Care Home: Southfields House EPH

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What the care home does well The care plans contain detailed information on the health, personal and emotional needs of people using the service.There is a strong emphasis on raising the quality of the care provided for people using the service, regular quality reviews take place on the care plans and risk assessments with the aim of focusing on outcomes for people using the service. The organisation has undertaken a staff survey and based upon the outcome, improvements have been made on the support systems for staff and managers. One to one formal supervision is taking place, with the focus on staff development needs. A keyworker system is now in place where each member of staff is assigned to an individualusing the service, each unit holds their own rseidents meetings, this gives people using the service the opportunity to contibute to decision making within their home. Risk assessments and monitoring systems are in place people who are prone to falls, poor diet and hydration and pressure area ulcers. The assessments are backed up with a care plan stating the aims and objectives on how risks are to be minimized. The home seeks the advice and intervention of health care professionals such as the district nurse, falls specialists, opticians, podiatrists and visits by the general practitioner. General observations on how people are supported at the home showed that people have the opportunities to interact with staff and each other, to be involved in general day to day tasks such as setting dining tables, and washing up. To participate in group and one to one activities, listening to music, watching TV, knitting and playing board games with staff. People who are independently mobile are encouraged to move around the home as they wish, visiting other units within the home and spending time in the communal areas. Individual bedroom doors have a photograph of the person to whom the room is occupied on the door this aids in enabling people to orientate themselves around the home and to identify their own rooms. Within each of the lounges there is a TV, CD, DVD and Video player, books, newspapers, games and rummage boxes, the small kitchenettes attached to the dining areas gives good opportunities for people to be engaged in making snacks and drinks and be involved in day to day household tasks, this promotes independence and gives people a sense of purpose in being involved in day to day life within the home. What the care home could do better: For people identified at risk of falls at night, the night care plans would benefit from more detail and instruction for staff to follow in order to effectively monitor those at risk. The risk assessments for people at risk of falling out of bed would benefit from being more individualised and specific to the bed occupant, recording whether there is any risks of entrapment, how the person responds to having this equipment in place and whether they understand and have given their consent to havijg this equipment in place. Catheter care risk assessment should be in place to ensure all staff are fully aware of catheter care procedures and cross infection control practices when caring for people who are cathererised. People using the service who require their blood sugar levels to be monitored would benefit from records of the readings being held within their care records. This would ensure that staff have the opportunity to closely monitor dietary intake and behaviors and take swift action in seeking medical advice if needed. The medication administration records (Mar charts) held within peoples bedrooms should be signed whenever a prescribed cream and/or food suppliment has been administered. People who regularly refuse or do not require their medications to be given on a regular basis should have their medications reviewed by their general practitioner. This would ensure that people receive their medicatations as prescribed.The small kitchenettes are beginning to look in need of refurbishment as some of the doors and worktops look worn, one cabinet had a drawer front missing. Microwaves are available to reheat meals, to ensure meals are reheated to the correct temperature it is advisable that temperature probes are used when reheating meals. It was noted that the daily menus are not prominent within each of the lounge diners, it may be of benefit to have the menu on display within the kitchen diner area either on a board or placed on the dining tables for people to pick up and read. The outside areas of the home are looking neglected the gardens are in great need of weeding, grass cut and general tidy up, and outside the laundry area old furniture is need of being disposed of. We were informed that several calls had been made to the organisation to arrange for a gardener and for the old furniture to be removed. In order for people to enjoy the outside space this needs to actioned as soon as possible. Random inspection report Care homes for older people Name: Address: Southfields House EPH Farmhill Road Southfields Northampton NN3 5DS 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Irene Miller Date: 0 9 0 6 2 0 1 0 Information about the care home Name of care home: Address: Southfields House EPH Farmhill Road Southfields Northampton NN3 5DS 01604499381 01604790719 pterry@northamptonshire.gov.uk www.northamptonshire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Phil (Ian Philip) Terry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Northamptonshire County Council care home 46 Number of places (if applicable): Under 65 Over 65 46 9 5 dementia old age, not falling within any other category physical disability Conditions of registration: 2 0 0 No person admitted within the DE category will be below the age of 60 No person falling within the DE category can be admitted where there are already 2 people of DE category already in the home No person falling within the DE(E) category can be admitted where there are already 46 people of DE(E) category already in the home To be able to accommodate nine named service users who have needs within the OP category To be able to accommodate one named service user who has needs within the LD(E) Care Homes for Older People Page 2 of 12 category To be able to accommodate one named service user who has needs within the MD(E) category. To be able to accommodate up to five people within the DE (E) category who have additional needs within the PD(E) category Total number of service users in the home must not exceed 46 Date of last inspection Brief description of the care home Northamptonshire County Council owns Southfields House. Southfields House provides accommodation for up to forty-six older people over the age of 65 years. Southfields House is focussing on providing care for residents with dementia conditions and associated disability. Southfields House is situated in a residential area, close to local shops and accessible by public transport. The premises offer all ground floor living areas with single bedrooms. There are six self-contained units each with their own lounge/dining areas, kitchenettes, bathrooms and toilet facilities. There are seating areas by the main entrance and in the conservatory area providing people with additional communal space. Residents have access to garden areas and the home has surrounding security fencing with access through electronically operated gates. The Northamptonshire County Council carries through a financial assessment of all residents to determine their contributions towards the cost of their care. The fees charged are 331.60 GBP per week, received after the site visit although people may wish to obtain more up to date information from Southfields House. Additional costs for individual expenditure such as personal toiletries, newspapers, magazines, and private chiropody and contribute towards trips. Care Homes for Older People Page 3 of 12 What we found: This unannounced inspection took place on 9th June 2010. We were formally notified in September 2009 of a change to the management arrangements at Southfield House, which involved the home being managed by an acting manager from another home within the organisation. The acting manager was not working on the day of the inspection, however a manager from another care home within the organisation was available at the home and also members of the senior team. In preparation for this inspection we looked at information we had about the service from notifications of accidents and incidents sent to us from the home, we reviewed information supplied to us within the homes Annual Quality Assurance Assessment (AQAA) which is a self assessment tool completed by the manager of the home. The information supplied within the assessment tells us how well outcomes are being met for people using the service. Also prior to the inspection, the Care Quality Commission (CQC) sent out to the home a selection of surveys for people using the service, and surveys returned to CQC were in the main very positive about the experience of the care people received at the home. Staff surveys received were also positive about what it is like to work at the home. We looked at information held on the care that people receive at the home, this involved looking at individuals care plans, risk assessments, daily notes and records of visits from health care professionals also involved with the care of people using the service. Within the care plans viewed there was detailed information available on the health, personal and emotional needs of people using the service. Some additional instruction on promoting a high fibre diet could further improve the well being of some people using the service. Individual risk assessments and monitoring systems were in place for falls, moving and handling, nutrition and fluid intake and pressure care. The assessments were backed up with a care plan stating the aims and objectives on how risks were to be managed. There was records available on advice being sought and medical intervention from health care professionals, such as the district nurse, falls specialists, opticians, podiatrists and visits by the general practitioner. We looked at the night care plan for a person identified at risk of falls, we were informed that the care plan was in the process of being updated, as it had instruction that the person was settled at night, on looking through the night reports it was noted that on several occasions the person had been found on the floor within their bedroom, and on some occasions they had removed the call bell out of the wall socket, and had only slept for short periods. One person who required the use of bed rails to prevent them from falling out of bed had a risk assessment in place for this equipment, the assessment would benefit from being more specific to the bed occupant, such as recording whether there is any risks of entrapment, how the person responds to having the bed rails in place and whether they are able to understand and consent to having this equipment in place. Care Homes for Older People Page 4 of 12 We looked at the care of a person who was currently receiving care from the district nurse for treament to a pressure ulcer, within this persons room there was records available on the treatment to heal the pressure ulcer and dressings were available. We spoke with staff about a person who was receiving care from the district nurse due to having a urinary catheter in situ, they informed us that staff change the day bag each evening over to a night bag, we were told that a catheter care risk assessments was not routinely completed, due to the district nurse being involved. A catheter care risk assessment would enable all staff to be aware of catheter care procedures and cross infection control practices when caring for people who are cathererised. We asked whether all the staff had received training on catheter care and were informed that staff who directly provide care for individuals who are catheterised had received training in this area. We looked at the care of a person who is a diabetic, the care plan was very detailed and stated that the district nurse takes readings of the persons blood sugar levels, we enquired with the senior staff as to whether records of these readings are held at the home and were informed this is not made available to them. We were told that the medication stock and administration records are audited on a weekly basis, we sample checked stocks of medication and the records of administration, which were generally in good order. The administration records of prescribed creams and food supplements are held within peoples individual rooms, this enables the staff who assist the person to wash and dress to apply the creams and to sign the administration record. One person had recently been prescribed a food supplement with the instruction to be taken three times a day, on checking the medication administration records we found that this medication had been recorded as only being given once a day. We checked the daily notes for the person and there was several entries of them refusing their meals and eating only small amounts and there was a record of a food supplement being given. This was brought to the attention of the senior staff during the visit who said that this would be investigate further. We sample checked the stocks and records of controlled drugs held at the home,and we found that one person prescribed a pain relieving medication patch had not received this medication as prescribed. The administration records showed that it had not been required due to the person stating they did not need it. The instruction for this medication was listed as one patch to be applied weekly. This was discussed with the senior in charge during the visit who said that they would contact the persons general practitioner to arrange for a review to determine whether the medication was still required to be prescribed. During the course of the inspection we carried out a tour of the building and visited each of the units within the home, we spent time speaking with people using the service and staff and made general observations on how people are supported at the home. People were seen to be interacting with staff and each other, involved in general day to day tasks such as setting dining tables, and washing up. Some people were observed listening to music, watching TV, knitting and playing board games with staff. People who are independently mobile were seen to move around the home as they wished, visiting other units within the home and spending time in the communal areas. Individual bedroom doors have a photograph of the person to whom the room is occupied Care Homes for Older People Page 5 of 12 on the door to aid people in identifying their own rooms. Some areas have been redecorated and pictures hung on the walls in the corridors to give a homely feel. All private and communal areas of the home viewed looked clean and tidy,within each of the lounges there was a TV, CD, DVD and Video player, books, newspapers, games and rummage boxes. Some of the small kitchenettes looked in need of refurbishment as some of the doors and worktops looked worn, one cabinet had a drawer front missing. Microwaves are available to reheat meals, it is advisable that temperature probes are used when reheating meals in a microwave, to ensure meals are reheated to the correct temperature. In one of the lounges the weekly menu was pinned to the notice board, it may be of benefit to have the daily menu on display more prominently within the kitchen diner area either on a board or placed on the dining tables for people to pick up and read. The gardens are in great need of weeding, grass cut and general tidy up, outside the laundry there was some old furniture waiting to be disposed of bed bases, chairs, fridge etc. which contributed to the over all neglect of this outdoor space. We were informed that several calls had been made to the organisation to arrange for a gardener and also for the old furniture to be removed. During the inspection a further telephone call was made to request a gardener. A keyworker system is now in place where each member of staff is assigned to individual people using the service, and each unit holds their own meetings, we were informed that this is a new initiative recently introduced. We were informed that the training plan is currently under review, and that staff have recently attended refresher moving and handling training. We looked at the file containing information on concerns, complaints and compliments and we were told that no recent complaints had been made to the home by any of the people or their families. Within the file there were many thank you letters and cards that had been received from families of the people who had stayed at the home. Quality reviews have taken place on the care plans and risk assessments with the aim of focusing on outcomes for people using the service. The organisation has undertaken a staff survey and based upon the outcome, improvements have been made on the support systems for staff and managers. One to one formal supervision is taking place, with the focus on staff development needs. What the care home does well: The care plans contain detailed information on the health, personal and emotional needs of people using the service.There is a strong emphasis on raising the quality of the care provided for people using the service, regular quality reviews take place on the care plans and risk assessments with the aim of focusing on outcomes for people using the service. The organisation has undertaken a staff survey and based upon the outcome, improvements have been made on the support systems for staff and managers. One to one formal supervision is taking place, with the focus on staff development needs. A keyworker system is now in place where each member of staff is assigned to an individual Care Homes for Older People Page 6 of 12 using the service, each unit holds their own rseidents meetings, this gives people using the service the opportunity to contibute to decision making within their home. Risk assessments and monitoring systems are in place people who are prone to falls, poor diet and hydration and pressure area ulcers. The assessments are backed up with a care plan stating the aims and objectives on how risks are to be minimized. The home seeks the advice and intervention of health care professionals such as the district nurse, falls specialists, opticians, podiatrists and visits by the general practitioner. General observations on how people are supported at the home showed that people have the opportunities to interact with staff and each other, to be involved in general day to day tasks such as setting dining tables, and washing up. To participate in group and one to one activities, listening to music, watching TV, knitting and playing board games with staff. People who are independently mobile are encouraged to move around the home as they wish, visiting other units within the home and spending time in the communal areas. Individual bedroom doors have a photograph of the person to whom the room is occupied on the door this aids in enabling people to orientate themselves around the home and to identify their own rooms. Within each of the lounges there is a TV, CD, DVD and Video player, books, newspapers, games and rummage boxes, the small kitchenettes attached to the dining areas gives good opportunities for people to be engaged in making snacks and drinks and be involved in day to day household tasks, this promotes independence and gives people a sense of purpose in being involved in day to day life within the home. What they could do better: For people identified at risk of falls at night, the night care plans would benefit from more detail and instruction for staff to follow in order to effectively monitor those at risk. The risk assessments for people at risk of falling out of bed would benefit from being more individualised and specific to the bed occupant, recording whether there is any risks of entrapment, how the person responds to having this equipment in place and whether they understand and have given their consent to havijg this equipment in place. Catheter care risk assessment should be in place to ensure all staff are fully aware of catheter care procedures and cross infection control practices when caring for people who are cathererised. People using the service who require their blood sugar levels to be monitored would benefit from records of the readings being held within their care records. This would ensure that staff have the opportunity to closely monitor dietary intake and behaviors and take swift action in seeking medical advice if needed. The medication administration records (Mar charts) held within peoples bedrooms should be signed whenever a prescribed cream and/or food suppliment has been administered. People who regularly refuse or do not require their medications to be given on a regular basis should have their medications reviewed by their general practitioner. This would ensure that people receive their medicatations as prescribed. Care Homes for Older People Page 7 of 12 The small kitchenettes are beginning to look in need of refurbishment as some of the doors and worktops look worn, one cabinet had a drawer front missing. Microwaves are available to reheat meals, to ensure meals are reheated to the correct temperature it is advisable that temperature probes are used when reheating meals. It was noted that the daily menus are not prominent within each of the lounge diners, it may be of benefit to have the menu on display within the kitchen diner area either on a board or placed on the dining tables for people to pick up and read. The outside areas of the home are looking neglected the gardens are in great need of weeding, grass cut and general tidy up, and outside the laundry area old furniture is need of being disposed of. We were informed that several calls had been made to the organisation to arrange for a gardener and for the old furniture to be removed. In order for people to enjoy the outside space this needs to actioned as soon as possible. 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 8 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 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, 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 9 13 Any changes to the administration of prescribed medication must only take place following a medication review by a general practitioner. This would ensure that people receive their medications as prescribed. 14/07/2010 2 9 13 The medication 14/07/2010 administration records held within peoples bedrooms must be signed whenever prescribed creams and/or food suppliments have been administered. This will ensure that medications are given as prescribed. Care Homes for Older People Page 10 of 12 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 20 The gardens should be tended to without delay. This will ensure that people using the service are provided with a safe and pleasant outdoor facility. Temperature probes should be used when reheating meals in the unit kitchen microwaves, this would ensure that meals are reheated to the correct temperature. People who require their blood sugar levels to be monitored should have records of the readings being held within their care records. This would ensure that staff are aware of the blood sugar level readings and can take swift action in seeking medical advice if needed. Catheter care risk assessment should be in place to ensure all staff are fully aware of catheter care procedures and cross infection control practices when caring for people who are cathererised. Risk assessments for bed rails should be individualised and specific to the bed occupant, record any risks of entrapment, and record that the person has given their consent for this equipment to be in use. 2 38 3 38 4 38 5 38 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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