Inspection on 04/09/07 for Fleetwood Hall

This inspection was carried out on 4th September 2007.

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

Other inspections for this house

Fleetwood Hall 10/06/09

Fleetwood Hall 13/06/08

Fleetwood Hall 14/09/06

Fleetwood Hall 22/03/06

Fleetwood Hall 18/08/05

Fleetwood Hall 05/01/05

Fleetwood Hall 22/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN Lead Inspector Mr Mike Perry Key Unannounced Inspection 10:00 4 September 2007 th 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.V332300.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fleetwood Hall Address 100 Fleetwood Road Southport Merseyside PR9 9QN 01704 544242 01704 503956 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 Mr Malcolm George Francis Rugen Care Home 53 Category(ies) of Dementia (15), Mental disorder, excluding registration, with number learning disability or dementia (21), Old age, of places not falling within any other category (12), Physical disability (5) Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may admit four named service users over pensionable age within the category of mental disorder (MD). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social care Inspection. To admit one service user under pensionable age to the elderly care unit (OP). 14th September 2006 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 Registered Manager is Mr Malcolm Rugan. The current fees for the service range from £500 - £1,750 weekly Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 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 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. Residents in the home were spoken to along with members of staff and the Manager as well as student nurses on placement at the home. A relative was interviewed and an advocacy worker who visits the home was also spoken to by phone. Prior to the inspection the inspector enlisted the help of some of the residents in the home with respect to distributing some resident surveys and assisting in the collection and return. This process returned 12 survey forms and some comments are included in the report. A separate inspection was undertaken by a pharmacy inspector on 10/9/07. This followed some concerns raised prior to he inspection. The visit lasted seven hours. Samples of medicines records and the medicines storage facilities were inspected in all three units. Three nurses and two carers were spoken with and a morning medicines round was observed. Feedback was given to the manager at the end of the visit. The pharmacists report and any requirements are also included in this report. 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 the general environment on the AMU. Although improvements have been made the cleanliness remains an issue. This was not a concern on the other two units. Requirements and recommendations are listed at the end of the report. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 6 What the service does well: Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. Assessments were seen both on the AMU and the top floor dementia care unit. These also included information from social workers and health care professionals. They were completed well in terms of detail and included relevant risk assessments. 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. A relative commented: ‘ I go on spec. Dad’s always clean and tidy. He’s doubly incontinent but there is never a smell. He’s always comfortable. Did have a Pressure sore but this is doing well. Carolyn [senior nurse] keeps me informed every time I go in’ A resident on the nursing unit commented: ‘Sometimes I get up [generally nursed in bed] and go out in the garden. Staff are very good to me. They are very helpful and nice people. The care is good. They never rush when carrying out personal care’. Staff on the older persons units understood the need for residents to exercise choice within the limits of their individual disability. For example on the dementia care unit the various bedtimes and rising times of residents was discussed. It was clear that residents vary in this and that individuals are accommodated. One relative commented: ‘Care is very person centred. They try and include the family and they show that they really care’. Other positive comments were received from the surveys returned. One summed up the general feeling; ‘Staff are always on hand day and night. My main problem is dietary – I have a soft diet and this has been arranged. All staff will take the time to talk and listen and are always available. Activities range from indoor or out door gardening, trips out. They are always well staffed and supervised. Menus are available and staff ask you for your preferred choice usually on a weekly basis’. There are some activities organised on the younger persons unit for residents to participate in. there is a mini bus available and twice weekly outings [minimum] are organised. Residents discussed the arrangements for a forthcoming holiday to Blackpool and were looking forward to this. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 7 The unit has a women’s section, which provides some privacy and separate space for female residents. One resident who had more diverse cultural needs felt that she could be listened to and that she had been well accepted on the unit. Both the nursing units were staffed appropriately in terms of both numbers and skill mix. The staffing ratios are consistent and staff interviewed stated that staff turn over had been minimal and is now settled and consistent. Staff records were viewed and all were comprehensive in that staff information available and the required Criminal Records [CRB] and vulnerable adult checks [POVA] were recorded along with suitable references. Training was discussed with the staff. Most were pleased with the training offered from induction through to access to vocational qualifications [NVQ] which has been stepped up and there are currently 21 out of 37 care staff who are NVQ trained which evidences a level competency regarding the ability of care staff. Staff are well thought of by residents and visitors alike and there were many positive comments recorded through out the inspection and the support observed was appropriate and genuine. What has improved since the last inspection? The assessment process prior to being admitted on the Andrew mason Unit [AMU] has improved and details of the assessments were completed and on file. The care planning on the AMU has been developed more consistently. There are still some recommendations but overall the care plans seen were well devised and covered need. The ongoing programme of replacing windows in the home continues to improve the overall ambience. Staff reported regular supervision and monitoring by senior staff so that they feel better supported. The nurses station on the ground floor nursing unit has been organised with reference to previous requirements around security of care files. Activities have been organised on the AMU with reference to holidays for some of the residents who reported a forthcoming 4-day break to Blackpool. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 8 Following on from recommendations on the last inspection report there has been some focus on training in dementia care and mental health with staff attending some train sessions and there is more planned. What they could do better: Two care files were reviewed on the top floor dementia care unit. Only one care plan contained reference to bedrails however and it would be recommended that this care need is addressed on the care plan. Neither care plan contained any reference to relative being formally involved in the care planning process. This is required so that relatives can feel more involved and better informed as well as assisting in identifying care needs. The care plans are evaluated on a regular basis by the staff. These are very brief however and record ‘continue care’ only. It would be recommended that the evaluations are in more depth, as they should be a statement set against the main aims and objectives of the plan. One staff member has commented that residents are not always dressed in their own clothes [on the dementia unit]. Relatives confirmed this. This needs to be addressed as it impinges on the dignity of residents. Medicines must be administered to residents as prescribed; the paperwork to support this needs improvement for this to happen. Receiving medicines at the wrong dose, wrong time or not all can seriously affect the health and well being of residents. One resident who has recently been admitted to the unit and had been asked to change GP to fit in with the units needs. This had caused some initial difficulties with ordering medication as well as not giving the resident the opportunity of maintaining his previous GP if he wished. Some residents interviewed a well as staff still felt that more could be done to provide stimulus and activity for residents on the younger adults unit [AMU]. One visitor commented: ‘The staff are good and are always busy with residents but there could be more for some residents who tend simple to wander around a lot with no focus’. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 9 It is recommended that each resident has an individual activities plan for each week and that this is constantly evaluated with key workers and specific goals set. One complaint received had been an adult protection issue concerning he alleged verbal and physical abuse of an elderly resident. It was a concern that this had not been referred through the appropriate channels with regarding to reporting of such incidents to social services or to the Commission for Social Care inspection [CSCI] so that the locally agreed adult protection protocols could be instigated. The younger adult [AMU] unit has very difficult practical problems associated with the destructive nature of some of the client group. The toilets on the main unit [excluding the women’s unit] were not clean with dirty water on the floors of each. The toilet near the dining room was unusable with poor standards of hygiene and a shower that was broken. Similarly the day room on this unit was in poor condition with the carpet frayed, soft furnishings, which were observed to be stained and smelled of urine. The room was very dark and there was varies bits of debris [crisp packet observed] littering the floor. This is unacceptable. Again the cleaning schedule must be reviewed and there must be an audit to provide more appropriate and serviceable furnishings. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 10 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.V332300.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards on assessment. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are admitted following an assessment so that the home are able to ensure that care needs can be met. EVIDENCE: Prior to admission the senior staff complete a preadmission assessment buy going out and visiting the resident. During the inspection the senior staff member on the AMU and the manager of the home were completing an assessment on a person who may possibly be admitted. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 12 Assessments were seen both on the AMU and the top floor dementia care unit. These also included information from social workers and health care professionals. They were completed well in terms of detail and included relevant risk assessments. Following admission further assessments are carried out so that care needs can be further identified and a care plan can be drawn up. Some of the assessments seen on the AMU were not signed or dated and this should be addressed [recommendation previously]. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are areas of good care in the home and residents are cared for well in some areas but this is inconsistent and improvements are needed. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 14 EVIDENCE: Nursing units Two care files were reviewed on the top floor dementia care unit. Both of these contained care plans, which outlined the care needs of the residents concerned. For example one resident has continence needs and this was well addressed on the care plan. Both residents were being nursed with bedrails when in bed. Both had risk assessments in place for this so that safety considerations were assessed. Only one care plan contained reference to bedrails however and it would be recommended that this care need is addressed on the care plan. Neither care plan contained any reference to relative being formally involved in the care planning process. This is required so that relatives can feel more involved and better informed as well as assisting in identifying care needs. The care plans are evaluated on a regular basis by the staff. These are very brief however and record ‘continue care’ only. It would be recommended that the evaluations are in more depth, as they should be a statement set against the main aims and objectives of the plan. It was discussed with the nurse on the dementia care unit that on some of the evaluations it would be a good idea to include relatives so that they are kept up to date. 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. One staff member has commented that residents are not always dressed in their own cloths [on the dementia unit]. Relatives confirmed this. The manager has been made aware through a recent associated complain t [on the AMU] and is addressing the issues with staff. A relative commented: ‘ I go on spec. Dad’s always clean and tidy. He’s doubly incontinent but there is never a smell. He’s always comfortable. Did have a Pressure sore but this is doing well. Carolyn [senior nurse] keeps me informed every time I go in. He was having trouble taking his tablets but they got medication changed to liquids and he’s much better. Sometimes he’s in clothes I don’t recognise but this is only once or twice. I’ve not seen the care plan although I’m happy that staff keep me informed’. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 15 A resident on the nursing unit commented: ‘Sometimes I get up [generally nursed in bed] and go out in the garden. Staff are very good to me. They are very helpful and nice people. The care is good. They never rush when carrying out personal care’. AMU The care planning on the AMU has generally improved. The care files seen were better organised than previous and easier to follow. Each care need was addressed in some detail on those seen and these were evaluated appropriately. There were also risk assessments which contained care interventions and actions are included as part of the care planning process. The improvements were discussed and some recommendations for further direction also discussed s there is still evidence that staff struggle to maintain care standards due to the diverse needs of some of the residents. For example one of the elderly residents on the unit had care needs around managing aggression because of his dementia. The care plan included the teaching of anger management and also attending relaxation groups. These were not being provided and could be considered unrealistic given the overall clinical picture. Clearer identification of care needs are therefore required and these need to be matched to appropriate interventions by staff. The key worker for this resident was able to give a clear outline of the care and this included reference to the importance of the family relationships and how staff were supporting this. For example the relative confirmed that staff escort the resident out to town on a weekly basis and this both supported the resident and the relative. This was included in the care plan risk assessments under management of aggression and was being evaluated. There was no reference to the family involvement however and this needs to be addressed so that the relative is involved in the care planning. The key workers spoken to clearly had a lot of interaction with residents but this was not clearly recorded. Staff reported that they could contribute to the care documentation but that the format for this kept changing and it was confusing. Another resident who has early dementia has a lot of personal care from staff and this is listed in some detail on the care plan. The resident had no support from family and staff had been careful to involve an external advocate who had seen and had had input into the care plan. This resident as observed to displaying behaviours which were causing other residents to react negatively and both staff and advocate felt that there was a risk element involved in his being on the unit because of his vulnerability. This was further evidenced by Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 16 incidents of aggression / violence towards him from other residents. This resident was discussed and there is a need to further review the care plan. Another younger resident was able to show the inspector a copy of her care plan which had been given to her. She discussed various aspects such as going out for daily walks with staff and weekly trips to town. Also how she was managing cigarettes. The care plan was very detailed and contained 15 – 16 separate sheets. Although staff had discussed the care plan the resident was not able to relate to it and found the detail overwhelming. There was some discussion with the senior nurse on the unit as to how the care plans given to residents could be refined and include more easily identified targets that the resident could work with at any given time. Residents reported good relationships with key workers [care staff] on the unit and felt that they could communicate with them. They generally felt that staff supported them on a daily basis. Staff were seen interacting with residents. One resident commented: “Its fine here, I can do most things for myself. I go out in a taxi to town, have a pint, go by myself. Christine the manager is good and will listen if I’ve got any problems’. Although the diversity of the care needs of residents on the unit needs to be kept under review there was evidence that diverse needs are addressed. For example one resident who has cultural needs around her Muslim faith had these needs addressed in the context of her overall mental and physical condition and there was clearly an understanding of the individual needs of this resident being addressed. This was evidenced in the care plan as well as the key workers understanding. One resident had careful attention paid to a diabetic condition and had appropriate diet and regular monitoring of blood levels. The overall health of residents is monitored well. There is an attendant consultant psychiatrist who holds regular reviews. There is also a visiting GP for the AMU. This raised an issue with one resident who has recently been admitted to the unit [from the dementia care unit] and had been asked to change GP to fit in with the units needs. This had caused some initial difficulties with ordering medication as well as not giving the resident the opportunity of maintaining his previous GP if he wished. Pharmacy Medicines were administered at or just after mealtimes and this was confirmed by nursing staff. Part of the morning medicines round was observed on one floor and this was carried out in an organised and dignified way. However several medicines were seen to be given at the wrong time in relation to food Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 17 intake, which could affect the way they work and can increase the chances of side effects. The medication administration records were not always complete. Records of medicines received into the home and given to service users were not always accurate showing staff were not giving and recording medicines the right way. Numerous examples of medicines not “adding up” correctly were found which showed that some medicines had not been given as prescribed and also showed that some medicines could not be accounted for. Handwritten records, notably for new supplies of medicines were often incomplete or incorrect which had contributed to some of the mistakes. Medicines prescribed as “when required” or, as a “variable dose” did not have clear written instructions for nursing staff to follow to ensure they are given correctly. This is particularly important for residents that are suffering with pain or who are agitated and have difficulty communicating. Regular checks (audits) on medicines records and stocks were carried out by the manager but these had not identified mistakes that had been made. Having good audits is important to ensure staff are handling medicines in the right way. Arrangements for the safe storage of medicines were in place but advice was given to the manager on how to improve the current arrangements for the safe disposal of medicines to help prevent mishandling and misuse. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social life of residents are given some priority and there is good support provided for some individuals. There should be specific activity programmes for residents on the AMU in particular so that residents can be clearly focused in their activities. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 19 EVIDENCE: Nursing units 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. For example on the dementia care unit the various bedtimes and rising times of residents was discussed. It was clear that residents vary in this and that individuals are accommodated. One staff member commented ‘x had a bad night last night and didn’t sleep so had a lie in this morning and didn’t get up till near dinner time’. This evidenced good flexibility on the unit although it would be recommended that preferred routines be recorded in the care plan. One younger adult had been supported by staff to make contact with family members. Staff commented that this had been very rewarding and that the resident concerned now had monthly meetings with family and transport was arranged by the home. One relative commented: ‘Care is very person centred. They try and include the family and they show that they really care’. Other positive comments were received from the surveys returned. One summed up the general feeling; ‘Staff are always on hand day and night. My main problem is dietary – I have a soft diet and this has been arranged. All staff will take the time to talk and listen and are always available. Activities range from indoor or out door gardening, trips out. They are always well staffed and supervised. Menus are available and staff ask you for your preferred choice usually on a weekly basis’. 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 her care plan, which sets targets for helping to manage cigarette consumption and includes regular weekly trips to buy cigarettes and manage within a budget. Staff were supporting her in this. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 20 There are some activities organised on the unit for residents to participate in. there is a mini bus available and twice weekly outings [minimum] are organised. Key workers discussed their daily input with residents and some need a lot of prompting with personal care issues. It would be recommended that the key worker input be better evidenced in the care files [see previous recommendation on care planning]. Residents discussed the arrangements for a forthcoming holiday to Blackpool and were looking forward to this. The unit has a women’s section, which provides some privacy and separate space for female residents. One resident who had more diverse cultural needs felt that she could be listened to and that she had been well accepted on the unit. Some residents interviewed a well as staff still felt that more could be done to provide stimulus and activity for residents. One visitor commented ‘the staff are good and are always busy with residents but there could be more for some residents who tend simple to wander around a lot with no focus’. There is a designated staff member who links in and supports activities. It is recommended that each resident has an individual activities plan for each week and that this is constantly evaluated with key workers and specific goals set. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are good complaints processes in the home and residents feel their concerns are listened to but there is a concern that allegations of abuse a not referred appropriately and therefore residents may not be fully protected. EVIDENCE: The complaints procedure for the home is displayed in the main foyer and is also in the various literature available in the home. Residents interviewed were clear about whom to complain to or to speak to if they had concern and felt that they would be listened to. The manager maintains a comprehensive file for the recording of any complaints or concerns received. Some of these were reviewed and it was clear that the manager is responsive to any complaints made and provides a written reply with in a reasonable time frame. Complaints are audited at the monthly managers meetings with the provider. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 22 One complaint received had been an adult protection issue concerning he alleged verbal and physical abuse of an elderly resident. The details of this were discussed. The homes managers had completed an investigation and founded some of the allegations and had taken the action of dismissing the member of staff concerned. It was a concern that none of this had been referred through the appropriate channels with regarding to reporting of such incidents to social services or to the Commission for Social Care inspection [CSCI] so that the locally agreed safeguarding protocols could be instigated. The perpetrator had also not been referred for inclusion on the Protection of Vulnerable Adults [POVA] registered as is required. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The nursing units provide good accommodation for residents but some areas of the AMU have fallen below acceptable standards so that residents are not living in comfortable accommodation. EVIDENCE: 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 Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 24 has included some décor, upgrading of various areas of the home including garden areas, new staff facility, training / meeting room, upgrading of the nursing unit day room and ongoing decoration. There is a monthly audit conducted and the manager has ongoing targets for maintaining the home. 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. The unit as a whole is comfortable and provides good facilities. Likewise the top floor dementia care unit has very personalised bedrooms and the day space is homely and generally comfortable. The previous recommendation regarding the upgrading of the day room floor has not been actioned and this should now be given more urgent consideration. The environment here is generally lacking with respect of orientation aids for residents [signage etc] and this was discussed with regard to good practice guidance in dementia care and suitable reference material was recommended. All areas seen were clean and hygienic. The AMU 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 last inspection but this has not been maintained on the evidence of this visit. There are still areas such as the toilets and some bedrooms that must receive greater staff vigilance however. The toilets on the main unit [excluding the women’s unit] were not clean with dirty water on the floors of each. The toilet near the dining room was unusable with poor standards of hygiene and a shower that was broken. The manager stated that this room will be upgraded to a walk in shower room in the near future. Similarly the day room on this unit was in poor condition with the carpet frayed, soft furnishings, which were observed to be stained and smelled of urine. The room was very dark and there was bits of debris [crisp packet observed] littering the floor. This is unacceptable. There have been improvements made to other parts of this unit [women’s toilet / shower for example] but these are masked by standards in these particular areas. Again the cleaning schedule must be reviewed and there must be an audit to provide more appropriate and serviceable furnishings. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 25 Toilet areas have charts pinned to walls for staff signatures so that regular monitoring can be recorded but these were not in use consistently and if used should be dated. 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. The women interviewed have taken some ownership of this area and were quick to remind the inspector that the day room had not been decorated for a number of years. Although this is not a priority given the other improvements needed this should be considered in the maintenance programme. There is evidence that the maintenance programme for the home is now more consistent but again in a home the size of Fleetwood Hall here are still signs that maintenance is not responsive enough. An example of this was the doorframe of one bedroom, which had been damaged a week previous and was still in need of repair. Also the washing machine on the women’s unit, which remains unplumbed, some 3 months after being supplied. It is a requirement that an improvement plan is supplied to the Commission which outlines the improvements to be made and meets requirements set. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this area is good based on the available evidence. There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood and met EVIDENCE: Nursing Both the nursing units were staffed appropriately in terms of both numbers and skill mix. The top floor unit, for example, had 10 residents and was staffed with 1 trained nurse and 2 care staff. These staffing ratios are consistent and staff interviewed stated that staff turn over had been minimal and is now settled and consistent. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 27 Following on from recommendations on the last inspection report there has been some focus on training in dementia care and mental health with staff attending some training sessions and there is more planned. The manager discussed a training initiative developed by people who have experienced mental health needs. This package covered environmental issues and relationships. The pre inspection returns stated that a training manager had been employed but this is currently being reassessed. It is recommended that further training initiatives in mental health are instigated to evidence improved quality in this area. AMU The AMU had 19 residents. Staffing on both days when visiting this unit consisted of 2 trained staff and 6 carers. There are two residents currently who are on one to one observations or close observations and designated staff are assigned. The figure also includes the unit manager. Residents reported that staff are always available. There are trained staff who are appropriately qualified and experienced with regard to nursing this client group with three full time staff who are mental health trained. Again the rate of turnover of staff is currently fairly low so there are therefore consistent personnel on the unit. General. Staff records were viewed [3 in total] and all were comprehensive in that staff information available and the required Criminal Records [CRB] and vulnerable adult checks [POVA] were recorded along with suitable references. Files also contained some training certificates and supervision records. Training was discussed with the staff. Most were pleased with the training offered from induction through to access to NVQ which has been stepped up and there are currently 21 out of 37 care staff who are NVQ trained which evidences a level competency regarding the ability of care staff. Staff spoken to felt supported and said that managers gave regular supervision sessions and assisted where they could with things like training needs. All staff spoken to had received statutory updates in manual handling health and safety issues. Staff are well thought of by residents and visitors alike and there were many positive comments recorded through out the inspection and the support observed was appropriate and genuine. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are management systems in place to help ensure that the home is managed in the best interests of residents but there needs to be some review of the quality on some of the audits conducted so that issues are clearly identified and acted on. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 29 EVIDENCE: Malcolm Rugan is the Registered Manager for the home and has been in the management role for approximately 2 years. He has worked in the home for a number of years prior to this and was employed in a deputy management role. He is undertaking an NVQ course in management and has an RMN [Registered Mental Nurse qualification]. He was able to evidence examples of continued professional update. Feedback from staff, residents and visitors generally is that he is consistent in approach and is easy to communicate and talk to. One visitor commented that, despite his senior role, he seems to know all of the residents independently and all ways has time to provide clinical input if needed. The manager was able to discuss some developments in terms of the 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. New developments include the cook who collects views regarding meal provision by visiting each unit. This displays a willingness by the managers of the home to listen to the views of the people who use the service and try to develop the home in their best interests. It is of some concern that two of the areas highlighted as needing urgent action [pharmacy and environmental standards on the AMU] are subject to internal audit on a regular basis but issues have not been picked up and appropriate action taken. Resident’s monies are managed through the home residents monies account and the records are maintained satisfactorily. Residents interviewed had no problems in terms of the management of finances and were pleased that this was a convenient way of accessing monies. Health and safety issues were reviewed. The pre inspection returns by the manager indicate that all of the safety certificates required are up-to-date and some of these were examined during the inspection including fire safety records and electrical upgrading [work nearly completed on this]. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 30 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 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 3 36 X 37 X 38 3 Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 15(1) Requirement The care plans on the elderly care units [dementia care] must be drawn up with the involvement of the relatives / advocates involved. An accurate record of all medicines received into the home and administered to residents must be made to help ensure residents receive them as prescribed. Medicines must be given to residents as prescribed and at the right time in relation to food intake. Receiving medicines at the wrong dose, wrong time or not all can seriously affect the health and well being of residents. Any allegation of abuse must be reported through correct channels so that full support and investigation by the appropriate authorities can be instigated. The perpetrator in the allegation discussed must be referred through to the POVA register. Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 32 Timescale for action 30/11/07 2 OP9 17(1)(a) Schedule 3 (i) 01/10/07 3 OP9 13(2) 01/10/07 4 OP18 13(6) 01/10/07 5 YA24 23(2) b 6 YA24 16(2) c The areas identified on the AMU must be appropriately upgraded with reference to comments on the report. An improvement plan must be submitted and dates for completion of work to be within the timescales set on this report. The manager must audit the suitability of furnishings on the AMU in the day area and replace those, which are now unsuitable. The cleanliness of the areas identified on the AMU must be addressed. The manager must ensure that the auditing systems in the home are robust enough to monitor standards effectively and can identify clear failings in standards. 30/10/07 30/10/07 7 8 YA30 OP33 16(2) j and k 10(1) 30/10/07 30/10/07 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. Refer to Standard YA2 OP7 Good Practice Recommendations All assessments care plans etc on the AMU need to be completed with signatures and dates. Evaluations of the care plan should be more detailed and link to the aims and objectives on the care plan. There needs to be clear identification and management of the key worker system on the AMU so that all staff are aware of their responsibilities in terms of contributing and writing up their care interventions in the care file. Care interventions planned need to realistic and, if on the care plan, should be carried out. Any family involvement with the older persons on the AMU need to evidenced in the care planning and evaluated with Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 33 3. YA6 the relatives / advocates. The resident discussed regarding the difficult to manage behaviours should be reviewed with respect to his safety and ongoing needs on the AMU. The care plans for some of the residents need a simpler format for them to understand and work with. This should be considered with respect to the discussions at the time and comments in the report. Key workers need some clarity around their contribution to the care planning documentation so that their input is recorded. 4 OP9 Medicines prescribed as when required or, as a variable dose should have clear written criteria for care staff to follow to ensure they are administered correctly. Patient information leaflets should be used for all medicines kept in the home to ensure medicines are administered correctly. All handwritten medicines records should be an exact copy of the pharmacists dispensing label, which should be double-checked and countersigned, this should help prevent mistakes. The procedures for administering medicines should be improved to help staff give and record medicines correctly. 5 6 7 YA19 OP10 YA12 The residents on the AMU should be given to opportunity on admission of retaining their existing GP. The issue of some residents in elderly care not having there own clothes on occasions should be addressed. It is recommended that each resident [AMU] has an individual activities plan for each week and that this is constantly evaluated with key workers and specific goals set. The manager on the top floor unit should consider orientation aids for residents as discussed and mentioned in this report. The flooring in the day room on this unit needs some attention and possible replacement t of carpet [see report]. 8 OP19 Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 34 9 YA24 The furnishings on the AMU need to be given some consideration in terms of choosing items that are more easily maintained. More training for staff in dementia care and mental health issues is recommended. 10 OP30 Fleetwood Hall DS0000017279.V332300.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 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