Care Home: Field House Nursing Home

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What the care home does well People continue to express a high level of satisfaction with the service they are provided with. One person told us `we are completely delighted and reassured by our relatives place in Field House, they are well staffed and very caring, responsive to needs, always ready to discuss, they are wonderfully compassionate`. A medical professional said Field House could act as a `beacon for other nursing homes`, they said it was `an excellent nursing home in all respects`. People can be confident that their nursing needs will be met by staff who have a good record of taking preventative action to improve the health and well-being of frail older people with complex needs. People can be confident they will be supported by skilled staff. Residents tell us the staff are sensitive and understanding. One person said `the staff are very good there is always someone to talk to`. Another person said `we are thoroughly spoilt, there is nothing I would change`. People tell us they enjoy their meals and are involved in planning menus. One person said `the meals are lovely never the same twice`. People are provided with a service that discretely meets their nursing needs and enables them to focus on the social side of their daily lives. Despite people`s frailty and mobility needs the staff at Field House provide a range of stimulating social and recreational activities both inside the home and trips further afield. What has improved since the last inspection? To make sure high standards are maintained redecoration and refurbishment of the home has continued year on year. People are particularly enthusiastic about the garden, which provides them with varied areas to sit and enjoy the flowers and features. People can be confident that there are training programmes in place to develop the skills of staff and keep them up to date with changes in nursing practice. A recent development has been the link between nurses at Field House and a tissue viability nurse employed by Bupa to provide advice and guidance across their services where needed. Particularly in relation to the prevention of pressure sores. To encourage people in wheelchairs to maintain their independence a ramp has been added to one of the external doors to enable easier access into the garden. The manager and Bupa continue to develop ways of getting residents involved with the running of the service and are currently focusing on menu planning. What the care home could do better: People can be confident that the current manager keeps things under review, responds to changes needed within the service and is enthusiastic in her approach to identifying future developments to enhance people`s experiences. Key inspection report Care homes for older people Name: Address: Field House Nursing Home 8 Townsend Road Harpenden Hertfordshire AL5 4BQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sheila Knopp     Date: 1 9 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Field House Nursing Home 8 Townsend Road Harpenden Hertfordshire AL5 4BQ 01582765966 01582769622 alland@bupa.com www.bupa.com BUPA Care Homes (BNH) Ltd care home 37 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Field House is a care home registered to provide nursing care for older people. The home is situated in a pleasant residential area of Harpenden within walking distance of the town centre facilities and pleasant parks and gardens. It is accessible by public transport and is a short walk away from the bus stop and the train station is approximately three - quarters of a mile away. The building is an extended period house with some modern additions. The lounge and conservatory, which overlook the garden, provide a focus for most of the service users and their visitors during the day. Meals are taken in the attractive period style dining room. Field House is part of Bupa Care Homes. Care Homes for Older People Page 4 of 27 Over 65 37 0 Brief description of the care home The current fees are £1145 - £13500 per week depending on room size and an assessment of nursing needs (correct on 19/8/09). Information about the home in the form of a Service User Guide and a copy of the latest inspection report can be obtained from the manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Our last inspection of Field House took place on 23rd August 2006. At that time the home was given an excellent rating, which meant we carried out annual service reviews during 2007 and 2008. Annual service reviews do not involve a visit to the home but are an assessment or risk based on the information we have received and the views of people using the service. These reviews told us that people continued to express a high level of satisfaction with the service provided at Field House. For this inspection we visited the home and met with residents, visitors and staff. We reviewed relevant records that provided information on the care provided, staff recruitment and management of quality and safety systems. To make sure a wide range of views have been considered for this assessment we sent surveys to 10 residents and their relatives and 5 health and social care professionals, such as general practitioners. We received replies from 4 residents, 3 relatives and 3 Care Homes for Older People Page 6 of 27 health care professionals. We have also reviewed information we have received about the service since the last review took place. This includes the Annual Quality Assurance Assessment (AQAA) sent to us by the manager. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also provides numerical data. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: People can be confident that the current manager keeps things under review, responds to changes needed within the service and is enthusiastic in her approach to identifying future developments to enhance peoples experiences. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People looking to move into Field House can be confident that they will be involved in an assessment to make sure support can be provided to meet their individual needs and preferences. Evidence: To look at the arrangements made for people choosing to move into Field House we met two people who had recently come to stay and discussed their experiences. We found that people were happy with the support they were receiving from staff to help them settle in. When new residents arrive at Field House the manager makes sure key people and department heads are informed about peoples individual wishes and lifestyle choices so that an individual service can be developed for them. People had been assessed by the manager before their admission was agreed to make sure staff in the home knew what people needed and any specialist equipment could Care Homes for Older People Page 11 of 27 Evidence: be provided before they arrived. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will receive the care and support they need according to their individual preferences because they have an individual plan of care, which is regularly reviewed and are supported by well trained staff. People can be confident that they will receive the medicines they have been prescribed when they need them because there are well managed, safe systems in place. Evidence: To assess whether people are receiving the care and support they need according to their individual wishes we have considered the views of residents and relatives we spoke to during our visit. We have also reviewed relevant care and medication records and taken account of the information we received from community health & social care professionals, who visit Field House and the information we received from the managers self assessment. People have detailed plans of care in place that tell staff what their personal preferences are and how they wish to be supported. Care Homes for Older People Page 13 of 27 Evidence: People are supported to achieve high levels of personal care and attention to their appearance. The hair dresser was present on the day we visited. Peoples privacy and dignity is supported because staff attend to their needs discretely and sensitively. This means the emphasis on peoples daily lives revolves around the sociable atmosphere at Field House. Regular audits of the nursing care provided to people are carried out and these tells us staff continue to maintain high standards of care. This includes improving the health and nutritional status of people who are very frail on their admission to Field House from hospital. One person told us their relative had gone from strength to strength since moving to Field House. The home has a very good record of preventing pressure sores and treating wounds that are present on admission from hospital. There are close links with St Francis Hospice and other community health & social care staff available to provide people living in the home with support. A health professional told us the staff were always professional and had a good knowledge of patients medical histories and were caring towards patients. Staff continue to receive training to meet the needs of people with complex needs who require high levels of nursing intervention. There are safe systems in place for the management of peoples medicines and regular audits are carried out to make sure standards are maintained. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People express a high level of satisfaction with the arrangements made to provide stimulating activities, social occasions including friends and family, entertainment and meals they enjoy. Evidence: The residents and relatives we spoke to during our visit were able to confirm that there are opportunities to take part in a range of stimulating activities and social events. These include pampering sessions, exercise classes, a recent themed world tour visiting different countries and involving the experiences of residents and staff in celebrating the cultural diversity of each area. People are supported to maintain any religious connections they may have and are supported to go out to church if they wish. The manager has made a computer available to residents but this is not currently connected to the internet. The activities organisers plan a programme that encourage people to think about things outside the home. For example supporting and following specific charities. There are opportunities for family and friends to attend social occasions. A jumbulance is made available to organise trips outside the home. Special occasions are supported and celebrated. For example a birthday trip to Luton Hoo for afternoon tea. Care Homes for Older People Page 15 of 27 Evidence: BUPAs own residents satisfaction survey show us that residents rate the provision of activities and the meal arrangements highly. There is a good understanding of peoples individual preferences with regard to their meals and dietary needs. People are able to have their meals in a well appointed dining room or their own rooms as they wish. The meals are delicately served and well presented. People are able to have drinks of their choice including wine and sherry with their meals. As well as a choice of meals during the day BUPA have a Nite Bites system which enables people to have hot and cold snacks through out the night. People who needed assistance to eat their meals were offered discrete and sensitive support from staff. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be listened to if they have any concerns and involved in discussions about any action that needs to be taken. People feel safe and protected at Field House because they are fully involved in decisions about their lives and their rights are respected. Evidence: The manager has daily contact with residents and makes sure the company procedures for seeking the views of residents and their relatives are implemented. She sees her day to day involvement with residents as key to making sure standards are maintained and peoples individual wishes are respected. This means any emerging problems are dealt with as they arise and there are a low number of complaints. The company monitoring systems have recently been reviewed and the manager now submit information about concerns as well as formal complaints to make the information more sensitive to emerging trends. This tells us there is close monitoring of peoples experiences. We have not received any complaints or concerns between our reviews. There is a high level of satisfaction with the service which tells us people feel safe and supported. Staff fully understand their role in making sure peoples rights are protected and they report any concerns. They receive training to maintain their skills and level of awareness in this area. Care Homes for Older People Page 17 of 27 Evidence: Staff demonstrate understanding and awareness, supported by policies and procedures, on the use of nursing equipment that could be seen as restrictive if not properly assessed and recorded. For example the use of bed rails and wheelchair lap belts. Staff receive training in understanding the Mental Capacity Act and peoples rights to make decisions for themselves. Where necessary peoples capacity to make decisions in various aspects of their lives is assessed and recorded in their plan of care where necessary. Independent advocacy services are available for people who need additional support. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that Field House will provide them with a clean, comfortable, well-maintained home to live in that supports their individual needs. Evidence: People living at Field House will experience a Country House style atmosphere in a building with many period features. There are lifts to the upper floors and platform lifts in areas where changes in floor level affect people with mobility problems. Ramps have been provided to enable people in wheelchairs to get into the garden on their own. The bedrooms are of varying sizes and the manager considers this when assessing peoples nursing needs. Specialist equipment in the form of height adjustable beds and aids to independence in bathrooms and toilets are provided. The call system in each room enables the manager to monitor the staff response. There is a rolling programme of maintenance and renewal to maintain standards. The maintenance records we reviewed were up to date and their are contingency plans for any unexpected incidents that may occur within the building. The last Bupa resident satisfaction survey indicated a 100 satisfaction rate in relation to peoples individual rooms and the communal areas. Care Homes for Older People Page 19 of 27 Evidence: People are able to personalise their rooms with furnishings and fixtures. The maintenance person plays a big part in the life of the home and will hang pictures and make any adjustments people need. The televisions in each bedroom are being replaced with flat screen digital televisions that can pivot out from the wall to suit the resident. There are two large communal lounges and a dining room which means people have a variety of places to spend their time. The well tended garden has a large patio and various seating areas which were being used by families on the day we visited. The maintenance person continues to add features of interest and planting to brighten up areas of the garden. There is a newly installed fish pond and fountain that provides a soothing sound. A high standard of housekeeping is maintained. All areas were fresh and clean. Staff receive training in preventing infections and are provided with the protective equipment they need. There are good hand washing facilities for residents and staff. People are provided with a high standard of laundry which means they have smart clothing and fresh crisp white bed linen. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they will be provided with a consistent and high quality service because there are rigorous recruitment processes in place and staff experienced and well trained. Evidence: Our assessment on the quality of the staff provided at Field House is based on our discussions with residents and relatives, observation of the interaction between residents and staff on the day of our visit, discussions with staff and a review of personnel and training records. Residents and visitors describe very positive relationships with the staff who support them. The last Bupa resident satisfaction survey indicated a 100 satisfaction rate with staff. A flexible approach to staffing the home enables the manager to make additional staff available at key times. We checked the records of 4 staff who had joined the service since our last visit. There are clear check lists in place to track the recruitment process and make sure that the required checks on suitability, references, criminal records and health checks are carried out before people start work in the home. New staff complete a 4 day induction covering key areas of health & safety, ethos of the service and responsibilities towards residents. A new member of staff told us that their training Care Homes for Older People Page 21 of 27 Evidence: and support went well beyond the basic induction days until staff were confident that they could work on their own. This shows us staff place a high priority on making sure residents receive quality care. The personal identity numbers of the registered nurses are checked with the Nursing and Midwifery Council to make sure they maintain their registration to practice. the nurses are supported to maintain their clinical skills through training. A recent initiative has been in the area of tissue viability. Link nurses within the home have received training to act as a resource in this area, cascade information to other staff and liaise with a tissue viability nurse employed by Bupa to give advice across their services. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the service provided at Field House because the home is well managed, their views are fully considered and the company systems for monitoring the quality and safety of the service are kept up to date. Evidence: The information in this report tells us that Field House continues to be well managed and the interest of the service users are at the fore front of the managers approach. Dorothy Allan has been part of the management of home for over 10 years. The self assessment she provided us with showed us she continues to review and evaluate the service and remains enthusiastic in planning future developments to further enhance peoples experiences. Bupa has detailed quality monitoring systems in place that involve visits and reports from senior managers. The manager is supported by a national team of Quality and Compliance managers to make policies and procedures remain in line with current practices and legal requirements. The records we saw indicates that audits are kept up Care Homes for Older People Page 23 of 27 Evidence: to date and there are clear lines of accountability within the home in relation to monitoring health & safety. Reporting systems are in place to alert Bupa to any emerging issues. Staff receive the training they need to work safely. The managers self assessment indicates the systems for maintaining and servicing safety systems, including gas, water, fire and hoist safety are kept up to date and this was confirmed by a review of the records. Accidents are recorded and the manager keeps us up to date with events occurring in the home. The systems for people to deposit money for safekeeping are a subject to external audit to make sure everything is in order. Bupas own 2008 resident satisfaction survey, which received a 74 response rate based on 19 questionnaires sent out rated the overall satisfaction with the service at 93 . This supports our findings and the managers self assessment, which gives us confidence in this service. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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