Inspection on 09/02/06 for Freshfield Cheshire Home

This inspection was carried out on 9th February 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Freshfield Cheshire Home 06/02/07

Freshfield Cheshire Home 27/05/04

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

CARE HOME ADULTS 18-65 Freshfield Cheshire Home College Path Freshfield Formby Merseyside L37 1LE Lead Inspector Mrs Janet Marshall Unannounced Inspection 9th February 2006 09:30 Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 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 Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Freshfield Cheshire Home Address College Path Freshfield Formby Merseyside L37 1LE 01704 870119 01704 834408 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) www.leonard-cheshire.org.uk Leonard Cheshire Mrs Julie Anne Perry Care Home 35 Category(ies) of Learning disability (3), Physical disability (32) registration, with number of places Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 32 PD and up to 3 LD. Maximum no. registered - 35, of which up to a maximum of 30 PC (personal care) and up to a maximum of 12 N (nursing). 3rd February 2005 Date of last inspection Brief Description of the Service: Freshfields is owned and operated by the Leonard Cheshire Foundation. It is registered to provide nursing and personal care for adults with physical disabilities. The home is also registered to provide a service for three adults with learning disabilities and one planned respite placement. A Day care facility is also available within the home that provides a service to residents as well as members of the local community. Accommodation in the home is provided in a variety of settings. Single rooms are available in the large section of the building whilst double and single selfcontained flat like rooms are available in the extensions that are linked to the main building. A large part of the home is purpose built and provides modern facilities. Plans to demolish and rebuild older parts of the building are due to commence in the near future. Freshfields is located in a highly popular residential area of Formby, it is accessed via a private road and shares grounds with another residential care home. Local shops, pubs, and other facilities are within walking distance of the home. Public transport links are also easily accessible. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection to be held at Freshfields this inspection year (April 2005 to March 2006). This was an unannounced visit and was held during the day. The inspector used a number of National Minimum Standards for this service to measure the quality of care provided at the home. The inspection included a tour of the premises, examination of a selection of records as well as gaining the views of residents who live there. Discussion also took place with senior staff, care and ancillary staff and some relatives who were visiting residents at the time of the inspection. The home had a pleasant atmosphere and staff were observed spending time with residents in the main lounges and also chatting to relatives. Communication between staff and residents was good and discussion with staff confirmed that they had a good knowledge and understanding of the needs of the residents. What the service does well: What has improved since the last inspection? Since the last inspection redecoration of the corridors in the Nutcracker suite have begun improving the appearance of that part of the home. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 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. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Full and proper assessments are carried out prior to admission of residents to ensure that the home is able to meet their needs. EVIDENCE: Several new residents have been admitted to the home in the last twelve months. The current procedure when choosing to live at the home is a gradual process of moving in which was discussed with and confirmed by the 2 residents. Both the resident’s recently moved in. Before moving in, they had a process of visits to the home to view it, to meet other residents, to join a meal and to stay overnight. Assessments for new residents were detailed and informative. One resident said, of moving into the home, “ I was allowed to bring my own belongings which make me feel more at home. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. Key standards 6, 7 & 9 were assessed at the last inspection and were met. EVIDENCE: Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 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. Key standards 12, 13, 15 & 17 were inspection during the last inspection and were met. Residents are given choices and are able to move freely around the home as part of an independent lifestyle. EVIDENCE: Residents were seen using all parts of the home. Staff provided the help and assistance that is required to enable residents move around the home. Information in care files provide staff with clear information about how best to support residents to move about the home freely and safely whilst respecting their right to do so. Several good-sized communal lounges and a large dining room, which is located close to the kitchen, provides residents with a good amount of shared and private space apart from their own bedrooms. Staff were seen offering residents with choices and respecting decisions that they made. Lunch was served in the dining areas and if a resident wishes to receive their meal in their room this service is provided. A number of residents commented Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 11 on the good choice and quality of the food. The menu for the day was clearly displayed in the dining room. Staff were seen offering assistance to residents with their meals in a discreet unhurried manner. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. Key standards 18, 19 & 20 were assessed during the last inspection. Standards 18 & 19 were met. Standard 20 was not fully met so was reassessed during this inspection. Residents are not completely protected by the homes procedures for administration & recording of medication. EVIDENCE: A requirement was raised as part of the last inspection report to ensure that all Medication Administration Record (MAR) sheets are appropriately completed. That was because some parts of the MAR sheets that were examined at the last inspection showed no signature or mark at intervals when prescribed medication needed to be administered. The nurse in charge gave various reasons for the gaps, for example, absence of residents due to being on holiday, hospital admission or medical appointment, residents refusing to take medication and the completion of a course of medication. The Nurse on duty was unable to explain several of the unsigned records, a signature or mark is required whatever the reason for medication not being administered. Unsigned MAR sheets indicate that prescribed medication has not been given, putting residents at risk. The manager responded to this by providing written guidance for staff to follow. This was provided in the form of a chart titled ‘Recording Codes’, which Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 13 was displayed on the wall near to, were medicines were being administered. A copy was also viewed in the file were MAR sheets were kept. The chart clearly identifies which code is to be used and what for. For example, ‘A’ when a resident is absent ‘C’ for course completed ‘R’ for refused and so on. Some MAR sheets that were examined at this inspection again showed in parts no signature or mark at intervals when prescribed medication needed to be administered. Other discrepancies were also noted including inconsistent stock balance recordings and incorrect balance of medication. The nurse in charge explained that it is the responsibility of the nurse in charge of each shift to check medication stock balances, which are then recorded on MAR sheets. In some cases records showed that stock balances had not been recorded other records showed incorrect balances which were indicated by the mark of a circle, however there was no record of any action taken in response to this. It was clear that some staff that are responsible for the administration of medication were not following the homes policies and procedures in relation to this practice therefore putting residents at risk. During this inspection an immediate requirement was given for this. Within the timescale given the manager carried out a full investigation and took the necessary action in response to the outcomes. The details of this were forwarded onto the Commission and found to be satisfactory. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Residents were confident that their concerns or complaints would be listened to and acted upon. Safeguards were in place to protect the people living in the home from abuse. EVIDENCE: A complaints procedure was viewed at the home. The procedure includes details about the action and timescales involved in the process, and it also included details of the Commission for Social Care and Inspection (CSCI). Residents spoken with had no concerns about the service and said that if they did they would be confident in approaching the staff should any arise. A number of other policies and procedures were in place to protect the safety, health and welfare of residents including a Protection of Vulnerable Adults Procedure (POVA), which clearly describes what action, must be taken in response to suspicion or evidence of abuse. Records reflected that all staff are up to date with POVA (Protection Of Vulnerable Adults) training. Service users have regular meetings as a group and individually with their key workers where they can raise any concerns or worries they may have. Over this and previous inspections, service users who have been spoken to were all quite assertive and positive about telling someone if they felt bullied or abused. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. Key Standards 24 & 30 were assessed during the last inspection. Standard 24 was not fully met so was reassessed during this inspection. Parts of the environment are being improved to enhance the comfort and dignity of the residents. EVIDENCE: A partial tour of the home was carried out. All parts of the home were clean and tidy. A number of policies and procedures, which relate to maintaining a healthy and safe environment, were available in a handbook for staff and residents to refer to. Such policies included Control of Infection and Health and Safety in the work place. The correct procedures were carried out and the appropriate equipment such as protective gloves, aprons and water-soluble bags were seen being used to minimise the spread of infection. Most parts of the home were maintained to a good standard. A requirement was raised as part of the last inspection report for the chairs in the smoking room to be repaired or replaced that was because they were heavily stained and/or damaged. The chairs, which were seen during this inspection, have not yet been attended to. The senior nurse said that the area is soon to be refurbished which will include the replacement of the chairs. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 16 Another requirement that was raised as part of the last inspection report was for the décor in the corridors of the ‘Nutcracker’ Suite, which was in poor condition to be redecorated. A tour of this area showed that redecoration of it is well underway. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35. Key Standards 32 & 34 were assessed during the last inspection and were met. Up to date medication training is required by all staff that administer medication so that they are fully able to meet the needs of the residents. EVIDENCE: Training is identified and arranged by a training officer who is based in the home. A database, which has been set up by the training officer, was viewed during the inspection. It showed that all new staff follows a structured induction programme during the first part of their employment and that all staff have completed or are booked on mandatory training courses. Other training specific to residents needs is also provided. Records showed that medication update training has not been completed by staff that are responsible for administering medicines to residents. Staff are required to undertake training specific to the roles that they perform. This includes the safe handling, recording and administration of medication. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Key standard 42 was inspected at the last inspection but was not fully met was reassessed during this inspection. Residents are consulted about how the home is run. Residents health and safety is put at risk by practises used for holding open fire doors. EVIDENCE: Records showed that quality monitoring systems are in place at the home. This involves residents and/or their relatives/representatives being consulted on their views about the home. This is done through discussion, which is recorded and/or written questionnaires. This is an important process as it shows that the home is run in the best interests of the residents. Also as part of a quality assurance process and in accordance with Regulation 26 of the Care Homes Regulations 2001 Amended (2004), a representative for the home visits the premises monthly. They interview residents and staff and inspect the environment. It is important that this is done to check records and form Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 19 an opinion of the standard of care in the home. Following the visit the representative writes a report and sends a copy to the Commission. Records and discussion with staff showed that they have completed health and safety training. A requirement was raised as part of the last inspection to ensure that fire doors are kept closed or held open by use of appropriate equipment. That was because fire doors were being held open by use of hooks and string, which posed a risk to residents in the event of a fire. The use of automatic door closures was advised as a more appropriate method of holding fire doors open. During this inspection it was noted that some fire doors were still being held open by the methods as described above. This practice continues to put residents safety at risk. A safer method of holding fire doors open must be used. Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 1 X 3 X 3 X X 2 X Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 21 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 2 Standard YA42 YA20 Regulation 23(4)(a) 17(1) Schedule 3 3(i) 23(2)© Requirement Fire doors must be kept closed or held open by use of appropriate equipment. Medicine Administration Records (MAR) sheets must be completed according to the homes Policies and Procedures. The furniture in the smoking room must be repaired or replaced. Medication update training must be provided for all staff that administer medication. Timescale for action 31/03/06 09/02/06 3 YA28 31/05/06 4 YA35 18(1)©(i) 30/04/06 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 Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Freshfield Cheshire Home DS0000017236.V284767.R01.S.doc Version 5.1 Page 23 - 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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