Inspection on 10/10/06 for Fleming House

This inspection was carried out on 10th October 2006.

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 27/02/06

Fleming House 10/10/05

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 Inspection 10th October 2006 10:00 X10015.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 Fleming House DS0000039582.V313212.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. 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 DS0000039582.V313212.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fleming House Address Heron Square Eastleigh Hampshire SO50 9JD 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) 023 8061 2538 Hampshire County Council Mrs Deborah Ann Harrington Care Home 55 Category(ies) of Dementia - over 65 years of age (55), Old age, registration, with number not falling within any other category (55) of places Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2006 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 registered to accommodate up to 55 older people who have support needs associated with old age or dementia. There are thirty single bedrooms in a newly built nursing wing and twenty-five in the newly refurbished residential unit. Current Fees as given in September 2006 range from £392-£434 per week Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Visits to this service took place on 10 and 12 October.2006 At the time of the visits, nineteen people were living in the nursing wing and twenty five in the residential unit. Some people living there spoke about life in the home and commented on the quality of service provided. Other service users needs were such that they were unable to contribute verbally and so time was spent with them observing how staff interacted with them and how they were cared for. Other evidence gathered for this report was obtained through talking to the staff, talking with visitors and with one visiting professional, touring the building and by looking at some paperwork in the home. Other evidence was gathered from a pre inspection questionnaire, a written feedback form completed by a visitor and from reports of monitoring visits to the home. The findings of this report are that the overall quality of the service is good. One requirement has been made as a result of this visit. This relates to the suitability of one dining room area. What the service does well: All people spoken with were happy with the overall service provided. One visitor for example, said that their relative was lucky to have a place in Fleming House and that they had settled extremely well. Another visitor said staff are helpful, cheerful and caring towards residents. Resident’s needs and abilities are clearly established before admission and plans of care drawn up for each person are detailed and are consistently followed by staff. Staff work hard to encourage service users to maintain their existing skills, for example, in helping them to stay as mobile as possible. Food is good and resident’s dietary needs and preferences are observed. Health is effectively monitored and there is good liaison with other health care professionals. Procedures for dealing with medicines protect service users and privacy and dignity are respected. There are effective procedures to handle complaints and to protect service users from abuse. The environment is clean, spacious and bright. Staff are provided with a good range of training and recruitment procedures are thorough. The home is well managed. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 DS0000039582.V313212.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 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 the following standard(s): 3. Standard 6 is not applicable because Intermediate care is not provided. Quality in this area is good. The judgement has been made using available evidence including a visit to the home. Service users do not move into the home unless a detailed assessment has been completed which establishes that their needs can be met. EVIDENCE: The manager said that all prospective service users have a care management assessment of need. This is followed by a further assessment completed by staff from Fleming House. This considers all care, social and medical needs. People are not offered a placement until staff are confident that Fleming House can provide appropriate care and support. Service users are able to visit the home before admission, although staff said that in practice they are not always physically able to. Relatives are welcome to visit either with them, or on their behalf, to find out more about the home. Those visitors talked to during the visit confirmed that this was the case. Two files sampled contained completed pre admission assessments and one also had information about the person’s needs that had been obtained from a previous nursing home. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 9 Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 7 8 9 and 10 Quality in this area is good. The judgement has been made using available evidence including a visit to the home. Care plans identify skills and needs and staff work effectively to them. Staff monitor health and offer appropriate assistance to ensure that health care needs are met. Privacy and dignity is respected within the home. Policies and procedures for dealing with medicines are being improved and safeguard service users. EVIDENCE: The report of February 2006 concluded that although lengthy, the care planning system appropriately addressed the needs of residents. The system remains the same for recording peoples needs and wishes, although staff have adapted care plans for those in the nursing wing to make them more usable by staff and to give further guidance to staff on how to manage risks. Two current care plans were seen during this visit to the service These are very detailed and provide information for carers about what service users could do, as well as what they needed help with. Through discussion with staff it was evident that they work hard to maintain existing skills and to promote as much independence as possible for example by encouraging service users to be as mobile as possible. Records showed that where a need or preference staff had Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 11 followed this through. Examples of this were when a service user said that they would prefer to be cared for by female staff and where a service user had said that they would like visits from a vicar. One service user asked said that their care plan was in their bedroom and that their key worker filled it in and talked to them about it. Two others said that they did not know what their care plan was but that staff were always helpful and that they felt well cared for. Records showed that care plans are reviewed every month and that risk assessments are regularly reviewed and updated as necessary. One risk assessment seen had been updated because the individual’s needs had changed following a fall. Information about health needs is contained within the plan of care. A local GP visits every week. Health care professionals confirmed that they are able to see service users in private and that staff call on them for assistance appropriately. A health care professional described communication between themselves and staff at the home as very good. Visitors asked said that they that health care needs were attended to and that their relatives were being well looked after. The home has recently started a nutritional screening programme for all service users and those that have been identified as needing additional assistance in this area are being closely monitored. Staff were observed to treat service users respectfully and service users confirmed that this was always the case. Staff were also observed to knock on bedroom doors before entering. No service user self medicates although a lockable space is provided in each bedroom so that service users could manage their own medication, if this is their wish and if they are able to do so safely. Some medication administration records seen had a few omissions. It was therefore not always clear whether medication had been administered or refused. A senior member of staff said that she intended to follow this up. Drugs seen were safely and securely stored, although it was discussed that those that were due to be returned needed to be stored in a more appropriate container. Staff said this was already being addressed. The manager said that the medication training programme for staff has improved since the time of the last visit. Staff said that they would benefit from having access to an up to date BNF (British National Formulary) this would provide them with more information about the drugs that they are administering. Staff also said that it would help them to audit medication if they had a medicine tablet counter. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12,13,14 and 15 Quality in this area is good. The judgement has been made using available evidence including a visit to the home. The range of activities available within the home could be improved, although most are happy with what is available. The home welcomes visitors . Food is good and plentiful. EVIDENCE: Staff spoken with had a good understanding of service users interests and of the things that they liked to do. Service users who were able to comment said that there was enough to do. They said, for example, that some people come in to entertain residents sometimes, that a local vicar visits and that they hoped to be able to see the Christmas lights again this year, as they had enjoyed it last year. Some visitors said that there were not as many recreational activities as there had been before the service had been expanded. Staff in the residential unit also said that they also felt that this was the case. Staff in the nursing area said that a lot of the service users in the nursing wing benefited from one to one stimulation. Staff said that training is available to help staff to provide suitable activities for residents Visitors asked said that they are made welcome at Fleming House and that they can see their relative in private, if this is their wish. One visitor said that it would be helpful to have staff photographs and their names on display in the Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 13 foyer to help visitors, as there has been a lot of new staff employed as the service has expanded. Bedroom seen had been personalised. Food was described as “very good” by service users. It is evident that special diets are catered for appropriately, for example for one person who is vegetarian. A mealtime was observed in one of the nursing units and in one of the residential dining areas. Food arrived in a heated trolley and service users had a choice of two hot meals. Staff were observed to ask service users what food they wanted and to provide appropriate support during mealtimes, although service users had to wait for a while until sufficient staff were available to support them to get to the tables. Staff said that mealtimes could get hectic and that there were a high proportion of service users who either needed help with feeding, or to be closely supervised. Dining arrangements in the upstairs dining area of the residential unit were observed to be cramped once all service users were seated and there was not adequate room for them to have their walking aids next to them. Some staff said that they were concerned that it was difficult to support service users satisfactorily in these circumstances. The manager said that this had already been identified as an issue and discussions had taken place as to how this could be resolved. A requirement has been made that dining arrangements must be appropriate to meet the needs of service users. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 16 and 18 Quality in this area is good. The judgement has been made using available evidence including a visit to the home. Complaints are taken seriously and are acted upon appropriately. The record of complaints could be improved to reflect more accurately actions taken and timescales. Policies and procedures in place help to protect service users from abuse. EVIDENCE: Service users asked said that they felt safe and that they felt that staff listened to them. A visitor also confirmed that staff had taken action over a concern that had been raised. There is a procedure for complaints, which specifies how complaints can be made, who will deal with them and an assurance that they would be responded to within a maximum of twenty-eight days. Although all complaints had been responded to in a timely fashion, the record of complaints kept at the home was not always detailed enough to reflect this. The manager said that this would be improved upon. Staff receive training in adult protection issues as part of their induction. There was evidence that appropriate actions had been taken to protect service users where a need to do so had been identified. Small amounts of money are held on behalf of service users. The procedures for keeping this money safe have been considered during previous visits to the home and were found to be appropriate. Staff confirmed that procedures remain the same and that records of money continue to be externally audited. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 15 Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19 and 26 Quality in this area is good. The judgement has been made using available evidence including a visit to the home. The home is clean, very comfortable and for the most part suits residents needs. Slight changes are needed in one dining area to ensure that staff can support residents safely. EVIDENCE: The nursing wing has only recently opened and will when full accommodate up to thirty residents in 4 units. All bedrooms are single and all in this wing have en suite facilities. There are dining/living areas in each unit, which are shared by small groups of residents. The residential unit has been completely refurbished, some bedrooms have been made larger and two have been adapted to provide overhead hoisting facilities. There is an enclosed communal garden, which can be accessed from both the residential and nursing units. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 17 Visitors described the home as very comfortable and said that bedrooms were very nice. One service user was pleased that they had a bigger bedroom than they had before the refurbishment took place. Staff said that there were very good aids and adaptations available and this made caring for people a lot easier. Staff in the nursing wing voiced concerns over people wandering, particularly in the areas of the stairwell as they felt that they could not guarantee that they could observe where people went all the time. The design of the building is such however that a resident would not be able to leave the building without staff being aware of this. Staff in the residential unit were concerned about lack of shelving space and were concerned that the dining area upstairs had insufficient space for them to assist service users safely. The home was very clean on the days of the visits and had suitable laundry and sluicing facilities. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this area is good. The judgement has been made using available evidence including a visit to the home. The number of staff provided is generally adequate although current levels can place a strain upon the staff teams and in some cases this has affected morale. Thorough recruitment procedures and good opportunities for training for staff help to safeguard service users EVIDENCE: Service users asked who were able to comment said that there were enough staff around and that they were given the right amount of help. One person said staff are “very nice and very friendly. They help you without being too pushy.” Visitors agreed that staff are friendly, and said that their relatives were well looked after. Some said that there were enough staff around; others said that staffing numbers seemed to vary. One person said that sometimes when they were visiting they would be in the dining area with about three residents and there would be no staff about for periods of about half an hour. One staff member described staffing levels as “minimal”, some said that they felt that they had to rush to complete all their jobs and felt that they could offer less activities for service users than they used to. Some staff described the staff group as happy; others said that morale had been badly affected. It was observed during the visit that at times no staff were present in communal areas although it was also observed that staff responded quickly and efficiently when needed by a service user. The manager said that the service is still developing and that recruitment process continues for permanent staff. She anticipated that the strains Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 19 experienced by some of the staff team should ease when the recruitment process has been completed. She said that when fully operational there should be eight staff on duty in the nursing wing during the day. This is to include two nurses. In the residential wing there during the day there is a carer on each of the two floors with an additional staff member floating between the two. The manager said that at busy times this would increase to four care staff in total. At night there are two waking carers in the residential unit and there will be two nurses and two carers on duty in the nursing wing. Recruitment records for two staff members were viewed. These contained evidence of identity and evidence that staff had undergone a thorough recruitment process, including a criminal bureau records check. Staff described training available as “fine” and “good”. Records show that all new staff undergo a detailed induction programme, to include all essential health and safety areas. Training is also provided in dementia care. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 35 and 38 Quality in this area is good. The judgement has been made using available evidence including a visit to the home. The home is well managed and quality is monitored effectively. Service users health and safety is appropriately protected. EVIDENCE: The registered manager is Mrs Deborah Harrington. She is a registered nurse and has completed an NVQ level 4 she has considerable experience in working with older people, including those with dementia. Residents meetings and staff meetings are held. Relatives said that they are also invited to residents meetings. There is a monthly visit to the home by a representative of the organisation who is not employed at Fleming house. A report is compiled as a result on the conduct of the home. The most recent report was seen and recommendations to improve the service are being Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 21 addressed, for example there will be a change in the way in which laundry is collected. Resident’s financial interests are protected, as discussed in a previous section. All staff training in health and safety issues is regularly updated and records showed that all equipment in the home is serviced and maintained appropriately. Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 22 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP19 Regulation 23 Requirement Current dining arrangements must be reviewed must be reviewed so that staff can assist service users appropriately Timescale for action 12/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fleming House DS0000039582.V313212.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 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 DS0000039582.V313212.R01.S.doc Version 5.2 Page 25 - 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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