Care Home: Fieldway Residential Home

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What the care home does well All of the people involved in this inspection were positive about the manager and the staff and their caring attitudes to the people who use the service. The atmosphere in the home is relaxed and people say they find the staff and manager approachable. The home is well maintained and provides a comfortable and safe environment for people. There are enough staff available in the home to meet people`s needs. There is a stable staff group offering the people who live there consistency. Visitors are made welcome and people confirmed they can come and go as they please. Overall medication is well managed, meaning people who use the service are suitably protected. What has improved since the last inspection? Three requirements were made at the last inspection. We can confirm these have been addressed. The Service User Guide now includes the fees to be paid, what is included and any extras that people may be expected to pay. A written criterion for the administration of prescribed `as required` medication in respect of individual people is now available. This ensures that people are given medication within appropriate circumstances. Regarding the staff files we looked at, we can confirm there are two written references for prospective staff members, this ensures the people who use the service are fully safeguarded. As this was the inspectors first visit to the service no other evidence is available to illustrate improvements. All people we spoke with were happy living at Fieldway and staff and visitors also expressed their satisfaction with the service. What the care home could do better: There was little evidence to confirm the home assessed people prior to them moving into Fieldway. Records need to contain more information and identify assessments are carried out prior to admission. This means the home can demonstrate their ability to meet peoples individual needs. Evidence is required to confirm a stimulating and active life is offered to everyone living at Fieldway. Mandatory training is required in a number of areas and should be provided to all staff, this will ensure the staff have the skills and knowledge to support people living at Fieldway. Management plans and risk assessments need to be in place for behaviours that challenge. This means a safe and consistent approach will be adopted. The home needs policies and procedures on the Deprivation of Liberty Safeguards, (DOLS). This means staff have clear information to establish whether the home needs to make an application to request a deprivation of liberty from the appropriate professionals. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature. Key inspection report Care homes for older people Name: Address: Fieldway Residential Home 5 Fieldway Blythe Bridge Stoke on Trent Staffordshire ST11 9HL     The quality rating for this care home is:   two star good 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: Rachel Davis     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 31 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 31 Information about the care home Name of care home: Address: Fieldway Residential Home 5 Fieldway Blythe Bridge Stoke on Trent Staffordshire ST11 9HL 01782388332 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Mavis Hope,Mr Thomas Hope care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Physical disability (PD) age 60 years and above. The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 4, Old age, not falling within any other category (OP) 18, Physical disability (PD) 10 Date of last inspection Brief description of the care home Fieldway Residential Care Home is registered to provide care to eighteen older people of whom four may have dementia care needs and up to ten may have a physical disability. Fieldway is owned by Mr and Mrs Thomas Hope and is managed by Mrs Hazel Malbon. The home is all on the ground floor with sixteen single and one shared Care Homes for Older People Page 4 of 31 Over 65 0 18 0 4 0 10 Brief description of the care home bedroom, all but one single room have en-suite facilities. There are two lounges and a conservatory, which is the smoking area for the people who use the service; there is also a separate dining room. The home has a pleasant private garden and adequate parking. Fees vary from £377.00 to £400.00 per week. This was correct at the time of our inspection on 19/08/2009. Care Homes for Older People Page 5 of 31 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: two star good 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: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the services and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We ask managers to fill in a questionnaire called an Annual Quality Assurance Assessment, which tells us how well their service provides for the people who use it and how they intend to improve their service. We received this back from the manager within the required timescale. We also reviewed all the information we have received about the service since we last visited in September 2007 and we considered this in planning the visit and deciding what areas to look at. Care Homes for Older People Page 6 of 31 The main method of inspection we use is called case tracking which involves us selecting a number of people who use the service and looking at the quality of the care they receive by speaking with them, observation, reading records and asking staff. On 6/8/09 we sent three professional questionnaires for the service to distribute to visiting district nurses, occupational therapists etc. Four were sent for relatives, five to the staff and six to people who use the service. Their return date was 25th August. On 1st September 2009, when writing this report, none had been returned to us. The last key inspection took place on 4th September 2007, there have been no additional visits made to Fieldway since that visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: There was little evidence to confirm the home assessed people prior to them moving into Fieldway. Records need to contain more information and identify assessments are carried out prior to admission. This means the home can demonstrate their ability to meet peoples individual needs. Evidence is required to confirm a stimulating and active life is offered to everyone living at Fieldway. Mandatory training is required in a number of areas and should be provided to all staff, this will ensure the staff have the skills and knowledge to support people living at Fieldway. Care Homes for Older People Page 8 of 31 Management plans and risk assessments need to be in place for behaviours that challenge. This means a safe and consistent approach will be adopted. The home needs policies and procedures on the Deprivation of Liberty Safeguards, (DOLS). This means staff have clear information to establish whether the home needs to make an application to request a deprivation of liberty from the appropriate professionals. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature. 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 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the home to help them decide if they wish to live there. More evidence is needed to confirm peoples needs can be met prior to moving into the home. Evidence: We were told by the deputy manager that the Statement Of Purpose and Service User Guide are given to people who use the service when they move in. We checked both documents and can confirm the fees have been included as required at the last key inspection. This information is available in the brief description within this report, and it means people know how much it is to live at Fieldway. The home has two people living their who choose to smoke, the Statement Of Purpose should therefore be updated to advise prospective people of this, this means they can make an informed choice as to whether to live there under these circumstances. The Care Homes for Older People Page 11 of 31 Evidence: Statement Of Purpose reads; clients may choose to accommodate any of the areas within the home. However, a non smoker may not wish to reside in the conservatory as it is the designated smoking area for people who use this service. It is recommended that people using the service are informed that the Statement of Purpose and Service User Guide could be made available in a format appropriate to the people who use the service, their individual capacity and language. The home may also wish to consider an audio or pictorial version. Terms and conditions of residence are provided, this means people are clear of what to expect. The AQAA completed by the registered manager tells us : All new service users are admitted on a full assessment undertaken by people trained to do so. We could not validate this statement from the evidence we found during our inspection. We asked for the pre admission documentation for two people who used the service but it was not available (not completed). We requested this information for a further two people. The information seen and recorded by the home does not contain the necessary detail and a number of sections were incomplete. The pre assessment documentation does not evidence that it was undertaken prior to admission, this is because it is not dated. Not having this information means there is no confirmation from the home to assure they can meet peoples needs. Standard 6 is not applicable to this home as there is no intermediate care provision at Fieldway. Care Homes for Older People Page 12 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare needs are assessed and provided for in a way which shows respect for the privacy and dignity of people who live at the service. Medication practices are safe therefore people who use the service are protected. Evidence: The AQAA completed by the registered manager under what we do well tells us : We regularly review care plans, maintain personal care hygiene through working together. We continue to monitor regularly food and fluid intake on clients who have problem with nutrition and urinal problems. Review risk assessments, prevention of slips, trips and falls. Periodically engage with the Opticians, Dentists, Medical care etc. Continue to handle medicines safely and are undergoing safe handling of medicines at the moment. We still continue to also have personal training via the pharmacist too. We can verify this information is correct but further risk assessments are required in some areas, for example behaviours that challenge. Care Homes for Older People Page 13 of 31 Evidence: All people living at Fieldway have a plan of care, we found the plans of care and care records are person centred, this means they are developed with the person and are individualised. Plans of care also include clients personal wishes, this again verifies person centred care and that choice is available to people who use the service. All parts of the plan of care are well documented and there are clear day to day records to confirm how people wish to live. People who we spoke with told us: The staff are very kind and attentive. They always do as I ask and let me make choices. Very caring staff. I am very well looked after. We are satisfied that other professional support is requested when necessary e.g, from the district nurse or community psychiatric nurse as records verified this. Relatives also told us they were contacted if there are any significant changes or professional visits arranged. One visitor we spoke with stated communication is excellent. People who can bare weight have a weight chart but those who do not are not weighed. This should be addressed by either providing appropriate scales or discussing other recording processes with the district nurse. We noted that behavioral management plans were not in place and this must be implemented as soon as practicable. This means there are clear instructions for staff to follow and ensures consistent and appropriate care management is provided to the people who use the service. Some daily records seen were not written factually and were staffs assumptions for example in a good mood today. The information recorded should be factual accounts only. All plans of care are regularly reviewed and relatives are invited to be involved with care planning and review. This is evidenced by a relatives care plan declaration. We observed the senior carer administering medication during breakfast and saw she was following appropriate procedures in handling and recording what she gave to people. She kept the medication secure at all times. We recommend evidence is available with regard to any missing medication. The home have had difficulties in ensuring all medication is available as they advised us the surgery and deliveries have not always tallied with the required medication so sometimes they have run short. The home confirmed they are confident this situation is now resolved. We checked the records and storage for controlled drugs. These were accurate and well managed but we recommend the home purchases the appropriate controlled drugs register to fully comply with the safe handling and recording of medication. Care Homes for Older People Page 14 of 31 Evidence: Care Homes for Older People Page 15 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and stimulation are in place but evidence needs to be improved upon to confirm everyone living at Fieldway is appropriately supported. Evidence: The home has a key worker system, which enables closer resident staff relationships where likes, dislikes and needs can be shared and should be recorded. Fieldway does not employ an activities coordinator and care staff are responsible for providing this support. We saw no activities programme but were assured that activities are regularly offered. Evidence of one to one stimulation is not recorded and we consider this should be evident. People told us they played board games, cards, dominoes etc; but external entertainers were infrequent. The home should consider whether people who use the service would like more stimulation. This could be evidenced within plans of care, reviews or their internal quality assurance questionnaires. We would like the home to revisit the activities and stimulation provided and consider how they evidence this, especially for those with complex needs. Care Homes for Older People Page 16 of 31 Evidence: The AQAA tells us that presently there are no individuals in residence from the ethnic minority groups or anyone with specific religious needs. The deputy manager reported that links with the community are forged and the home has an open door policy. Visitors confirmed they could visit at any time , were always made welcome, and could take their family members out if they so chose. We spoke to the cook and can confirm the kitchen is well maintained, it was clean and tidy, crockery and cutlery were of a suitable standard. The cook told us they recently received a three star rating following the environmental health inspection. Food supplies are plentiful and fresh fruit and vegetables are available. The cook is recording the fridge temperatures as required and the temperature probes. The home has one dining area and lunch is relaxed and informal. The people who use the service considered the food to be good: Its good, I like it. The cook asks everyday what people wish to eat, they are all asked individually and alternatives are offered. The meals are nice. I can have an alternative meal if I dont like it. We observed lunch being served and alternatives were seen, a record of what was on offer is usually written on the menu board. When we asked, the majority of people did not know what was for lunch. The home should consider various ways in which to advise the people who use the service on what is for dinner dependant on their level of need, for example pictorial format. Staff were seen assisting people who use the service at lunchtime in a discreet and sensitive manner. The home provides aids to support people who use the service with eating for example plate guards and large handled cutlery. The home offers a four week menu, to further improve their menu the home may wish to consider extending this. Care Homes for Older People Page 17 of 31 Evidence: Some people receive a soft or liquidized meal. The vegetables, meat and gravy are liquidized together. We recommend all items should be liquidized separately to improve the visual and taste experiences for people who require their meals in this way. Care Homes for Older People Page 18 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to raise their concerns freely. There are adult safeguarding policies and procedures in place but these need to be developed to comply with new legislation. Evidence: People can access the complaints procedure because it is displayed in the hall (although difficult to see, as it was under other literature). It is also available within the Service User Guide. It describes the procedure for people should they have any concerns however, it is not very user friendly. We consider it should be easy to understand by meeting the needs of the people who use the service, explain what the procedure is and identify how long the process will take. We discussed this with the deputy manager whilst we were at Fieldway. The complaints book identified one complaint since the last inspection, this had been dealt with and concluded. Through discussion it was evident other issues, grumbles or concerns had been raised but not recorded. We recommend all issues are evident to support the service with identifying how changes are made to improve the services for the people who live there. One good example of positive change was with regard to the laundry system which is working well, people have their own laundry baskets in their bedrooms and therefore have more control over their own clothing and choices of Care Homes for Older People Page 19 of 31 Evidence: whether or not it is washed. The staff have improved the management of laundry to ensure it is done seperately, this helps to reduce the risk of cross infection. There is a suggestions box available within the home should people wish to raise informal comments or concerns. This was inaccessible but moved next to the visitors signing in book whilst we were there. All records need to be changed to reflect the new Care Quality Commission (CQC came into being April 1st 2009), rather than the Commission for Social Care Inspection (CSCI). Safeguarding Adults is a process of identifying and reporting suspected or potential abuse to vulnerable people and provides a framework of consistency to protect those individuals who are at risk. During our inspection we check to ensure vulnerable people are suitably protected. There have been no safeguarding referrals made since the last inspection. The deputy manager assured us suitable safeguarding of adults policies and procedures are in place, although they could not be found on the day of the inspection. Some staff require training in this field and a requirement has been made about this. The manager needs to ensure staff are made aware of The Mental Capacity Act Deprivation of Liberty Safeguards. They must be aware of their responsibilities and ensure there are no other less restrictive ways of keeping people safe and well if liberty is compromised. Decisions must always be in the persons best interests and assessments and questions must be satisfactorily answered. We have asked the home to follow this through and ensure records are in place to evidence liberty is not compromised where people lack capacity. Referrals should be made to the local authority if necessary. We have made a requirement that the home drafts appropriate policies and procedures. Care Homes for Older People Page 20 of 31 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. Fieldway is clean, tidy and homely. Evidence: Fieldway is clean, warm and safe, there was no mal odour noted during our visit. The conservatory is the designated smoking area for people who live at Fieldway and the smell does pervade into the lounge area. The deputy manager advised us there have been no complaints regarding this. One visitor told us The home is always clean , there is never any smell, The home has a variety of aids and adaptations which are suitable for dependent people, there is a staff call bell system throughout the home. We checked with staff and they felt there was enough equipment to support the people living there. Presently people may only shower as the home is waiting for a new bath, we were advised it should be in place within two weeks of our visit. Toilets are situated throughout the home, are accessible, and have grab rails. Cleaning products and other solutions are locked away reducing hazards to the people who live there. Care Homes for Older People Page 21 of 31 Evidence: We found infection control procedures are in place, such as liquid soap, gloves, aprons and paper towel dispensers. We were told two of the people who live at Fieldway hold keys to their own bedroom. We saw that a number of bedrooms had been personalised and are decorated in different colour schemes. Whilst looking around the home we noted the laundry was unlocked and washing products were not locked away. The home must either remove these products to a safe location or provide a lock on the laundry door. Care Homes for Older People Page 22 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are suitably recruited but require training to ensure they can meet the needs of the people who use the service. Evidence: Records were checked and staff are suitably recruited to make sure people who use the service are protected. There was evidence of induction and supervision or appraisals on the staff files seen. To comply with legislation the service should remove the date of birth from their application forms to meet with age discrimination legislation. They should also ensure their medical questionnaire confirms people are mentally fit for purpose. We checked the training records and noted that some training has not been provided. For example eight staff require training of vulnerable adults and six are without basic food hygiene, another eight require fire safety training. The AQAA tells us : We have 75 of staff with NVQ2, one member of staff are near completion of NVQ3, and nearly all staff has NVQ2 in Infection Control. We are awaiting training for Food and Hygiene to come through (October), the two cooks have now completed NVQ2 in cooking Staff spoken with are very happy at Fieldway, there is little turnover offering the Care Homes for Older People Page 23 of 31 Evidence: people who use the service consistency. Male care staff are also employed offering people choice. Staff said : We work well as a team. We communicate well. We support each other. We can always discuss things, there is an open door policy here. During the time we spent at Fieldway we spoke to a number of staff and observed some of them supporting people. We found there were very positive and engaging interactions between those people living at the home and the staff members. Visitors were present during the inspection and were either in the communal lounges or with people in their own rooms for privacy. When touring the building we observed staff knocking on doors to bathrooms and bedrooms. This means they are respecting peoples dignity and privacy. We are clear there are enough staff to support people who live at Fieldway in a timely manner. People who use the service confirmed call bells were answered quickly. Care Homes for Older People Page 24 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate arrangements in place to keep people safe, meet their needs and promote their health and wellbeing. More evidence and documentation are required to verify this. Evidence: The manager was not available during this key inspection but we are aware she has the required qualifications and experience necessary to run the home. The Annual Quality Assurance Assessment was completed by the registered manager and it was returned to us within the required timescale. The annual quality assurance assessment (AQAA) is a legal document that all services have to complete on a yearly basis . The information was not sufficiently detailed to demonstrate the service was based on robust and continual self assessment. All sections of the AQAA are completed but the information could be expanded upon to give us a clearer picture. Care Homes for Older People Page 25 of 31 Evidence: More supporting evidence would have been useful to illustrate what the service has done or how it is planning to improve. The AQAA only gave us limited detail about the areas where they still need to improve and the ways that they were planning to achieve this are only briefly explained. For example under complaints it records on how they have improved : More staff communication and team work. And under staffing: All the team through knowledge and experience and skills. It does not tell us how or evidence ways in which this has improved the service at Fieldway. The registered manager has formulated and distributed quality assurance questionnaires to people who use the service, staff, relatives or stakeholders. This means there is information available to assess how the service is meeting needs or viewed by other people. This needs to be evaluated and a written copy produced and made available to the people who live at Fieldway. This will again evidence how improvements and changes are made. Staff we spoke with told us Hazel is approachable and provides support to the staff team. Relatives we spoke with also said that they feel they can go to the management team with any problem and will be listened to. Staff meetings and resident meetings do not take place but relatives are asked to contribute any suggestions they have about the running of the service. The home has appropriate arrangements in place for the safekeeping of peoples money. We checked the records and found receipts available for transactions, balances were also checked and accurate. As expected no member of staff is an agent for peoples money and all monies coming into the home are receipted. Care Homes for Older People Page 26 of 31 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 27 of 31 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 1 8 12 Regulation 12( 1)(a) The home needs to ensure there are risk assessments and management plans in place for people where specific care is required. This means consistent and safe care is provided and suitable information is available to the staff. 01/10/2009 2 18 12 Regulation 12 (3) To make sure people are safeguarded the service must ensure there are policies and procedures in place in regard to The Mental Capacity Act Deprivation of Liberty Safeguards. This is to make sure staff know what course of action to take, understand the assessment processes and are clear of their legal responsibilities. 01/10/2009 Care Homes for Older People Page 28 of 31 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 3 30 18 Regulation 18(1)(c) 01/11/2009 (i) To make sure people are supported appropriately the staff team requires training to meet peoples needs. This is to ensure everyone is safe. 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 1 1 It is recommended that information is made available to confirm that the Statement of Purpose and Service User Guide are available in a format appropriate to the people who use the service, individual capacity and language. The pre assessment documentation should include all information detailed in Standard 3 and evidence completion prior to moving into the home. This means the home can guarantee they can meet people needs prior to them moving in. Ensure daily records contain factual information only. This means records remain consistent and do not include the staffs personal thoughts. Provide sit on scales or an alternative means of weight recording for people who cannot stand. This means all people who use the service have a weight record which will identify any gains or losses The home should review their medication policy and incude information on the management of errors. This means a consistent approach is in place. All staff administering medication should undergo periodic assessments to ensure their ongoing competency to follow the homes procedures correctly. 2 3 3 7 4 8 5 9 6 9 Care Homes for Older People Page 29 of 31 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 7 12 Evidence of one to one activities should be recorded. This means individualised activity programmes for people who use the service are available. Soft meal items should be liquidized seperately to offer people who use the service different tastes and textures. You should consider offering daily menus produced in appropriate formats, such as large print or pictorial, suitable for people with dementia care needs or sensory impairments. This will assist them with understanding and help people make realistic choices. The home may wish to consider extending the four week menu to offer more choices to the people who use the service. The complaints procedure should be updated and consider the needs of the people who live there. We recommend a more user friendly complaints procedure. All records should be updated to reflect the change in name of the regulatory body from the Commission for Social Care Inspection (CSCI) to the Care Quality Commission (CQC). The home should ensure all products are stored safely. This means people who use the service are suitably protected. Staff should confirm they are both physically and mentally fit for purpose on their medical questionnaire. This means they are able to provide appropriate support to vulnerable people. The date of birth should be removed from the application form to comply with age discrimination legislation. The service should ensure they record their findings following their quality assurance audits. This means they can evidence how improvements or changes are made. The content of the AQAA should be improved upon and offer evidence on how the service corroborate their statements. 8 9 15 15 10 15 11 16 12 16 13 14 19 29 15 16 29 33 17 38 Care Homes for Older People Page 30 of 31 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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