Inspection on 17/05/07 for The Field House

This inspection was carried out on 17th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Field House 02/06/08

The Field House 09/05/06

The Field House 18/01/06

The Field House 15/06/05

The Field House 13/01/05

The Field House 23/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Field House 110 Harborne Park Road Harborne Birmingham West Midlands B17 0BS Lead Inspector Jill Brown Key Unannounced Inspection 17th May 2007 08:50 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 The Field House DS0000059651.V335909.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. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Field House Address 110 Harborne Park Road Harborne Birmingham West Midlands B17 0BS 0121 426 3157 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) Park House Care Ltd Ruth Bosworth Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered to accommodate 21 OP That a minimum of 2 care staff are on duty at all times with additional ancillary & support staff as necessary to meet the needs of the service users That the manager completes the Registered Managers Award and supplies a copy of the certificate to the Commission by 31st August 2006. 23rd November 2006 Date of last inspection Brief Description of the Service: The Field house is a privately owned residential home for 21 older adults. The home is a Georgian house built in 1760 and retains some of its original features and appearance. Care facilities are provided on three floors and all areas can be serviced via a passenger lift. All rooms are for single occupancy and fourteen of these rooms have en-suite facilities. There is a split-level lounge, two dining rooms, and kitchen and laundry facilities on the ground floor. The home has pleasant gardens and a swimming pool in the grounds. The home has a separate hairdressing salon. The home is within a short walking distance of Harborne High Street and is on a main bus route. The home had yet to determine its fee level with social services for April 2007 to March 2008 previous years fees were for between £1416-£2600 per calendar month. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced key inspection, where the majority of standards were looked at, took place in this home in May. Since the previous key inspection an unannounced random inspection took place in November 2006. This report is about what was found on both of those visits. In May the inspector spent over 8 hours at the home case tracking the care to three sampled residents. As well as talking to these residents and looking at their care records, records of medication administration, residents’ personal allowances, accident records, were looked at. Staff files were checked and staff were talked to about their training and the care of residents. Most of the building was looked at over these two inspections. The inspector joined residents for the main meal of the day. We also received comment cards about the service one from a resident, two from relatives, two from health professionals and one from a voluntary visitor. There have been no complaints reported to us since the last key inspection in May 2006 What the service does well: Residents have a thorough assessment before being admitted. From this assessment the home collects further information from sources such as NHS direct to ensure they understand the needs of the resident. Residents have the opportunity to visit the home as many times as they wish to decide if it is what they want. Residents have the benefit of a contract with the home. Small details are recorded such as a resident needs a spoon at meal times to ensure that residents can be met on arrival. The home records and tries to provide opportunities for residents to follow their religion. Residents with health care needs had these checked and where there were concerns these were referred to health professionals. A health professional thought the residents were well cared for. Relatives that made comments thought ‘the home gives love and friendship and help’ and ‘cares for people in the right way.’ The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 6 The medication systems were good and records were generally accurate. Visitors were made welcome in the home and the home has spaces where visitors can talk to their relatives privately. Residents and relatives thought that the food provided was homely and good, fruit was always available. Residents likes and dislikes in food was catered for. Residents were able to spend time in their own rooms if they wished, residents brought in furniture and belongings from their homes if they wanted. The home responded well to allegations about a member of staff to ensure residents safety. The home was clean and fresh on the day of the inspection. Residents that needed aids to ensure their safety had these aids provided. Staff are employed on the basis of an application form an interview and checks. Ruth Bosworth the manager is experienced and trained in the management of the care of older people. There were good records of the maintenance and inspection of equipment in the home and this ensured gas, electrical and fire safety. What has improved since the last inspection? What they could do better: At the moment there are no male carers although there are 3 male residents this means that male residents cannot choose to have their personal care delivered by a male carer. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 7 Risk assessments must be completed as soon as residents enter the home to ensure for example that residents are transferred from place to place safely and that they are safe to self administer medication. The manager needed to ensure that staff always where required counted the medication and ensured it was correct before signing. Whilst activities are provided these are not consistent and recording of activities undertaken was inconsistent. Whilst residents were happy with the meals provided a more formal choice of lunchtime meal would involve residents more. Small grumbles and concerns need to be recorded to ensure that the home can continue to improve and a range of methods of getting views from residents need to be explored. Records of discussions about residents behaviour with professionals need to be recorded and decisions about how the situation is to be managed clearly recorded. One member of staff was working in two places however they need to have a Criminal Records Bureau disclosure for each place of work and this must be followed up. A matrix of staff training needs completing to ensure that the skills of the staff on duty are enough to meet the needs of the residents. A quality assurance system needs to be in place that takes accounts of residents’ opinions and develops a plan of improvement for the home. Residents were paying for services such as hairdressing and chiropody by invoice, records of this were not in the home so it was not possible to audit this information. A resident has recently needed a supply of oxygen arrangements had not been made to ensure that the storage of oxygen bottles was sufficient to maintain the safety of residents and firemen in the event of a fire. 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. The Field House DS0000059651.V335909.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 The Field House DS0000059651.V335909.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): 2,3,4 &5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive a contract about the terms and conditions of their stay and this protects residents’ rights. Residents’ needs are fully assessed prior to admission; this ensures that residents are confident that their needs will be met. The home tries to ensure that all residents’ needs and wishes are met and this makes residents satisfied with the care in the home. EVIDENCE: Residents of the home had a contract. The fees for the home for this year had yet to be finalised. Privately funded residents received a letter each year about the changes to any fee level. Residents that came in via social services had a three-way contract between them, social services and the home. A comment card received said that the resident had enough information before admission and received a contract. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 10 Admission dates were not easily trackable from the file but were supplied later. An assessment of resident’s needs was in place for each resident case tracked. These needs assessments took place before residents were admitted into the home. Residents were encouraged to visit the home before coming to stay. A resident visited the home four times before deciding it was the home for them residents can stay have a stay over night if they wish before reaching a decision to try the home. A thorough assessment was undertaken with detail about residents’ health, personal care and social care needs being described. For example where a resident had a health condition that affected their behaviour. Previous admissions to hospital were recorded and descriptions of health conditions such as emphysema were downloaded from NHS direct website including information on how to manage these conditions. This enabled staff to be aware of how residents can be affected by their health condition. The assessment details matched information given by social workers if they were involved in the admission process. Useful information about how residents’ disabilities can be accommodated was collected. For example has hearing aids but cannot put these in has an induction loop television, needs a spoon at mealtime to remain independent and likes a glass with a handle. These items were found in place for the particular residents during the inspection. Residents that are able and wish to are assisted to use services such as ring and ride and activities that they did prior to admission. These details assist residents in maintaining their independence. Resident’s religion was recorded and their views about it such as ‘No longer attends church but would like the vicar to give communion.’ In an effort to ensure that the home could meet the residents spiritual needs. The home arranged for visits from both Church of England and Roman Catholic churches. Residents in this home were all from white UK backgrounds and the majority of staff were white UK there are no male staff and the home has three male residents. This means that whilst residents have staff that understand their cultural background male residents did not have the opportunity to have male carers if they wished. The Field House DS0000059651.V335909.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 adequate This judgement has been made using available evidence including a visit to this service. The home is now planning care for residents well resulting in their personal care needs being met. The delay in the risk assessing new residents could put residents health at risk. The home manages residents medication needs well and this promotes residents health. Residents are treated with dignity and respect and this is likely to ensure residents are happy in the home. EVIDENCE: The manager had developed a new care plan to help staff to get information quickly from the residents care files. Not all files had been updated but the manager had made good progress whilst managing the home without a deputy manager. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 12 Care plans that had been changed to the new system, including all new residents, were detailed and ensured that staff had clear instructions for providing care. The care plans also contained information about resident’s life history, which is important to assist staff to remember the varied and full lives people have had before requiring assistance they need whilst resident. Care plans had specific details such as the resident ‘needs bathing on Sunday and Wednesday at least’ and night routines such as ‘7.30 pm cake or toast with hot milky drink.’ These details help care staff provide the care in the way residents want. Care plans seen had been reviewed and any changes to the residents needs had been updated in the plan. One resident’s care plan out of the three case tracked did not have all their risk assessments completed. This resident did have some risks about their moving and handling and medication administration. These risks had been identified, and practical steps taken but these were not backed up by a clear risk assessment so consistency of approach and triggers for concern were not clear. However those risk assessments that had been completed were of a good quality. For example a moving and handling risk assessment resulted in instructions that described the equipment, the number of staff needed, how the member of staff was to provide the support for each transfer the resident needed throughout the day. A resident that falls had equipment described of a pressure mat by the bed so staff could hear an alarm if she was up. This equipment was in place during the inspection and the inspector saw good moving and handling practices. A health professional however thought more training on moving and handling needed to be undertaken. Residents that had pressure areas had district nurse intervention to ensure that these needs were met. Two health professionals were asked to complete comment cards. The one returned said ‘the home is very well run staff are well trained and it seems a happy care home. Clients seem well cared for.’ Residents’ health needs were referred to health professionals and appointments made were kept. Residents personal hygiene needs were seen to be met. One health professional commented that there was ‘good information with the multi-disciplinary team –always quick to phone us about information or help with residents.’ The home had good systems in place that should ensure that a safe administration of medication takes place. Residents that were allergic to penicillin had this placed in their care plan on their care summary and on the Medication Administration Record (MAR). Photographs were with the medication administration record and this gives another check during the administration. Medication brought in by the resident were discussed with the GP and medication needed confirmed. Residents that wish to retain selfadministration of medication were assisted to do so one resident selfadministered part of their medication. However formal risk assessments were not always completed in a timely way. All the medications checked in the The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 13 monitored dosage system were correct. One tablet, not in the monitored dosage system, could not be accounted for. All medications of that type were checked by the inspector and found to be correct in number. The manager had done audits of medication in March and April. Staff talked to about administration of medication were clear that staff that were not trained did not give medication to residents. Residents comments about the home were ‘I find the care and support of the ‘’management’’ in the home very encouraging.’ and ‘ the staff are very good and I am happy in this home’ One resident when asked what she would tell other people about this home said ‘I would say ‘its wonderful and the staff are very kind.’ Staff seen during the day treated residents with appropriate levels of respect. One staff being heard to encourage a resident down the corridor saying ‘well done X.. I’m behind you…well done hold on to there that’s lovely.’ All the 21 bedrooms are for single occupancy and 14 of them have en suite facilities and this enable residents to maintain their privacy if they wish. The Field House DS0000059651.V335909.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. Residents that are able to determine what they wish to do are encouraged to do so, the home does not provide enough activities for residents that are unable to initiate activities for themselves. Residents are able to receive visitors and this contact enhances their lives. There are no undue restrictions and residents are able to make some choices about how their care is delivered. Residents enjoy the food provided at the home. EVIDENCE: Recording of activities provided could be improved. Residents records seen showed that residents attended sessions to improve their mobility, had their nails painted, had walks in the garden. Conversations with staff showed that some residents enjoyed cards, bingo and monopoly. On the day of the inspection a representative from the PAT, a scheme that brings animals and in The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 15 this case a dog, came into the home. A comment card said that the home should provide ‘more indoor activities during the day when possible I think this would benefit some clients.’ One resident was encouraged to go out on ring and ride and to assist in the home and this is good practice as it maintains their skills. Visitors thought they were made welcome in the home and comment cards from five sources spoke of the friendliness and kindness of the staff in the home. There are areas where residents can sit with visitors to talk privately if they wish. Residents tend to have meals at set times and in the dining rooms unless the resident is too unwell to join the other residents. Residents were able to return to their rooms and spend time there if they were safe to do so. Residents thought they could go to bed when they wished. Residents were offered the planned meal at lunchtime and there were other choices available on request. Choices were clearly available on the menu for other meals. On the day of the inspection residents were seen enjoying a cooked breakfast or cereals and toast. Residents were responded to as requested and needed during the mealtime. Residents that needed equipment or needed special considerations had these taken care of such as ‘cannot see white cup against a white background.’ Residents said of the food, ‘The food is good I like the puddings,’ ‘I like the roast beef and the rice pudding,’ ‘I have been ill but it hasn’t affected my appetite and the food is good.’ ‘The meals are all right you can’t please all the people all of the time.’ And ‘look at all that fruit we can eat it when we want.’ A visitor’s comment card said ‘The meals supplied are good quality home cooking.’ Special diets were catered for and there was an awareness of residents’ favourite foods. For example one resident had a liking for duck eggs and these were found in the fridge during the earlier inspection. The home had large amounts of fresh frozen and dried foods to prepare meals. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are aware of how to make a complaint but the lack of documentation about their small issues can lead to these recurring. Whilst aware the need to protect residents the lack of full consultation and recording could lead to inconsistent outcomes for residents. EVIDENCE: The home had received no formal complaints about its service and neither had we. Complaints were not raised with the inspector in either of the two visits. Residents meetings had not been held for some time and there were no records of small concerns that had been resolved on a day. This recording could be beneficial in planning improvements and monitoring performance. Residents spoken to knew who they would speak to about any concerns they had. Ruth Bosworth the manager of the home was clear about maintaining the safety and protection of residents. The manager contacted Social Services and us about the performance of a member of staff that could have put residents at risk. With consultation this was dealt with appropriately through the home’s disciplinary processes. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 17 One resident had behaviour that caused injury to them and this was not sufficiently recorded. Records of discussions with professionals and relatives did not make clear whether this was an issue that required multi agency discussion. Discussions with health professionals were not in sufficient detail to determine agreed methods of management. Staff had adult protection training 2 years ago and the manager is trying to arrange refresher training. Residents are checked for injuries on admission and this process ensures that the home can be clear about how any future injuries may have occurred. Residents have an inventory of their belongings on admission to the home to ensure their safety. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 18 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): 19,22,24,25 &26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment provided is comfortable for residents and is improving however further work is needed to ensure that risks to residents are minimised. EVIDENCE: The home’s environment had improved. The home had completed the electrical rewiring needed and corridors were being decorated at the time of the inspection. The garden appeared to be well maintained and the swimming pool was drained awaiting repairs. The home had made a bid against monies from Social Services, to replace the carpets in the two dining areas and lounge and to refurbish a bathroom. These have been requirements following previous inspections. The kitchen also needs refurbishment as cupboard doors showed signs of the board underneath the melamine on the edges and this makes them difficult to clean. There a number of stepped areas in the home which The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 19 means residents have to be able to negotiate these. This was of concern for a health professional. Eight residents bedrooms were looked at and these were well furnished and decorated a number having new furniture. A number of residents’ wardrobes were not restrained against the wall and this could lead to residents accidentally pulling them over. Bedrooms showed that residents were able to bring items of their own furniture, a queen sized bed being seen in one room and televisions and photographs being found in others. Residents’ room met the needs of the residents in the home. One resident was found to have an alarm floor mat that indicated that she had got up during the night and this fitted with the risk of falling assessment the home had completed. Residents that wanted had telephones in their rooms that had large digits for ease of use. Wheelchairs were available for residents that needed. A resident talked about the use of the wheelchair in the home saying that it was used when she needed it but that they also assisted her to walk. The home was found at previous inspections not to have fail safe devices fitted on hot water taps to ensure that water is not at a temperature to scald residents. However the home was having these fitted incrementally and had fitted all the communal bathing and shower areas and 14 bedrooms with these by this inspection. The home was clean and fresh. Comments received said ‘doesn’t smell like an institution. Ambience of clean spacious comfortable and friendly place.’ ‘The grounds are kept in good condition and the interior is well maintained.’ ‘The washing and laundry is to a good standard.’ The home was found to have appropriate checks on water quality. The kitchen kept appropriate records of fridge and freezer temperatures and ensured that by food probing food was served at an appropriate temperature. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 20 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 adequate This judgement has been made using available evidence including a visit to this service. Whilst the home is undertaking training for staff it could not show that the minimum standards for training were met and this may mean that staff and not adequately trained to meet the needs of residents. The level of staffing in the home is appropriate and checks were made before staff were employed and this keeps residents safe. EVIDENCE: Rotas provided showed that two care staff were on duty at all times but that at times three care staff were available during the morning. The home had a cook available every day and housekeeping support five days a week. Residents thought that there were enough staff available. The home has just under 50 of the care staff qualified with an National Vocational Qualification level 2 in care (NVQ2) other care staff have started this training this ensured that care staff have a basic knowledge about the care of older people. Three care staff have also completed an NVQ 3 and another is completing the course. The home ensured that new staff complete an application form, were interviewed and records were kept of this process. Checks were made about future staff’s background by gaining of 2 references and checks of the The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 21 Protection of Vulnerable Adults register and gaining enhanced Criminal Records Bureau (CRB) disclosures. One staff member continued to be employed elsewhere and although this employment had not ceased another CRB disclosure was needed as these are not transferable. The home had an induction process that met Skills for Care recommendations. The manager had not updated the staff training matrix and this is important because it enables the manager to determine what training is needed next. One staff file showed that there were certificates for, first aid, basic food hygiene, medication, moving and handling, infection control, adult protection, person centred dementia care. Staff interviewed had a range of training. The manager had arranged training recently in fire safety, moving and handling, Dementia care and mental health issues and first aid. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management time is stretched at this home and this means that areas of quality assurance, supervision of staff and gaining the views of residents are not met. This lack means improvements cannot be planned in the residents wish. EVIDENCE: Ruth Bosworth is an experienced manager of the care of older people. Whilst she has completed the Registered Managers Award she is awaiting verification of this award. Comments from all sources were positive about the management of the home one comment was ‘she is a good manager she makes time for you and the resident.’ The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 23 A formal quality assurance system was not found. A quality assurance system needs to take all stakeholders views and audits of the service into account. This should result in an annual report and an improvement plan for the next year. However there are areas of the homes practice that can be built upon. The owner of the home visits the home produces a report. These reports were usually bi monthly. The reports were detailed and showed evidence of checks being made of the building and examination of records. Residents and staff were talked to and feelings about the care provided recorded. Residents that are privately funded receive letters every year about the fees and some information about what has happened in the previous year and what is planned and this could be a good starting point. The home had started a key working system and this too could give valuable information to improve the service. Staff and residents meetings had not happened due to the lack of management time and this needs to be rectified. Residents of this home either managed their own finances or were assisted by relatives. One resident had a sum of money in the safe and asked for amounts, as they wanted. It was the homes practice to invoice residents or relatives following having services such as hairdressing and chiropody. These records were not available at the home and the inspector was unable to track these to ensure good systems were maintained. The manager had undertaken formal supervisions of some staff but the shortage of management time had meant that some staff had not received formal supervision latterly. This is important it ensures that standards are met and that staff have the opportunity to discuss concerns. Records of the maintenance and inspection of services such as gas safety and electric safety were found. Qualified companies checked lifting equipment including the passenger lift. Fire safety was maintained equipment and alarms were checked routinely, drills were undertaken and staff interviewed understood their responsibilities. The manager had just completed their fire risk assessment to the meet the new fire regulations however a new resident had been admitted that required oxygen. There was no notification on the door where oxygen was housed and oxygen bottles were not secured to a wall. These measures help to ensure safety of residents and firemen in the event of a fire. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 17 X 18 2 2 X X 3 X 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 2 X 2 The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 13(4)(c) Requirement Timescale for action 25/06/07 2. OP9 13(2) Risk assessments must be in place without undue delay following a resident’s admission into the home to Ensure risks to residents are identified and steps taken to prevent or minimise these risks. Outstanding since 30/12/07 30/06/07 A self-administration risk assessment must be completed with residents that wish to selfadminister medication to ensure that residents are safe to do so. Controlled drugs must not be signed for if the balance of medication is incorrect and discrepancies must be investigated to ensure that such mediation is only used for the resident intended. 3 OP18 13(6) Records of all contact with health 25/06/07 professionals about residents with self-injurious behaviour must be kept. This is to ensure that residents are receiving appropriate treatment for their mental health and any concerns raised can effectively show this DS0000059651.V335909.R01.S.doc Version 5.2 Page 26 The Field House 4. OP19 23(2)(b) 13(4)(c) 5. OP29 13(4)(c) 19 6. 7. OP35 OP38 17(2) Sch4 9 23(4)(a) behaviour has been appropriately investigated and the right steps taken. The home must have a system in place to ensure that wardrobes cannot be accidentally tipped over to ensure that residents remain safe. The home must ensure that all staff have a criminal records bureau check relevant to the home. This is to ensure the safety of residents. Records of financial transactions with residents must be available in the care home for inspection. A safe system of storing oxygen must be found to limit the potential for and protect residents and firemen in the case of fire. 30/06/07 31/07/07 30/06/07 25/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations All resident’s care plans should be organised and updated to ensure that information is set out in the same way can be collected quickly. A record must be maintained of the service users interests and the arrangements made to fulfil these needs. Individual plans must be devised for residents not able to benefit from group activities or those that spend their time in their room. 3 4 OP16 OP19 Small concerns should be recorded to inform the improvement of the service. A carpet in a dining room should be replaced and in the mean time must be monitored for any risks it can cause. DS0000059651.V335909.R01.S.doc Version 5.2 Page 27 The Field House 5 OP19 6 7 8 9. 10. 11 OP25 OP30 OP31 OP32 OP33 OP36 The cupboards in the kitchen should have surfaces that are cleanable. This is to ensure that the kitchen can be cleaned appropriately and does not become a hazard to the health of the residents. A programme of ensuring that residents’ wash hand basins have hot water that cannot go over 43 degrees centigrade. This is to ensure that residents do not get scalded. The home must produce a matrix to demonstrate the care teams training and devise a training development plan. The manager must complete the Registered Manager’s Award and send a copy of the certificate to the Commission. Staff meetings should be held on at least 2 monthly basis and be recorded A system should be implemented to take the views of those people using the service into account. This will contribute to person centred care. Staff formal recorded supervision should be a minimum of six times a year. The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 The Field House DS0000059651.V335909.R01.S.doc Version 5.2 Page 29 - 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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