed a pressure sore and the home has made the necessary referrals for a specialised mattress. Medication administration charts were seen on the GF with regard to a requirement on the previous inspection report. All seen were clear in their recording with no omissions. Standards of personal care on the elderly units were good. Those residents seen 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. AMU The care plans on the AMU were not as consistent in that while care plans are drawn up and all residents have a copy of the plan [requirement last inspection] some have not been reviewed with any consistency so that changing needs are not recorded or addressed appropriately. An example of this was one resident who discussed his care plan dated June 2005. The interventions for managing ‘aggression’ had changed since this time but had not been updated on the care plan. The reviews tended to be ‘continue plan’ as opposed to a statement whether or not the care goals were being met. Other care plans seen were more consistent with needs identified and reviews recorded appropriately. Residents reported that staff did discuss the care plans with them and this helped them to feel part of the care. Relatives interviewed also stated that the staff worked well with them and communicated effectively. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 13 One recent admission had been in the home for 10 days but no care plan had been drawn up [even provisional plan]. There is no set standard in the home with respect to the timescale for the provision of a care plan although the manager stated that a plan should be completed within 7 days. Some of the residents reviewed on the AMU have poor volition in terms of being able to maintain their own personal care on the unit. Two residents spoken to were unable to maintain satisfactory standards of cleanliness either in their bedroom or for themselves. A social worker for one of the residents was very pleased that the staff had worked well with one resident and his personal care was improving although remains unsatisfactory. Staff must be aware, however, that the ‘choice’ for residents to spend time in their bedrooms must be balanced against the duty of care to maintain acceptable levels of personal hygiene for residents. More consistent ways of managing this were discussed. Some of the residents are restricted because of risk factors associated with both their mental state and legal status. One resident was undergoing review during the inspection and the nurse responsible was aware of the issues involved. Another resident was on leave from hospital at present and remains under the legal care of the referring agency with respect of the Mental Health Act. Staff on the AMU were not wholly clear about the legal status of this resident however [some staff advised the inspector that he was discharged from hospital others that he remained on leave]. The lack of any Section 17 leave forms perhaps complicated this and must be addressed. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 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 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP14, YA7 The home is able to demonstrate an understanding of need for residents with dementia as well as those younger adults with mental health needs to exercise some control over their lives so that their rights are respected EVIDENCE: OP / YPD Staff on the older persons units understood the need for residents to exercise choice within the limits of their individual disability. Staff identified choice of activity, clothing and food as daily examples of how this can be facilitated. One Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 15 resident with particular communication difficulties has input from the local advocacy service. Another elderly resident interviewed explained how the staff assist with getting him to town and have also made representation regarding his funding in the home. Another [younger] resident spends a lot of time in his room which has been well personalised and staff have assisted him with some of his pastimes. Comments received from residents were “glad I moved here, I feel I can live my life” and “it might look a bit tatty sometimes but there’s nowhere better”. AMU 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. One resident discussed his care plan, which sets targets for reduction in alcohol consumption, and staff were supporting him in this but his choice to visit the pub on occasions was also respected. A visiting social worker was aware that staff on the unit did well in getting a practical balance in this respect. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 16 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 the following standard(s): OP18, YA 23 The home provides a protective and caring environment but there needs to be more awareness amongst the management and staff regarding the local adult protection procedures so that residents are fully protected from abuse. EVIDENCE: Staff spoken to had received little training in the awareness and understanding of abuse. They were, however, able to give examples of how they would recognise abuse and what the principles of good care where in terms of the need for dignity and privacy for example. Staff were able to give an account of how an allegation of abuse might be dealt with and felt confident that allegations would be taken seriously but did not have an understanding of the role of the statutory bodies such as the police, social services or the Commission for Social Care Inspection [CSCI] and that the home should not take on the role of full investigators without reference to the Adult Protection process. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 17 The homes policies and procedures were seen and there is no reference in the Fleetwood Hall policy to the Sefton / Liverpool Adult Protection policy and procedures. The manager did have a copy of these procedures but this has not been communicated to staff and some training is obviously needed. [The manager should access training from social services if available] All staff in the home must be in a position to report allegations appropriately. Relatives and residents interviewed felt that the staff approach to the care of vulnerable residents was supportative and respectful. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 18 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 the following standard(s): OP19, OP26, YA24, YA30 There has been improvement to the general environment on the nursing unit and the maintenance programme outlined together with the recommendations in this report should ensure that satisfactory standards are maintained and residents live in a well-maintained environment. The standards of cleanliness and maintenance vary on the AMU although generally standards of cleanliness have improved over the last few inspections. There are some requirements and recommendations to be achieved so that standards are consistent and acceptable. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 19 EVIDENCE: The general maintenance of the home has consistently been an issue in past inspection reports. The building is both large and old and is in need of constant upgrading and repair. The manager was able to demonstrate an ongoing programme, which has included some décor, upgrading of the electrical system, external and internal plumbing work. Over all the home has improved in this area over recent inspections but there remains a constant need to budget and plan effectively if standards are to be both maintained and improved. OP / YPD The areas seen on the older persons and physical disabled unit on the ground floor are maintained satisfactorily and were clean and tidy. There has been some décor in bedrooms as well as the main corridor, which has enhanced the homeliness of the environment. The day room on this floor is warm and comfortable with appropriate furnishings and this was commented on by some of the residents. The T/F unit has had some décor over the past year but still needs further upgrading. Some of the windows are in need of attention and this has been a feature of past inspections. Staff reported that draughts can penetrate and residents can sometimes feel cold. The manager is aware and there is an ongoing programme of window repair and replacement but this needs to be stepped up. There are no curtains on windows in the day room and some bedrooms on this floor and both from an aesthetic and practical viewpoint [exclude draughts on a cold day, protect from the sun on a hot day] this must be addressed. Some flooring in bedrooms is poor and carpeting should be looked at as replacement [practicalities allowing] in some bedrooms rather than a continual programme of hard flooring. All areas seen were clean and hygienic. AMU This unit has very difficult practical problems associated with the destructive nature of some of the client group. There has been an improvement of the general consistency of cleanliness on the unit and this must continue to be a priority for both domestic and care staff. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 20 There are still areas such as the toilets and some bedrooms that must receive greater staff vigilance however. 2 bedrooms seen in particular were unacceptable with standards of hygiene poor. One resident’s room [resident has Huntington’s disease] had a bedside chest of draws in poor condition and the sink area was difficult to maintain in a clean state. Toilet areas have charts pinned to walls for staff signatures so that regular monitoring can be recorded but these were not in use on the inspection. The toilet / shower room at the rear of the unit is in poor condition with dirty and disused commodes observed rendering the use of the shower facility redundant. The manager states that the shower facility needs to be upgraded before use and this should be made a priority. Residents [both male and female] stated that they would use this facility if available. The creation of the women’s unit has been a good achievement and female residents spoken to were pleased with the privacy and safety afforded by this. There has been an attempt to make the AMU more homely by the introduction of softer furnishings. These however are easily soiled and difficult to maintain in a clean state [soft furnishings in the non smocking room although only a year old are a case in point]. Given the residents on the unit and the practical difficulties of maintenance the management and staff need to think very carefully about replacement of furnishings and perhaps good quality easy chairs that are more easily cleaned and durable should be an option. There is a lack of space on the unit for meetings and general privacy. [A visiting social worker was hard pressed to find space as the office as busy and was therefore writing notes in the dining room]. There is a small room, currently being used for storage, that could be developed as extra space for this purpose [has been used in the past for this purpose]. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 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, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP27, YA33, OP29, YA34, There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood and met. Residents are protected by the homes recruitment processes, which include appropriate checks for all staff. EVIDENCE: OP / YPD For 11 residents on the G/F unit there were 2 trained and 2 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 13 residents and was staffed with 1 trained nurse and 2 care staff. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 22 These staffing ratios are consistent and staff interviewed stated that staff turn over had reduced over the past year and that the staffing, particularly on the top floor, which had been a problem, is now more settled and consistent. Staff on the top floor unit reported that some male residents would benefit from more male staff presence with respect to carrying out personal care [only 1 male staff employed on the unit presently]. In terms of trained staff update the general nurses working with residents who have dementia would benefit from attending both updates and specialist nursing training in dementia care [the nurse in charge of the unit for example]. AMU The AMU had 20 residents. Staffing on both days when visiting this unit consisted of 2 trained staff and 4 carers. There is one resident who is constantly on 1:1 staff input during the day. The manager would also normally be in addition to these figures although staff holidays had prevented this. Both staff and residents reported that if staffing is reduced to 6 over the day this can affect resident’s choice and planning to leave the unit as many activities are off unit and escorted. Staff reported that if the elderly unit is short staffed then the AMU would be asked to supply cover. Generally however staff and residents reported enough care staff cover to carry out the care on the unit. General. Staff records were viewed [5 in total] and all were comprehensive in the staff information available and the required Criminal Records [CRB] and vulnerable adult checks [POVA] were recorded along with suitable references. This requirement from the previous inspection is now met. Not all files had a photograph of staff available and this was discussed wit the administrator. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 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 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP31, OP33, OP35, OP36, OP38 The manager of the home must now be registered with the Commission for Social Care Inspection to ensure he is fit to run the home and maintain standards of care. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 24 There are some good quality initiatives that can be built on so that residents’ views can be instrumental in the running of the home and the service can continue to improve. There are satisfactory arrangements to manage residents’ finances so that they are protected. Some staff are receiving supervision but this needs to be further addressed so that all staff are supported in caring for residents. Fire and electrical safety records are now complete so that residents can live in a safe environment. EVIDENCE: The current manager of the home is Malcolm Rugan. Malcolm has been managing the home for the last 3 – 4 months following the resignation of the previous manager. Malcolm has applied to the Commission for Registration and this is currently being processed. 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 is undertaking an NVQ course in management and has an RMN [Registered Mental Nurse qualification]. The home has suffered in the past due to a history of constant management changes over the past 5 -6 years and the aim of the management team at present should be the development of a consistent approach to the organisational development. The manager was able to discuss some developments in terms of the development 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. There was some discussion as to how this could be expanded and developed. Recent innovations have included relatives meetings and a suggestion box outside the main office. Over the past 2 –3 inspections there has been, despite the management changes, a more consistent effort to meet requirements and recommendations of CSCI reports and this should continue with particular reference to more consistency on the AMU. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 25 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. The manager has commenced some staff supervision in the home but staff interviews evidenced this needs to be built on so that all staff receive supervision a least 6 times yearly. Health and safety issues were reviewed with respect to requirements made on the previous inspection around fire safety and training which have now been addressed. The electrical wiring in the home was being checked and upgraded during the inspection. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 26 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 3 3 X 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 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 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 2 37 X 38 3 Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 27 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 YA6 Regulation 15 Requirement All care plans on the AMU must be developed consistently so that all care needs are addressed and are reviewed regularly [last requirement date 30.9.05 not met]. Residents on leave from hospital under the MHA must have their legal status clarified on the care plan and the relevant [Section 17 MHA] forms be made available so that any restrictions are also clearly identified. Residents on the AMU who require higher levels of staff input for personal care must be monitored more effectively and a minimum standard attained with some consistency. The manager must ensure that the homes policies and procedures are updated regarding the management and reporting of Adult Protection / abuse issues and that all staff are aware of these and receive training. All toilet and bathroom areas on the AMU must be maintained in a consistently satisfactory state of DS0000017279.V287554.R01.S.doc Timescale for action 04/07/06 2 YA6 15 30/04/06 3 YA18 12 30/04/06 4 YA23OP18 12 04/07/06 5 YA30 23 30/04/06 Fleetwood Hall Version 5.1 Page 28 hygiene and cleanliness. 6 YA30 23 The bedrooms of the residents discussed on the inspection must be maintained in a satisfactory clean condition. [Last timescale date of 30.9.05 not met]. The programme of replacing repairing windows must be completed. The current manger must be registered with CSCI [currently being processed]. All staff must receive regular and ongoing supervision a least 6 times per year. [Last requirement date 30.1.05 not met]. 30/04/06 7 8 9 YA24 OP19 OP31 OP36 23 8 18 04/07/06 26/04/06 04/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard YA6 OP19 OP19 YA24 YA24 YA24 YA24 Good Practice Recommendations The manager should agree a standard with the staff on the AMU identifying a time by which a care plan should be drawn up. Curtains should be fitted for the day room on the Top floor unit as well identified bedrooms. The floor coverings for some bedrooms on T/F nursing need to be replaced / upgraded. The shower room on the AMU should be upgraded so that residents have the choice of using this facility. The furnishings on the AMU need to be given some consideration in terms of choosing items that are more easily maintained. Some consideration could be given to creating a small interview room out of the current storeroom on the AMU. The bedroom for the resident discussed on the AMU should have the chest of draws replaced and the sink unit assessed and arrangements made so that it can be cleaned more effectively and maintained at a consistent standard. DS0000017279.V287554.R01.S.doc Version 5.1 Page 29 Fleetwood Hall 8 9 OP27 OP27 10 OP29 The staff gender mix on the top floor of the home would benefit from more male presence. The general trained nurses working with residents with dementia on the top floor unit should consider further specific training in dementia care [manager of the unit a priority]. All staff files should contain a photograph for identity purposes. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Fleetwood Hall DS0000017279.V287554.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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