Inspection on 08/11/07 for Fleming House

This inspection was carried out on 8th November 2007.

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 10/10/06

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 Jan Everitt Unannounced Inspection 8th November 2007 09:15 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.V349418.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.V349418.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.V349418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 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 £403-£446 per week. This fee does not include the contribution for nursing care. Personal items, hairdressing, chiropody and newspapers are not included in the fees. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site inspection visit to Fleming House Residential and Nursing Home, which was unannounced, took place over a one-day period on the 8th November 2007 and was attended by one inspector. The registered manager, Mrs. Deborah Harrington assisted the inspector throughout the visit. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The provider had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit made to the home in October 2006. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. The inspector toured the home and spoke to residents, visitors and staff in order to obtain their perceptions of the service that the home provided. Those spoken to were very satisfied with the care and services that were being provided. Surveys were distributed to service users, relatives, care managers, GP and other visiting professionals. Three service user surveys, twelve relative/carer surveys, eight staff surveys and one visiting professional survey were returned to the CSCI. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally residents and relatives were pleased with the care in the home. At the time of the inspection the home was accommodating 54 residents with a number of these who were unable to communicate effectively with the inspector to gain their views of the service. No residents were from a minority ethnic group. One requirement has been made as a result of this visit. This relates to activities in the home. What the service does well: The pre-admission assessments undertaken by the manager and care manager on all potential service users are comprehensive. Each person admitted to Fleming House is given an information pack, which includes a copy of the contract of residence. An initial review takes place six weeks following admission and includes the care manager, relatives, the service user, and key worker/carer. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 6 Service users’ health care needs are well met by the home, which is supported by the primary health care team and other visiting professionals. Service users and relatives say that staff are friendly and helpful. Comments on the surveys say: ‘The staff make sure my relative is clean’. ‘I leave my mother to go home knowing she has as much love and care given by the carers as humanly possible’. ‘The staff take care of my wife so well’. Meals are nutritious and healthy, and are served in pleasant surroundings; the catering service responds to service users dietary needs and preferences. The comments from the surveys returned and talking to service users, indicated, generally there was satisfaction with the food served, with comments such as: ‘The food is very good we always get what we want’. ‘There are always choices at meal times’. ‘The food is very good’. During this visit it was noted that the general atmosphere in the home was relaxed and good interaction was observed between the service user and staff, with care being given unhurried and at the resident’s own pace. Residents spoken to confirmed that they were able to make decisions about how they spent their day. They complimented all the staff on their kind and supportive approach towards them. The environment is pleasant and homely and decorated to a good standard. Service user’s rooms are individual and pleasantly furnished. The residents and relatives report a high level of satisfaction with communal areas, their bedrooms and the environment in general. There is a variety of training available to all staff. What has improved since the last inspection? What they could do better: Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 7 The activities for residents in both the residential and nursing wings must be organised to meet their needs as far as their mental capacity with allow and tailored to meet their preferences. The surveys from service users, staff and relatives comment that there is a need for more stimulation throughout the day and more one to one activities for those who are in the nursing wing and choose not to leave their room. The AQAA identifies that the activities programme must be developed further over the next year. The AQAA has identified areas for improvement and these are building on existing knowledge and provide more training for staff in Dementia care, the Mental Capacity Act, Nutritional assessment training and end of life training. 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. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 8 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.V349418.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users do not move into the home unless a detailed assessment has been completed which establishes that their needs can be met. Intermediate care is not given in this service. EVIDENCE: A sample of five service user’s records was viewed and a pre-admission assessment was identified in each of those records. The pre-admission assessment tool was comprehensive and covered all the activities of daily living. The manager described the process of referral, which comes from the co-ordinating care manager for social services in the area, and must meet the needs led criteria. Part of the criteria is that those referred to the nursing wing must have a diagnosis of dementia. It is then the manager or her deputy will Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 10 go to the location of the potential service user to assess their needs and to ensure that the home is appropriate to meet their needs. The care manager’s needs assessment, risk assessment and continuing health care assessment will be shared with the home to support the admission. The manager said that for some service users it is not possible to fully include them in the decision making about coming to the home but that relatives are involved in the process and assessments. Those potential residents, who are able, are invited to spend a day at Fleming House to introduce them to the home. Service users spoken with said that they were very happy to be in the home, one stating: ‘I would not want to be anywhere else I am very happy here’. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place to ensure the personal and healthcare needs of residents are met. The practices and policies of the home ensure that the home manages medication safely and effectively. The home’s ethos and staff working practices ensure that residents’ privacy and dignity is promoted. EVIDENCE: A sample of five service user’s care plans and records were viewed. There is a great deal of information on each service user contained over three files. The information in care plans and the personal records, although lengthy, describes the planned care in detail to meet the needs of the service users. The care planning system has been adapted in the nursing wing to make it more user Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 12 friendly for staff and includes risk assessments and care plans of how the risks are to be managed. A copy of care plans is contained in service user’s room and provides 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. The AQAA states that the home promotes individual choice and plan care with residents and family. There was evidence in care plans that care plans had been signed by the resident or the relatives as agreement with the content and of their involvement in the planning of care. The home now has a key worker system and they get involved with the care planning and reviews of care plans. The care plans demonstrated that they are reviewed monthly or whenever a service user’s condition changes. Service users spoken with and survey comments received indicate that service users consider their needs are supported fully. One service user saying ‘staff are always helpful and I feel well cared for’. A relative comment was ‘The care staff have the ability and experience to look after the clients well’. The care plans contain information about health care needs. A local GP visits every week. A health care professional returned survey confirmed that they are able to see service users in private and that staff call on them for assistance appropriately. The person identified that ‘staff support to the best of their ability those with complex needs, but there was a need for staff to be trained in dementia care and challenging behaviours’. We observed that the care plans contained detailed records of all contacts the resident have with any of the health care professionals. A health care professional described communication between themselves and staff at the home as very good. The survey comments received from relatives in general indicated that they consider that the health care needs of the service users were attended to and that their relatives were being well looked after. The home undertakes 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. The medication system is that of dispensing from boxes and bottles. Medication administration record (MAR) sheets were viewed by the inspector and were generally recorded appropriately with codes to identify if medication had not been given. The senior nurse who identifies poor recording or missed medication audits these weekly. Trained nurses administer all medications in the nursing wing and assistant unit managers (AUM) in the residential wing. The AUMs spoken with said that they have received specific training for this Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 13 role and this was also stated in the AQAA and evidenced on the training matrix. We observed that all medications are stored in secure cabinets in a clean and orderly fashion. The ordering and receiving of medications is co-ordinated by two senior members of staff. The AUM said that she orders the medications monthly; the home checks the prescriptions before they are sent to the pharmacist for dispensing. This is seen as good practice, and avoids receiving unwanted medication. However, it was observed that in some cases there was a considerable build up of stock for some medications. Some were noted to be out of date and this was discussed with the co-ordinating member of staff and it was agreed that the cupboards are checked and excess medication is disposed of. The controlled drug cupboard and registered were viewed in which night sedation is stored and recorded as for controlled drugs. The balances recorded agreed with the stock held. We observed whilst walking around the home that staff members were observed giving support to residents in a sensitive and friendly manner. Residents spoken with said that the staff are friendly, nice and caring and will generally go out of their way to help you. A comment received on a service user survey said ‘I wish they would knock on my door before coming in’. This was discussed with the manager who related that this had been addressed and staff training had emphasised the importance of respecting the privacy of the residents. Staff were observed to be interacting well with service users and were familiar with their preferences and needs. Service users spoken to and comments from surveys from relatives indicated that it was felt that staff treated the service users with respect and that ‘staff are very helpful and kind’. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of activities available within the home has improved. However, through lack of specified staff there is no formalised activities programme in place. Service users are supported to keep contact with their relatives and friends and go out into the community if they so wish. Service users are encouraged to exercise control over how they live their lives. Food served to the service users is a well-balanced diet and is taken in pleasing surroundings at appropriate times EVIDENCE: The home does not plan a formal activities programme. The manager told the inspector that although there are no activities co-ordinator employed for that specific role, activities do take place. Most of the care staff undertake the role of organising and supervising the activities that take place most days. On the day of the visit a game of bingo was being co-ordinated by two assistant unit Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 15 managers and there were about ten residents participating in this and were observed to be thoroughly enjoying the competition of the games. Other activities described were outings to the pub, shopping, nail bar, hairdresser and other social events that relatives are invited to especially at the festive times of the year. The manager told the inspector that a list has been comprised by Hampshire County Council of people who have been vetted and who will be visiting the home imminently to entertain the service users. The clergy visit the home regularly. The AUM showed the inspector a record of the activities that have taken place, which identifies the residents who have participated, but not their level of participation in detail. There is a high level of participation from the residential service users who are more able both physically and mentally. These records indicated a more informal activities programme on an ad hoc basis and there was no evidence to support that activities are tailored to those who are more mentally infirm, taking into account past social history. Comments from talking to service users and from surveys returned by service users, staff, visiting professional and relatives were of a mixed opinion about the suitability and frequency of activities in the home. Some saying that the activities that take place were sufficient other comments were: ‘Wish there were more regular activities. ‘Allow more time to do activities and give more quality time to residents.’ ‘Improve staffing levels to allow for more individual stimulation’. ‘Staff shortages resulting in residents not being able to go out into community’. ‘Not enough time devoted to activities’. ‘More activities needed’. ‘I think that the residents should be encouraged to socialise more often with each other they spend most of the day in their rooms’. ‘Wish there were more regular activities on a weekly basis, it seems to be shortage of staff’. These comments were discussed with the manager who said that the budget to supply adequate staffing for care does not allow a designated person to be appointed as an activities co-ordinator and it would mean her cutting the care hours by that amount. However, the AQQA does state that in the last twelve months the activities programme has expanded and in the next twelve months the home will continue to develop the programme further taking into account the service users’ needs who have dementia. It also stated that staff are receiving training in a tool for assessing what activities would be appropriate to meet the needs of those individuals with dementia. It was observed in the care plans that a basic social history is recorded for those people who are living in the residential wing. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 16 The visitor’s book demonstrated a large number of visitors to the home. Those spoken with and from comments on surveys indicate that visitors to the home are always made welcome at any time. There are a number of private areas around the home as well as the service user’s own room, to enable service users to see their visitors in private if they so wish. Service users do go out into the community if they wish and are able to do so. Some service users spoken to said that they go out with their relatives for outings to visit their homes. The manager reported that there is a number of staff that are undertaking special training to enable them to drive a minibus and this will allow for more outings to take place. The manager said that the staff accompany as many residents as possible every year to see the Christmas lights locally. A service user said that they hoped to be able to see the Christmas lights again this year, as they had enjoyed it last year. Bedrooms seen had been personalised. Service users told the inspector that they are able to do as they wish throughout their days. They are not rushed to get up or go to bed and some choosing to go to bed or their rooms quite early after tea. Observation of practices and interaction between staff and service users indicated that good relationships exist between the staff group and residents and that staff are very familiar with service users needs and preferences. A comment on a survey did say that a service user wished to have the same gender carer, as one of the opposite sex, was embarrassing for her. This was discussed with the manager who said that there was no policy for same gender care and that this was not always possible with the gender staff mix the home employs. This should be reflected in the Statement of Purpose. Service users described food as “very good”. 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. 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 has been altered and more space has been created by the removal of part of a work surface that protruded out into the room. The inspector observed this area to be pleasant with plenty of space between tables and now meets the safety needs of the service user. The kitchen was visited and the cook demonstrated a wide knowledge of service users’ preferences and dietary needs. Nutritional risk assessments are undertaken on all service users and those at risk have care plans to monitor Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 17 their nutritional status and their expected dietary needs. The cook also demonstrated knowledge of how she fortifies diets for service users at risk of malnutrition. Comments from surveys from service users, staff and relative indicate a high level of praise for the choices, variety and presentation of the meals served to the residents. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive complaints procedure, which is made available to residents and visitors. Policies and procedures in place help to protect service users from abuse. EVIDENCE: The home has a comprehensive complaints procedure, which details all the necessary information including names, addresses, telephone numbers and timescales. The complaints log was viewed and ten complaints had been recorded in the past twelve months. The logbook demonstrated that all correspondence between the complainant and the manager is recorded and the action outcomes from the complaints are also documented. This demonstrated that the system for recording complaints and the outcomes from them has improved since the last inspection and are more detailed. Surveys from service users, relatives and staff indicated that they would know who to go to and what to do if they wished to complain or discuss an issue with a manager. One resident when spoken to indicated she would talk to the care staff if she was unhappy and one visitor stated she would feel very comfortable discussing any concerns with the manager. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 19 The AQAA states that the home has a robust adult protection procedure that is shared with adjacent local authority services. All staff are trained in the adult protection issues and this is undertaken as part of the induction programme. Staff spoken to and training records demonstrate that staff have received training in abuse reporting and adult protection. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable and well maintained and meets residents’ needs. EVIDENCE: At the time of this field visit there were fifty four service users in residence, thirty of which were accommodated in the newly commissioned nursing wing and all of which have en-suite bathrooms, and thirty four in the residential wing, which has also been refurbished. All accommodation is single occupancy. The rooms are large and all of them have been personalised by the service users with their own belongings. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 21 The home was clean and tidy and well maintained with both appropriate laundry and sluicing facilities available. The home employs a separate housekeeping staff to maintain the high standard of cleanliness. Service users and relatives commented that the home was very clean and comfortable and they were happy with the environment and said that bedrooms were very nice. The AQAA reports that the home has a maintenance contract for interior and external repairs and maintenance. The home has dedicated smoking rooms for residents only. Staff and visitors are not permitted to smoke on the premises. A pleasant enclosed garden that can be accessed from both nursing and residential units. The home has manuals that contain all policies and procedures and gives guidance on infection control. Staff training records also evidenced that staff do receive infection control training. The home has hand-washing facilities in all toilets and bathrooms with soap dispensers and paper towels. Protective aprons and gloves are available to all staff. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough recruitment procedures and good opportunities for training for staff help to safeguard service users The number of staff provided is generally adequate to meet the needs of service users. EVIDENCE: The staffing levels on duty for each shift was discussed with the manager. From surveys received from service users, staff and relatives there was a strong indication that it was considered by some that there was not sufficient staff allocated every day to meet the needs of service users and to give time to those whose mental health was frail. Comments made on surveys returned to the CSCI were: ‘Some staff are very good others are not suitable’. ‘Care lacks consistency through agency staff’ ‘Regular staff are very good but agency are not always’. ‘Caring staff but staff shortages cause problems a lot. Agency staff cannot do it the same if they are new to the home and do not know the ropes’. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 23 ‘I feel that one area we fail the service users is not having quality time with them’. ‘They are so short staffed she doesn’t always get the care that is needed’. ‘Some agency staff are not trained appropriately to care for the residents and cannot carry out tasks required of them’. Recruit more permanent staff’. These comments were discussed with the manager who told the inspector that she is finding the recruitment process long and is at present awaiting CRB checks for staff before they can commence employment and that was the reason agency staff were working in the home. She said that she is now fully complimented with care staff and is in the process of recruiting a trained nurse and is using agency staff to fill the gaps. The AQAA states that the recruitment process needs to improve from the time of application to commencement of employment. The manager said that it is anticipated that the staffing levels will be eight (8) staff on duty in the nursing wing during the day. This is to include two nurses. In the residential wing during the day there is a carer on each of the two floors with an additional staff member floating between the two. At night there are two waking carers in the residential unit and there are two nurses and two carers on duty in the nursing wing. On the day of this visit the manager was on duty, three (3) assistant unit managers, two (2) trained nurses and six (6) care staff. A number of these staff was agency. From observation of this visit the staff was not rushing about, there was a calm atmosphere and call bells were being responded to quickly. There was every indication that there was sufficient staff on duty that day to meet the needs of service users. Service users were observed to be interacting well with staff and staff were giving them time to go about their activities of daily living. Comments on relatives’ and visiting professional returned surveys say: ‘They all care for my mother very well and are always there if I need to ask anything’ The deep loving care they give to all the patients regardless of their illnesses. ‘The carers endless patience and commitment’. ‘The carer if often sat talking to mother when I visit’. ‘They do their best with the staff they have’. ‘Residents are looked after well’. ‘The home fully meets my mother’s needs’. ‘Staff manage to the best of their ability, complex nursing needs’. The AQAA states that the manager is developing a dependency/staffing ratio tool to enable her to reshape the staffing levels in relation to dependency and make best use of the resources available. The AQAA documents that 73 of care staff have achieved their NVQ level 2 or above and a further 9 are currently undertaking this. Staff surveys returned Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 24 and those staff spoken to report that they have the opportunity of good training and are supported to undertake this qualification. Recruitment records of staff are maintained centrally and the HR department of Hampshire County Council (HCC) undertakes all checks. The AQAA states that there is a standardised recruitment procedure with equality checks; interview questions and scoring and these are maintained on file in the HR department. The manager said that she is involved with the recruitment of staff and undertakes all interviews. The manager maintains a copy of the recruitment information and a sample of three more recently recruited staff were viewed and all appropriate checks and information was recorded. Staff surveys returned indicated that they were satisfied with their recruitment process. The AQAA records that the process for recruitment of staff needs to be improved. The induction programme document that was in the process of being undertaken and covers all the Skills for Care Induction Standards. All new staff undertake two inductions. The corporate induction for Hampshire County Council is over three days and the manager told the inspector that this does not always take place immediately it is a case of obtaining a place on the training when they are available and at a time that is convenient to the staff member. The AQAA acknowledges that HCC needs to improve the accessibility of the induction programme. The in-house skill based induction is over three months and staff work through the induction standards workbook and are signed off as they complete them. The training matrix is maintained electronically and identified the training that has taken place and identifies when mandatory training is due. There is a HCC training programme available to staff that the manager ensures all staff have access to. The AQAA states that all staff have regular supervision by a named senior staff member, these records were evidenced in the staff personnel files. All staff have training as part of their Individual Training Plan and these are reviewed annually. Comments from staff received on surveys returned were: ‘I have regular supervision where views, opinions, requests and further job development are discussed’. ‘Dementia and Alzheimer’s training is missing’. ‘I have regular meetings with my supervisor’. ‘I receive training relevant to my role and keeps me up to date’. ‘I receive very good training’. A visiting professional survey commented: ‘It can be difficult supporting people with dementia is the carers understanding of dementia is limited due to lack of training’. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 25 These comments were discussed with the manager and she said that currently there is a training programme in process for all staff to attend training in dementia care. The manager said that she is in the process of planning to cascade the Mental Capacity Act training to all staff and how this will impact on their roles. The AQAA also documents that senior nurses are to commence the NVQ level 4 and the management induction training which will enhance their roles to support the manager. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 &38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and quality is monitored effectively. Service users’ financial interests are safeguarded. 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. Mrs. Harrington has Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 27 achieved management qualifications in the Health Service that is equivalent to that of the registered manager’s award. The home has a quality assurance system. This includes surveys for resident satisfaction, which is analysed by the manager 6-12 monthly. The senior nurse audits MAR sheets, care plans and pressure sore occurrences monthly. The inspector evidenced records of this taking place. Residents meetings and staff meetings are held, minutes for which were seen on the notice board. Relatives said that they are also invited to residents meetings. Polices and procedures are developed corporately with the manager’s input, most of which have been reviewed in the last twelve months. 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 on this occasion. The home does look after some resident’s monies. These were observed to be maintained individually in a safe environment. Records of all transactions are signed by whoever undertakes the weekly checks of these monies. All financial records are audited by the financial department of HCC. Staff training in health and safety issues is regularly updated and this was demonstrated on the training matrix seen by the inspector and also indicated on the staff surveys returned to the CSCI. The home has a health and safety link person who attends monthly meetings and feeds back to the manager on issues. Risk assessments of the environment were viewed in the individual care plans of service users, along with an individual fire risk assessment for every resident The fire log demonstrated that the fire alarm system and equipment is tested at appropriate intervals. Records evidenced that staff receive regular fire training, which is in the form of fire drills and also structured training all of which is recorded. The HFRS visited the home earlier in 2007 and gave an excellent report on the fire integrity of the premises. Records viewed showed that all equipment in the home is serviced and maintained appropriately. Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 28 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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.V349418.R01.S.doc Version 5.2 Page 29 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 OP12 Regulation 16(2)(m) (n) Requirement The registered person must ensure that a structured activities programme to provide stimulation for all service users be arranged, taking into account the circumstances of the service users and their preferences and wishes. Timescale for action 29/02/08 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.V349418.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Fleming House DS0000039582.V349418.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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