Care Home: Fleming House

What the care home does well We had carried out an annual review of the service on 07/11/08 and comments we received from nine of the people who used the service were positive. During this visit we spoke with a visiting relative, who told us that the home is "very good" and "ticks all the boxes". The relative said that staff had offered them a meal when visiting. A person who lives in the home told us that the food is good and that the staff "take care of you well." The two people whose records we saw each had named key workers, who we spoke with during our visit. The key workers demonstrated clear knowledge and understanding of the care plans and of the individual`s needs and preferences. The staff members told us how they maintain flexibility in the support they provide depending on the individual`s changing needs. All the staff spoken with at the time of the inspection showed a professional and caring approach to their work. What the care home could do better: The pre-admission assessment for one of the people whose records we saw was not available and the senior nurse told us it would be in an archived file. The preadmission assessment for the other person was dated two years before they were admitted, the date appeared to relate to the form and not the content. Most of the handwritten records we saw for one of the individuals were difficult to read, however there was a good amount of information about the person`s needs and how these were to be met. The senior nurse said the home is restructuring care plans and that a member of staff was coming in on Thursday to assist her with organising some of the paperwork. The most recent regulation 26 visit report was dated 26/11/08 and the facilities manager confirmed that this had been the last such visit. A requirement has been made that regulation 26 quality monitoring visits must be done on a monthly basis and the reports must be available in the home. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Fleming House Heron Square Eastleigh Hampshire SO50 9JD two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Laurie Stride Date: 1 8 0 2 2 0 0 9 Information about the care home Name of care home: Address: Fleming House Heron Square Eastleigh Hampshire SO50 9JD 02380626640 02380626644 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) : Hampshire County Council care home 55 Number of places (if applicable): Under 65 Over 65 55 0 55 dementia dementia old age, not falling within any other category Conditions of registration: 0 55 0 The registered person may provide the following category/ies of service only: Care home with nursing - 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 - OP Dementia - DE The maximum number of service users who can be accommodated is: 55 Date of last inspection Brief description of the care home Fleming House is a large purpose built unit, situated in the residential area of Eastleigh. It is run by Hampshire County Council and is registered to accommodate up to 55 older people who have support needs associated with old age or dementia. Care Homes for Older People Page 2 of 10 Brief description of the care home There are thirty single bedrooms in a newly built nursing wing and twenty-five in the newly refurbished residential unit. Care Homes for Older People Page 3 of 10 What we found: We last inspected this service on 08/11/07. We carried out this random inspection visit on 18/02/09 following concerns raised through safeguarding meetings and two anonymous telephone calls. The concerns raised as part of the safeguarding meetings were about end of life care practices, which the subsequent investigation by Hampshire County Council found to be unsubstantiated. However the investigation raised further concerns about the management of the home and the registered manager was suspended from duty. We were later informed that the registered manager would not be returning to the post. It was also found that the use of non-standard documentation in the home had resulted in some routine procedures, such as weight checks, not being carried out. The home had ceased admitting people while care management reviews of each persons care were carried out. We wrote to the person responsible for the service and asked them to investigate the concerns expressed by the anonymous callers, which were in relation to staffing levels and care records. The service responded and stated that, while staffing levels were sufficient to meet the dependency levels of current residents, there were high staff sickness and absence levels, which the management was addressing in meetings with the staff and unions. During our visit we looked at the care records of two individuals, one who was receiving nursing care and the other who was in residential care. We spoke with the person who was receiving residential care and observed staff supporting the person who received nursing care. The senior nurse on duty told us that no-one was receiving end of life care. We also spoke with a visiting relative, the homes facilities manager, two nurses, two care assistants and a domestic assistant. The care records we saw included updated mobility assessments and post-fall observation records, hospital admission and discharge notes, risk assessments including bathing and the use of bed rails. Care plans in relation to behaviour, cognition and understanding, health, medication and pain care were also on file with monthly evaluations. We saw up to date records for skin care, continence, nutrition, weight, eating and drinking. The staff members we spoke with were aware of the individuals needs and of the agreed ways of meeting these. It was also evident from these discussions that clear lines of accountability were in place. We had received two notifications from the home about medication errors. A senior nurse told us about actions that had been taken and showed us the changes that had been put in place to reduce the risk of errors happening. Monitoring of the system for administering medication is now more frequent and records of this are kept. We saw a sample of one persons medication records and these were up to date. The senior nurse told us that training was planned in relation to a new Hampshire County Council medication policy. The previous inspection report had identified one requirement in relation to the provision of a structured activity programme for all people who use the service. During this visit we saw there were personal history profiles and evaluations of social wellbeing, activity and occupation plans. For one person this stated that they required encouragement to take part in activities. A recent entry in the daily diary indicated Care Homes for Older People Page 4 of 10 that such encouragement was given. We spoke with a care assistant who was the persons key worker, they said that the individual took part in some of the gentle exercise activities and short walks when the weather permitted. We spoke with another person whose records we had seen, who told us that activities are provided, which they enjoyed taking part in, such as music, arts and craft. They said trips out are also arranged, that there had not been any recently but perhaps would be when the weather improved. On our arrival at the home at 11a.m. we were shown round by the facilities manager. The majority of people were in their own rooms and some were sat in the communal areas and we saw that people had drinks near at hand. The activities for the week were advertised on notice boards. The activities listed were: Monday - Fun with Music; Tuesday - Armchair Exercises and Hairdresser; Thursday Church Service and Hairdresser. We did not see any structured activities taking place on the day of our visit. The home has employed an activities co-ordinator for 20 hours a week and we were told that there is no additional funding for this. The activities coordinator and the manager were not available on the day of our visit so we were not able to discuss the development of this aspect of the service. The facilities manager showed us a store of items used for activities such as art and craft and said the home had taken delivery of two Wii sets and were awaiting the installer. We observed care and domestic staff chatting to some people in their rooms. A domestic assistant told us that they try to encourage people to come out of their rooms to take part in activities. We heard a member of staff asking people what they would prefer for lunch the following day and giving two choices of meal. We observed the lunchtime meal taking place in two of the dining areas. The meal was taken in a relaxed, friendly atmosphere with staff providing assistance to people as required, including one-to-one support given at the individuals own pace. We heard staff speaking to one of the people whose care records we had seen, giving reassurance and encouragement to eat, reflecting the guidance in the care plan. The facilities manager and a senior nurse told us about some of the actions taken in relation to safeguarding issues, for example a disciplinary meeting was scheduled in relation to a medication error and there were two instances where staff had been temporarily put on alternative duties under supervision. We saw a notice indicating that adult protection training had taken place on 26/11/08. We also saw records showing the names of staff members nominated for the training, which is part of the core training programme. Two care assistants we spoke with demonstrated their understanding of their responsibilities under the whistleblowing procedures and confirmed they had received the relevant training. A staff member said that staffing levels are the most challenging aspect of the job. They said that the home needed more permanent staff and that they would like to be able to spend more time with the residents. The facilities manager confirmed that staff sickness and absence levels are being reviewed by management and the human resources department. The home had recently reached full capacity for the first time in 10 months and the facilities manager said that current staffing levels reflected this. The facilities manager said that staffing levels are reviewed, for example if end of life care is being provided. We were told that the service had reviewed the deployment of staff to provide cross-over shifts at busy times of the day. For example a general assistant works part-time 5 - 9pm. There are currently 4 permanent day nurses instead of 8 and the facilities manager said the nurse agency had not been able to consistently provide enough agency nurses. A new night nurse had been employed and Care Homes for Older People Page 5 of 10 the home was awaiting the completion of the recruitment process for a further 3 day and 2 night nurses, who they anticipated would start work next month. The home is also looking into the possibility of nurses from another home doing occasional overtime work. The nursing care assistant rota is made up of 6 care assistants per shift, we looked at the rota for the day of our visit and it reflected the stated numbers, with the exception of a 7 - 10 pm shift that the senior nurse was trying to cover. The night shift was covered by the required 2 nurses and 2 care assistants. The residential care rota is devised with 4 morning staff, 3 afternoon staff, 4 evening and 2 night staff. Due to an administrative error the home was 1 staff member down in the morning and a care assistant had started their shift two hours earlier to help cover this. The afternoon and evening shifts were covered as planned. We looked at the training records in relation to 3 staff members, including the key workers of the residents whose care records we had seen. The home keeps clear records of training attended by individual staff and the training they are nominated for. Training included a four-day dementia course, food hygiene, fire safety, mental capacity, emergency aid, medication (non-administrating), conflict management, moving and handling induction and refresher courses. One of the staff members had also completed an eight week training course and exam relating to dementia care. Another of the staff members told us there had been lots of recent training and spoke of the two day course they had just completed about challenging behaviour. The training programme also includes an induction and core skills set, as well as baseline NVQ level 2. The records for a nurse included additional training such as falls reduction, risk assessment, catheterisation, syringe driver, individual performance planning and supervision. Both of the care assistants we spoke with said they had found the dementia training useful and thought training on end of life care would be useful. Both told us they receive formal supervision approximately every six weeks and that their supervisors were supportive. We had been informed by the responsible individual that the current manager will be staying on to support the induction of a new manager. The current manager telephoned us after our visit and told us that a new manager had been recruited. What the care home does well: What they could do better: The pre-admission assessment for one of the people whose records we saw was not available and the senior nurse told us it would be in an archived file. The preadmission assessment for the other person was dated two years before they were Care Homes for Older People Page 6 of 10 admitted, the date appeared to relate to the form and not the content. Most of the handwritten records we saw for one of the individuals were difficult to read, however there was a good amount of information about the persons needs and how these were to be met. The senior nurse said the home is restructuring care plans and that a member of staff was coming in on Thursday to assist her with organising some of the paperwork. The most recent regulation 26 visit report was dated 26/11/08 and the facilities manager confirmed that this had been the last such visit. A requirement has been made that regulation 26 quality monitoring visits must be done on a monthly basis and the reports must be available in the home. 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 set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 12 16(2)(m)(n) The registered person must ensure that a structured activities programme to provide stimulation for all service users be arranged, taking into account the circumstances of the service users and their preferences and wishes. 29/02/2008 Care Homes for Older People Page 8 of 10 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 33 26 Visits by the registered 20/04/2009 provider or their representative in accordance with this regulation must take place at least once a month and the written reports must be available in the home. This is to ensure that the standard and quality of care in the home is regularly monitored by the service provider and that the service continues to meet its stated objectives. 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 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!