Inspection on 18/01/06 for The Field House

This inspection was carried out on 18th January 2006.

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 17/05/07

The Field House 09/05/06

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 Kulwant Ghuman Unannounced Inspection 18th January 2006 09:40 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 DS0000059651.V279527.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 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. DS0000059651.V279527.R01.S.doc Version 5.1 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 DS0000059651.V279527.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. The home is registered to accommodate 21 OP That locks are fitted to the bedroom doors within three months of registration That an assisted shower facility is provided on the first floor within six months of registration That an assisted shower facility is provided on the second floor within 12 months of registration 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 or equivalent by April 2005 15th June 2005 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. DS0000059651.V279527.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection during one day in January 2006. This was the second of the two statutory visits for 2005/2006. To get a full overview of the home this inspection report should be read in conjunction with the report of the inspection of June 2005. During the inspection a partial tour of the building was carried out, care records were sampled, and, six residents, one visitor, the cook and deputy manager were spoken with. What the service does well: What has improved since the last inspection? What they could do better: The home needed to improve the consultations with individual residents regarding the foods provided in the home and the activities available and include these in care plans to better meet individual needs. The management of medicines and meals needed to be improved. The documentation regarding the food needed to be better managed. Care plans for residents needed to cover all areas of need and the appropriate risk assessments needed to be put in place for any activities undertaken by the residents. DS0000059651.V279527.R01.S.doc Version 5.1 Page 6 All residents needed to be treated with dignity and respect by staff. 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. DS0000059651.V279527.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000059651.V279527.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 Residents and their relatives are able to visit the home and receive written information about the home to enable them to decide if the home can meet their needs. EVIDENCE: A visitor told the inspectors that they had visited the home prior to their relative being admitted to the home and that they had been given some written information about the home. Assessments were carried out by the home to enable them to determine whether they could meet the residents needs or not. DS0000059651.V279527.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 There were good assessment procedures in the home that informed the care plans but the care plans did not always indicate all the care needs of the resident and how they were to be met by the staff. There were risk assessments in place but some activities needed risk assessments to be put in place. The management of medicines needed some improvement. EVIDENCE: There were care plans in place for residents however it was noted that not all areas were identified including the management of dental, foot and eye care. Risk assessments were in place for falls on one of the files sampled however, there was no indication of how this was to be managed. The tissue viability risk assessment was carried out in August 2005 and showed no risk, however, the individual had a pressure cushion on his chair and a propad mattress on his bed. The nutritional assessment did not indicate that there was a need for build up drinks and for supplements to go into his food. The individual’s weight records showed that whilst he was in hospital he had put on weight. This could be an indicator that either he has not been receiving the food supplements or his diet was not meeting his needs. DS0000059651.V279527.R01.S.doc Version 5.1 Page 10 The file of another resident indicated in one place that his weight had to be recorded every two weeks but this was then contradicted by the action being described as weight to be recorded monthly. The actual weight was recorded in August, October and December 2005. One of the residents had a microwave oven in his room to re-heat meals and a kettle for making hot drinks however there were no risk assessments in place for their use. There was documentary evidence that the medical needs of the residents were being met by referral to doctors, district nurses, chiropody and dentists. The home used a weekly monitored dosage system and these medicines did not show any discrepancies. An audit of the boxed medication showed several discrepancies. Some of the audits showed that the staff had signed to say that medicines had been given but the audit showed that they had not; in other cases it would appear that too much medication had been given. Some eye drops that should have been stored in the medicines fridge were stored in the medicines trolley and eye drops had not been dated on opening. The manager needed to carry out audits of staff administering medicines to determine where the discrepancies were occurring. During a tour of the building creams were found in the bathroom on the ground floor that should have been returned to the resident’s bedroom after use. The controlled drugs record was well managed, as were the medicines fridge temperature recordings. One of the residents spoken with did not feel that all the staff treated them with respect. Other residents indicated that the staff were helpful and kind. DS0000059651.V279527.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Some residents were happy with the lifestyle experienced in the home whilst others were not. Contact with families and the community was encouraged. Not all residents were happy with the quality and presentation of the meals provided and the manager needed to ensure that the kitchen operated with the needs of the residents in mind. EVIDENCE: There was evidence in the files that a local priest visited the home. There was some evidence of activities taking place in the home including balloons warm up, build up aerobics, music, singers and card games. Some residents went out with families and one resident used the ring and ride service to attend clubs. Some of the residents said that they were bored. One said he had never been offered to be taken out. There was evidence that visitors were able to visit the home on a regular basis. The majority of residents spent their time in one of the two lounges however; some spent most of their time in their bedrooms, going to the dining room only for meals. DS0000059651.V279527.R01.S.doc Version 5.1 Page 12 The daily records for residents were basic and did not give an overview of what they had been doing during the day. Staff should include within the daily record what the residents had been doing during the day. The inspectors noted that at 10.20 am the mid-day meal had already been cooked. This included sausages, mashed potatoes and broccoli. The meals were then reheated for residents to eat at 12.30pm. No rationale could be found for why the meals were being prepared so far in advance. The inspectors were informed that it had been discussed with the environmental health officers who were satisfied that the meals could be reheated. The quality of the meals could be affected and the risks that the foods may not be reheated to a high enough temperature may increase the risk of infection to the residents. The manner in which the foods were being cooled to a satisfactory temperature was also not appropriate. The sausages were left on top of the stove in the baking trays and the kitchen area was found to be very warm as there was no mechanical extraction in operation although the kitchen window was open. The inspectors did not feel that these practices indicated that the home was being run according to the best interests of the residents. Some residents were not having the main meal but were having sausage sandwiches, cheese sandwiches, fish or corned beef. The home was catering for a gluten free diet and had gluten free bread and gravy available. The resident was going to have sausages. There were records of the food chosen by the residents and one of these indicated that one resident always had sandwiches, but the type of sandwich was not always indicated. In discussions with the resident it was determined that he preferred the sandwiches, but that he would not mind having a steak occasionally. Also his family brought in some meals that he could heat up in the microwave oven in his room. The home should make efforts to provide the food that residents want and there should be individual discussions to find ways in which their needs could be met. The inspectors were told that the managers decided what meals would be cooked. The record of meals provided by the cook could not be checked with the meals requested by the residents as the cook’s record recorded only the room numbers and she was not fully aware of everyone’s room and it did not always clearly record what the main meal was at lunch time. The meals recorded on the food temperature records did not always match with the menu and there were some days when the temperatures were not recorded. The temperature of the fridge on some occasions was recorded at 17 or 18 degrees, which would have been too high. DS0000059651.V279527.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents appeared to be confident that they could raise concerns and the manager would attend to these issues. EVIDENCE: There was a complaints procedure displayed in the home. Since the last inspection one complaint had been lodged with the CSCI that was still being investigated and would be reported on separately. Residents spoken with appeared to be confident that they could raise any concerns they had with the managers in the home. DS0000059651.V279527.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 25, 26 The home was generally well maintained and safe and investment in the home was ongoing to improve the facilities. Residents’ bedrooms appeared to meet their needs. EVIDENCE: The home was generally well maintained and there was ample communal space for residents and the furnishings were of a good quality. There were a number of level changes in the home and residents needed to be able to manage a couple of steps to enjoy all areas of the home. There were an adequate number of communal toilets in the home and there were some bedrooms with an en-suite facility. The shower facilities on the first and second floors had been decorated and refurbished to a good standard. The bathroom on the ground floor was due to be refurbished in the near future. DS0000059651.V279527.R01.S.doc Version 5.1 Page 15 There were adaptations made in the home including handrails, raised toilet seats, passenger lift and emergency call system. The manager told the inspectors that an assessment had been carried out for the home regarding any further adaptations that could be made to assist the residents. Three bedrooms were inspected during this inspection, which appeared to meet the needs of the residents. There continued to be an issue of odour control in one of the bedrooms on the ground floor. The bathroom on the ground floor had tiles that had come away in the shower area and the extractor fan was not working. This bathroom was due to be refurbished in the near future. In the bathroom was a pot of Sudocream belonging to a resident, all creams needed to be returned to the resident’s bedrooms after use. It was also noted that staff were disposing of disposable gloves and aprons in the ordinary household rubbish rather than in the clinical waste bins, which was not good practice in respect of infection control procedures. The kitchen was found to be clean and organised. It was noted that fridge temperatures were not always being recorded. Meals should not be cooked too far in advance leading to the need for food to be reheated on a regular basis. Staff were continuing to access the smoking area via the kitchen. There must be a policy in place indicating the times that staff can access this area so that it minimises any risks of accidents or cross infection. DS0000059651.V279527.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. EVIDENCE: DS0000059651.V279527.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 38 The home was well managed in most areas, however some practices such as food preparation needed to be organised with the needs of residents in mind. EVIDENCE: The home was managed and run by a manager who worked hard to ensure that the needs of the residents were paramount. Documentation was well organised and easily accessed. Now that the majority of documents were in place the manager needed to develop audits to ensure that they were being used in an appropriate manner. The inspectors were informed that the home was being externally audited although this was not examined during this inspection. The home looked after money on behalf to two residents however, there was no evidence of the money given to staff for safekeeping. The only record was on an envelope and there were no signatures. One of the balances checked DS0000059651.V279527.R01.S.doc Version 5.1 Page 18 was not accurate and short of a few pence. The manager needed to ensure that any monies or items received for safe keeping were recorded and signed for by the resident or their representative, and a member of staff, or, by two staff if the resident or their representative were unable to sign. Any expenditures made on behalf of the residents needed to be signed by two members of staff and receipts kept for the expenditures. Any items returned to residents or their representatives must be recorded and signatures obtained. Wherever possible individual receipts need to be obtained from the chiropodist and hairdresser. The inspectors noted that as a result of the current ongoing investigation the staff in the home were on edge and there was a strain within the staff team. The inspectors noted that staff kept themselves aware of where the inspectors were and that one of the residents had been returned to their bedroom due to the inspectors visiting. The resident had not wanted to go back to the bedroom. Health and safety was found to be generally well managed but with some issues to be attended to regarding food preparation and recording of food temperatures and fridge temperatures. Inspectors were also surprised to learn that some staff were in the home several hours before they were due to start their shift. DS0000059651.V279527.R01.S.doc Version 5.1 Page 19 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 3 3 3 3 X 3 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X 2 DS0000059651.V279527.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15(1) 15(2)(b) Requirement The manager must ensure that more details are included in the care plans. Care plans must cover all areas of need including oral, dental, foot and eye care. Care plans must be updated as soon as a change has been identified. Risk assessments must cover all areas of risk and activities undertaken by residents. Strategies for the management of these risks must be in place. The manager must ensure that residents receive medication as prescribed. Eye drops must be stored according to the storage advice. Eye drops must be dated on opening and discarded after 28 days. Creams must be removed from bathrooms after use. DS0000059651.V279527.R01.S.doc Version 5.1 Page 21 Timescale for action 01/08/05 2. OP7 13(4)(c) 14/02/06 3. OP9 13(2) 14/02/06 4. OP10 12(5)(b) 5. OP12 16(2)(m, n) The manager must carry out staff medication audits to identify any problems. The manager must ensure that good relationships are maintained between staff and residents based on the principles of respect and dignity. A record must be maintained of the service users interests and the arrangements made to fulfil these needs. Service users must be consulted about the programme of activities available in the home. Daily records for residents must show how they have spent their time in the home. Meals must not be prepared hours in advance unless for a specified reason. The records of food requested and food served must be auditable. There must be policies in place for the most appropriate way in which foods are to be cooled in order to minimise the risks of infection to the residents due to increased levels of bacteria. The food records must have sufficient details to enable any person inspecting them to determine whether the diet was satisfactory in relation to nutrition and of any special diets prepared for individual residents. The bathroom on the ground floor must be refurbished. Fridge and freezer temperatures to be recorded on a daily basis and where they were found to be outside the normal limits this must be brought to the DS0000059651.V279527.R01.S.doc 01/03/06 01/03/06 6. 7. OP12 OP15 12(1)(b) 13(3) 01/03/05 14/02/06 8. OP15 17(2) Sch 4(13) 01/03/06 9. 10. OP19 OP26 23(2)(b) 13(3) 01/03/06 14/02/06 Version 5.1 Page 22 manager’s attention. Staff must not use the kitchen to access the smoking area during times of food preparation. (Previous timescale of 15.7.05 not met.) Protective clothing must be disposed of in the clinical waste bags. The odour control issue in one of the bedrooms inspected must be attended to. CRB clearance must be received before staff are employed. (Compliance not assessed at this inspection. Previous timescale given 01/08/05.) Staff must receive induction training within 12 weeks of commencing employment. (Compliance not assessed at this inspection. Previous timescale given 01/09/05.) The manager must set up audits to ensure that the documents introduced into the home are being used, and include the details required. The manager must ensure that there is documented evidence of all monies left for safe keeping, or for purchases made on behalf of residents, with two signatures and receipts available. There must be records kept of items returned to residents or relatives. The manager must ensure that the balances and actual amounts of money held for residents tally. 11. OP29 19 2(7)(a) 01/03/06 12. OP30 18(1)(c) (i) 01/03/06 13. OP31 24(1)(a) (b) 01/04/06 14. OP35 17(2) Sch 4(9) 14/02/06 DS0000059651.V279527.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP35 Good Practice Recommendations Individual receipts should be obtained from the hairdresser and chiropodist. DS0000059651.V279527.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 DS0000059651.V279527.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!