Inspection on 10/10/05 for Fleming House

This inspection was carried out on 10th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Fleming House 08/11/07

Fleming House 10/10/06

Fleming House 27/02/06

Fleming House 01/02/05

Fleming House 09/08/04

Fleming House 10/12/03

Fleming House 22/07/03

Fleming House 16/01/03

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

CARE HOMES FOR OLDER PEOPLE Fleming House Heron Square Eastleigh Hampshire SO50 9JD Lead Inspector Kathryn Kirk Unannounced 10/10/05 10:30 a.m. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fleming House Address Heron Square Eastleigh Hampshire SO50 9JD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 8061 2538 Hampshire County Council Deborah Harrington CRH 25 Category(ies) of DE(E) Dementia - over 65 LD(E) Learning registration, with number Disability - over 65 OP Old age of places Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: . Date of last inspection 1st February 2005 Brief Description of the Service: Fleming House is a large purpose built unit, situated in the residential area of Eastleigh. It is run by Hampshire County Council and is currently registered to accommodate up to 25 service users who have support needs associated with old age or dementia. Building works are in progress to completely refurbish the original residential unit. Service users have moved into the new wing whilst work is being carried out. It is the intention that once this is complete, residents will move back and Hampshire County Council will apply for the new wing to be registered as a 30 bedded nursing unit. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of two that will be carried out during the year April 2005-March 2006. It took place on 10 October 2005 and lasted for five and a half hours. The manager Deborah Harrington was present throughout. Four staff members and twelve residents spoke of their experience of working and living in the home. Some documentation was seen and some parts of the building were visited. Staff had completed a questionnaire before the inspection, which provided further information about residents, staff and policies and procedures. Nine residents and three visitors also provided written feedback regarding their views of the home. What the service does well: What has improved since the last inspection? The original building did not meet a number of environmental standards and the new wing does. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 6 What they could do better: 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. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Prospective service users can be satisfied that their needs can be met at the home because the assessment process is thorough. Intermediate care is not provided. EVIDENCE: All service users are referred through social services after a care management assessment of need has been completed. A copy of this assessment was seen on two files viewed. Mrs Harrington said that she could also view a copy of any care management assessment made regarding residents in the home via computer. All prospective service users are invited to visit Fleming House for a day. During this time staff carry out a further assessment with them to consider personal care needs, physical and mental health issues and social interests. Two such assessments were seen completed on file. The home does not provide intermediate care. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 10 The care plan format that is being introduced is comprehensive. However, further guidance is needed for staff to ensure that care plans are completed with sufficient detail and clarity to enable all care staff to provide appropriate assistance. Service users are treated with dignity. EVIDENCE: Hampshire County Council have developed a detailed format for recording the plan of care for each resident. Three of these were seen, two of which were for people new to the service. They are completed by a key worker in discussion with the resident concerned. The plan details abilities, strengths, wishes and special requirements in all aspects of life. There is space to record any risks that have been identified. There is a daily living plan and the form also includes questions to ensure that equal opportunities are addressed. There is a separate form for night care. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 10 There were gaps in the care plans seen although all had been started. It was discussed with the manager that in their present state they did not contain adequate information to assist staff in providing the appropriate level of care. Additional information regarding care needs was however seen on contact sheets, which are kept separately to care plans. Examination of the care plans indicated that when a specific risk had been identified, there was not in all cases any guidance for staff as to how the risk could be minimised. This is a new system for care planning, which is in the process of being implemented. It will therefore be reviewed again at the next inspection. Mrs Harrington said that she intended to provide staff with some training in this area. All service users who provided written feedback said that they felt safe and eight out of nine said that they felt that staff treat them well. One replied “sometimes” to this question. All service users spoken with on the day of inspection spoke very highly of the staff team. Staff were observed to talk with residents in a friendly and respectful manner. Health professionals who visited during the inspection were observed to be shown to the individuals’ concerned private accommodation. Staff were seen to knock before entering bedrooms. Mail was observed to be given out unopened. All bedrooms are single. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) no standards were assessed on this occasion EVIDENCE: Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Appropriate procedures are in place to ensure that complaints are acted upon and to ensure that residents are protected from abuse. EVIDENCE: There is a complaints procedure, which specifies how complaints may be made, who will deal with them and which gives an assurance that any complaint will be responded to within a maximum of twenty eight days. Records were checked since the last inspection in February 2005. These showed that two complaints had been made to staff at the home. Both had been responded to quickly and appropriately. Staff continue to have a positive attitude towards comments and complaints made and see such feedback as an opportunity to review and improve the service. Positive comments made about the service are also kept and a number of these were seen. No complaints have been received about this service by CSCI. Service users asked said that they would be confident to discuss any aspects of the service that they were dissatisfied with and said that they were confident that they would be listened to. The home has an adult protection procedure. Training in adult protection issues is offered to all staff. The manager is aware of the need to refer staff that may be unsuitable to work with vulnerable adults for consideration for inclusion on the Protection of Vulnerable Adults (POVA) register. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 22 The environment is suitable and meets individual and collective needs. EVIDENCE: The new wing of the building was completed this year. Hampshire County Council intend to apply for registration to use it as a nursing home once the refurbishment of the adjoining original building has been completed. The twenty-five current service users have transferred over so that work can be undertaken. It is at present registered as a residential home and is able to accommodate up to twenty-five older people. The registration process took into consideration the requirements of the local fire service and the environmental health department both of whom agreed that it was suitable for purpose. Grounds between the two buildings only have very limited access at present because of the ongoing building work, but when complete there will be a landscaped courtyard for the use of residents in both the nursing and the residential wing. Some service users asked said that they were looking forward to returning to the original building. They felt that the new surroundings were very nice but Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 14 larger than they were used to and not as homely. One service user said however that staff had put up her photographs and pictures in her bedroom and staff said that they had ensured that all residents’ new bedrooms had been personalised in the way that they wished. The new building has been fitted with specialist aids and adaptations, for example, passenger lifts, ramps, assisted toilets and baths and grab rails. Call systems are installed in every bedroom and in all communal areas. The home has also introduced a new call system, which service users wear around their wrist and can press if they need assistance. Staff then must respond within a specified time or the call will go through to a central computer. One service user who had limited mobility was observed to have some difficulty in activating their alarm. Others said that they found the system to be good. The manager said that all new residents are given the choice as to whether they wish to have one of the new alarms. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Care staffing levels are sufficient to meet need. The recruitment process can be slow and current practices regarding where information about staff is held need to be reviewed. Training offered is appropriate, but some additional training is needed around the new system of care planning. EVIDENCE: An examination of the staff rota showed that there are four day care staff on duty between 7.30 and 2.30 and that there are three staff on duty in the afternoons. During the late afternoon and evening there are again four care staff on duty and there are two night staff and a night care coordinator on duty between 10pm and 8am. There is a separate rota for senior staff, which shows that at least one is on duty until 10pm every night. After this the night care co-ordinator takes over as senior in charge of the building. The rota also reflects that an activity coordinator is employed for two hours twice a week between 2 and 4pm. The rotas show that there is no difference in staffing levels between weekdays and weekends. The manager said that there are currently 70 hours a week allocated to cleaning. Staff identified that this was not sufficient to keep up standards in the new building to an acceptable level. An additional thirty hours a week were agreed by senior managers in July, but by the time of inspection the advert for Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 16 this vacancy had yet to go out. The manager explained that this is because recruitment is managed centrally. Other domestic staff, including cooks, kitchen assistants, and laundry staff are also employed. There is also a full time administrative officer. The manager confirmed that all staff that provide personal care are at least aged eighteen and all staff left in charge of the home are over 21. Service users and relatives said that in their view there was always sufficient staff on duty to respond to need. Ratios of staff to service users are in accordance with guidance recommended by the Department of Health. Two staff files were sampled. As discussed earlier, recruitment is undertaken centrally by the human resource team. Copies of some documentation were seen on the two files seen. These included an application form, confirmation that a satisfactory CRB check had been completed, photographs and references. It was discussed with the manager that some documentation was missing from both files seen. This included evidence that the person is fit for the purposes of the work, or a declaration signed by the person that they are fit, and copies of birth certificates. The manager said that this information is held centrally and that although it is requested copies are not always forwarded to the home. It will be a requirement that all documentation relating to staff that is listed under schedule 2 of the care home regulations be held at the home. Records and discussion with staff indicate that new workers receive a structured induction programme. This lasts for five days and covers principles of care; practical care skills, writing skills and adult protection issues. Key health and safety areas, moving and handling and fire safety are also addressed. Until a worker has completed this induction course they work with an experienced member of the care team. By the time that they are six months into their employment, staff are trained in record keeping, care of the dying and in communication skills. All staff asked said that they had undertaken fire training within the last six months and two confirmed that they had taken part in a fire drill since moving to the new building. The manager said that all staff are also updated every year in moving and handling. The manager also said that there is a member of staff in the building at all times who has completed a three day course in first aid. The home is registered to provide care for those with dementia. The manager said that all care staff that have not undertaken training in this area have been nominated for this course. Records show that NVQ training is ongoing, two care staff are currently working towards their NVQ level2 and two have been nominated for their NVQ level 4 in care. Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards were assessed on this occasion. EVIDENCE: Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x 3 x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 19 No 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 29 Regulation 19 Requirement Copies of all information and documents listed in Schedule 2 of the Care Homes Regualtions in respect of persons working at the care home must be available for inspection at the home. Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 20 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Fleming House H54 S39582 Fleming House v226631 101005.doc Version 1.30 Page 21 - 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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