Care Home: Fieldway

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What the care home does well People who use the service and their relatives said the service is `excellent`, `the food is extremely good`, `the management is superb`, `all staff are good, some are exceptional`, `staff are willing to help` and `we are fully satisfied with the care provided`. Staff say they provide `satisfaction to people who use the service`, by providing good meals, good up to date care practices and supporting people with good personal hygiene. Staff also feel they work well as a team. We saw good relationships between people who use the service and staff. We saw visitors made welcome and involved in the care individuals receive. We saw a `memory box` had been completed for one person. This is an excellent idea and keeps things `real` for the individual and provides staff with topics of conversation and discussions to provide more person centred care. Assessments are detailed and linked to care plans. People who use the service and their representatives are involved in the assessment and care planning process. What has improved since the last inspection? The Statement of Purpose has been updated and now includes details of all the services provided at the home. This ensures that people have the right information to help them make the decision about whether to move in. Staff have better training opportunities and all staff complete training in the care of people with dementia. We saw improvements in staff recruitment records, with evidence available to show gaps in employment have been explored and appropriate checks are carried out before staff start work. We found equipment stored appropriately around the home rather than in bathrooms as noted at previous visits. A quality assurance visit is carried out every month with a report written and actions taken to improve the service as required. A copy of this report is sent the CSCI, keeping us informed of changes and improvements. CARE HOMES FOR OLDER PEOPLE Fieldway 40 Tramway Path Mitcham Surrey CR4 4SJ Lead Inspector Emma Dove Unannounced Inspection 28th May and 3rd June 2008 2:20 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 Fieldway DS0000019090.V364264.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. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fieldway Address 40 Tramway Path Mitcham Surrey CR4 4SJ 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) 020 8648 3435 020 8685 0287 mackenis@bupa.com www.bupa.com BUPA Care Homes (AKW) Ltd Mrs Isabella Mackenzie Care Home 68 Category(ies) of Dementia (68), Old age, not falling within any registration, with number other category (68), Physical disability (68) of places Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - 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 Dementia - Code DE Physical disability - Code PD 2. The maximum number of service users who can be accommodated is: 68 30th November 2007 Date of last inspection Brief Description of the Service: Fieldway Nursing and Residential Centre is a registered care home for sixtyeight older people who may also have physical disabilities and dementia. Sixty-eight people currently live there. Fieldway Nursing and Residential Centre was purpose built. Accommodation is provided over two floors. Nursing care is provided on the ground floor, with residential care on the first floor. The two units have two lounges, a dining room, two assisted bathrooms, and have thirty-seven and thirty-one single bedrooms, each with en-suite toilet and wash hand basin. Both floors are served by a lift. People who use the service have access to gardens to the side and rear of the building. Parking is available at the front of the home. Information about the CSCI is available to people who use the service, their representatives and visitors. The current fees range from £695 to £856 per week. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. This unannounced inspection took place over four and a half hours on the 28th May 2008 and seven hours on the 3rd June 2008. One regulation inspector visited on the first day and a regulation inspector and regulation manager visited on the second day. We looked at records, spoke with people who use the service, five visitors, the manager, deputy, five members of care staff, an activities member of staff and the cook. Questionnaires were sent to people who use the service and staff. We received sixteen completed questionnaires, comments from these are included throughout this report. The manager completed an Annual Quality Assurance Assessment, which contained good information that is included in this report. What the service does well: People who use the service and their relatives said the service is ‘excellent’, ‘the food is extremely good’, ‘the management is superb’, ‘all staff are good, some are exceptional’, ‘staff are willing to help’ and ‘we are fully satisfied with the care provided’. Staff say they provide ‘satisfaction to people who use the service’, by providing good meals, good up to date care practices and supporting people with good personal hygiene. Staff also feel they work well as a team. We saw good relationships between people who use the service and staff. We saw visitors made welcome and involved in the care individuals receive. We saw a ‘memory box’ had been completed for one person. This is an excellent idea and keeps things ‘real’ for the individual and provides staff with topics of conversation and discussions to provide more person centred care. Assessments are detailed and linked to care plans. People who use the service and their representatives are involved in the assessment and care planning process. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 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 Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. It has developed clear information to help people understand the services provided. Admissions are only made after a detailed assessment has been made, ensuring the individuals needs can be met by the service. Intermediate care is not provided. EVIDENCE: The Statement of Purpose and Service Users Guide are available in written format. The manager said that both documents are made available to people who are thinking about moving into the home, to help them make the right decision. Ten people confirmed that they had had enough information to help them decide to move in. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 9 We saw detailed assessments in case files, which have been developed into care plans with people who use the service or their representatives. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 10 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 and 11 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Personal support is responsive to individuals needs and preferences. Staff respect privacy and dignity. The service listens and responds to decisions about who delivers peoples personal care. The health care needs of people unable to leave the home are managed by visits from local health care services. People have the aids and adaptations they need to support them in daily living. Medication is well managed. Staff work to clear practices when caring for individuals who have degenerative conditions and terminal illness. Care plans contain information about the individuals wishes, choices and decisions as their health deteriorates. EVIDENCE: We saw that care plans have been developed from assessments. Care plans identify the areas that individuals require assistance with and how the assistance should be provided. We saw one case file identify that the person was happy to receive personal care from both male and female staff. People Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 11 we spoke with were also happy to receive care from staff of either gender. One person said they prefer to be assisted by female staff and this was recorded in their care plan and staff were aware of this. Five people said they ‘always’ and five people said they ‘usually’ get the care and support they need. We saw that care plans are reviewed every month and any changes in care needs are documented and relatives and staff are updated. Six members of staff said they ‘always’ have up to date information about peoples needs. Case files contain a sheet titled ‘Map of Life’ we saw three of these completed in detail including the persons dreams and aspirations. One ‘Map of Life’ was completed but could have included more detail that the person was able to supply. These forms give staff information about the individuals history and provide ideas for areas to talk about with an individual. We saw that case files had the persons religion and whether they are practicing with details of any support they may require. We saw that case files contained details of visits from GP’s and other health professionals, with any actions to be taken by staff clearly noted. Seven people said they ‘always’ and three people said they ‘usually’ get the medical support they need. Daily records could be more detailed with how the person experienced the care and support given and how any social needs are met. Staff demonstrated a detailed knowledge of people who use the service and how to meet their needs. We saw positive relationships with staff offering help, support and encouragement to individuals. We saw peoples privacy and dignity maintained. Staff have appropriate medication policies and procedures to follow. We saw staff following the policies while administering medication. Medication is appropriately stored, labelled and records were up to date and signed by staff. Staff said they complete training in the administration of medication. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 12 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 and 15 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who use the service have access to a variety of activities in group and individual situations. People who use the service have the opportunity to develop and maintain important personal and family relationships. There is a varied menu which takes into account peoples medical and religious dietary requirements and likes and dislikes. EVIDENCE: The manager said that two members of staff are employed five days a week to organise activities and outings for groups and individuals. We saw one activities worker, who was aware of the peoples likes and preferences. Staff said a lot of sessions are done on an individual or small group basis, rather than big groups. Three people said they like to join in with some activities. For one person, Bingo is a favourite, this pastime did not suit two of the people we spoke with and they confirmed they only participate in things they wish to. A ‘race night’ was held at the beginning of June when bucks fizz, cocktail sandwiches and chocolate were served and people were invited to bet on Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 13 races. Two people said that they had enjoyed the evening. The company has a ‘calendar’ of events which include different cultural festivals being celebrated. Five people said there are ‘always’ and three people said there are ‘usually’ and one person said there are ‘sometimes’ activities arranged by the home that they can take part in. One person said that there are ‘never’ activities they can participate in and added that this was due to their disabilities. The cook said he spends time when people first move in, finding out their food preferences, in addition to being informed by staff of any allergies or medical or religious requirements. He then sees people every week to check on how they are finding the meals and makes changes to the menu if necessary. We saw lunch to be a pleasant social occasion for people. Most people eat in the dining rooms. Staff said some people have their meals in their rooms. We saw staff take trays to people in their rooms. Two people confirmed that they want to eat in their rooms and they get their meals on a tray, with cutlery and a serviette. Peoples comments about the food included: ‘the food is good, you get choices’; ‘we get very good meals’; ‘the food is usually good’ and ‘I get what I choose’. We saw visitors invited to stay for meals. One visitor said that they often stay for lunch and that the food is good. Three people said they ‘always’, two said they ‘usually’ and one person said they ‘sometimes’ like the meals. One person made additional comments about not being given appropriate meals to manage with their disabilities. We saw care plans contain nutritional assessments and records of weight indicated a general increase for most people when they move in. Staff were clear that any weight loss would be reported to the GP and or dietician. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 14 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 and 18 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The complaints procedure is supplied to everyone living at the home and is included in the Statement of Purpose. People who use the service and their representatives are aware of who to speak with about any concerns or issues. Clear policies and procedures are in place for safeguarding adults which include guidance on how to respond to allegations. EVIDENCE: The manager said that complaints are taken seriously and addressed quickly to make things better for the individual. Nine people said that they are ‘always’ aware of who to speak with about any concerns. Nine people confirmed that they are aware of how to make a complaint. People we spoke with had not had any need to make a complaint, but felt they could speak with staff, deputy or the manager and that things would improve. Records are kept of complaints with any actions taken to resolve the issue and prevent similar concerns in the future. Six members of staff were aware of how to deal with concerns. One member of staff said they would ‘follow the policy’. Staff complete training in the protection of vulnerable adults and are aware of their responsibility. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 15 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, 20, 21, 22, 23, 24 and 26 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Fieldway provides a physical environment that is appropriate to the specific needs of the people who live there. Appropriate aids and equipment are available to meet individuals needs. The home is a pleasant, safe place to live. Bedrooms are single with an en-suite toilet and wash hand basin. People are encouraged to personalise their rooms with photographs, pictures and small items of furniture. The home is well lit, clean and tidy and smells fresh. EVIDENCE: The home was purpose built and meets the needs of the people who live there. There is an on-going redecoration schedule, which has included communal areas being redecorated and new carpets fitted in corridors. We saw a few bedrooms in need of redecorating. The manager said that some rooms are Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 16 due to be painted and generally rooms are painted before someone new moves in. Bedrooms are single with an en-suite toilet and wash hand basin. We saw bedrooms have been personalised to individuals wishes, some people have bought items of furniture, pictures, ornaments, televisions and radios. One person said ‘I’m glad I could bring my comfy chair, it feels like home’. Another person said ‘my family moved in some of my belongings, I’m pleased they did’. One person was able to show us photographs of their family Peoples bedrooms have their name and a photograph of their named nurse or key worker. Two lounges, a dining room, two assisted bathrooms and a number of toilets near communal areas are on each floor. People told us that ‘a lot of work has gone on in the garden’, we were shown the new deck area with bird feeders and a bright coloured mural. Two people said they enjoy looking at the garden, staff confirmed that they assist people in going into the garden. We saw some visitors taking their friend or relative around the garden, looking at the plants and the wildlife. The home was seen to be clean. A few odours were noted and the manager reported that this is being addressed with carpets being cleaned. Six people said the home is ‘always’ and four people said it is ‘usually’ clean and fresh. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 17 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 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who use the service have confidence in the staff who care for them. Good recruitment policies and practices are in place. Staff have access to training to help them carry out their role. EVIDENCE: People who use the service and their relatives or representatives made positive comments about staff, saying: ‘staff are very good’, ‘staff care for me’, ‘they look after me’, ‘they are willing to help’, ‘nothing is too much trouble for them’ and ‘staff are helpful and polite’. We saw staff respond to peoples needs, offering support, assistance and reassurance. Staffing levels were seen to be sufficient to meet peoples needs. Five people said staff are ‘always’ and four people said staff are ‘usually’ and one person said staff are ‘sometimes’ available when needed. Four members of staff said there are ‘always’, one member of staff said there are ‘usually’ and one member of staff said there are ‘sometimes’ enough staff to meet peoples needs. We saw improvements in staff files, which contain the required checks before the person starts work and gaps in employment are explored at the interview. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 18 Six members of staff said they had checks including a Criminal Records Bureau check and references were taken up before they started work. Six members of staff said that their induction covered everything they needed to know ‘very well’. The deputy said staff have access to appropriate training to help them do their job. Six members of staff said they have relevant up to date training, including care of people with dementia, palliative care, infection control, health and safety and fire safety. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The manager has the skills and experience to run the home and has a clear understanding of the key principles and focus of the service. The manager understands the importance of person centred care and good outcomes for the people who use the service. Appropriate quality assurance systems are in place. Health and safety policies and practices are good with records up to date. EVIDENCE: The manager, deputy and senior staff are experienced in working with older people and are aware of the needs of the people who use the service and staff management. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 20 A representative from the organisation visits the home every month and speaks with people who use the service and any visitors about the care, support and food provided. Any issues are raised with the manager and addressed. A copy of the report from these visits is sent to the CSCI, keeping us informed of how things are going in the home. Residents and relatives meetings are held, with minutes available. A number of social events are held every year, this offers people who use the service and their relatives the opportunity to socialise. We saw some improvement in the timing of supervision of staff, this needs more work to ensure all staff receive individual supervision with their manager every two months. Four members of staff said they meet ‘regularly’ while two staff said they ‘sometimes’ meet with their manager. Five members of staff said the ways they communicate ‘always’ work well, while one member of staff feel they ‘usually’ work well. Staff meetings are held on each floor to ensure good lines of communication. Staff said they sometimes have a whole staff meeting. Minutes of meetings are available for staff who are not able to attend. Health and safety checks are carried out at the required intervals. A person is employed to deal with maintenance issues. We saw a quick response when someone found some ants in a bedroom, the area was cleared and sprayed with appropriate powder. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 21 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP12 OP36 Good Practice Recommendations Consideration should still be given to the provision of an appropriate vehicle, to enable people to access community activities and facilities. All staff must receive regular supervision. Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Fieldway DS0000019090.V364264.R01.S.doc Version 5.2 Page 24 - 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. 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