Inspection on 11/10/05 for Fairby Grange Rest Home

This inspection was carried out on 11th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fairby Grange Rest Home 26/03/07

Fairby Grange Rest Home 17/05/05

Fairby Grange Rest Home 25/10/04

Fairby Grange Rest Home 11/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fairby Grange Rest Home Ash Road Hartley Dartford Kent DA3 8ER Lead Inspector Elizabeth Baker Announced Inspection 11th October 2005 09:30 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 Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fairby Grange Rest Home Address Ash Road Hartley Dartford Kent DA3 8ER 01474 702223 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) Mr Gregory Brian Reeve Mr Gregory Brian Reeve Care Home 30 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (29) Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care for one older person with mental health difficulties is restricted to a person whose date of birth is 15 July 1921. 17th May 2005 Date of last inspection Brief Description of the Service: Fairby Grange is a care home providing personal care only for 30 Older People. Mr G Reeve is the Registered Provider. The home is a detached listed Grade II property built around 1685. A purpose built extension was added to the home in 1992. Bedroom accommodation is on two floors and comprises 24 single and three double rooms. Seven single rooms and one double room have ensuite WC facilities. The home does not have a passenger lift. Bedrooms on the first floor are accessed by a chair lift. Three bedrooms on the first floor mezzanine level have to be accessed by an additional four steps. All bedrooms are connected to the call alarm system. Day space comprises of one reception room, two-day rooms and a dining room. One day room is designated for residents who smoke. The home is situated within well-maintained gardens. There is a small secluded patio area at the rear of the property. The home is situated near to the village of Longfield. Longfield has a variety of shops and restaurants, as well as a bank, building society, small library and a church. Train services to London Victoria, the Medway Towns and Kent Coast are available from Longfield Station. Buses to the neighbouring areas of Dartford, Gravesend and New Ash Green, as well as the Bluewater Shopping complex, pass nearby the home. Car parking facilities are available. The home is easily accessible by car from the main A2/M25 road junction. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over seven hours on the 11 October 2005. A partial tour of the home was carried out. Some residents and visitors were spoken with, as well as a number of staff. One resident and one staff member were interviewed in private. At the time of the visit the 27 residents were residing at the home. The Manager Mrs C Brent was available throughout the inspection. Some judgements about the quality of care, life and choices were taken from conversations with residents, visitors and staff, as well as direct and indirect observations. Some records were seen as part of case tracking and to assess work on the requirements and recommendations made at the last inspection. In response to the announcement of this inspection the Commission received a total of 16 comment cards all from relatives/visitors. Some of their comments have been incorporated into the report. This is the second inspection of this home for the year 2005/06. Not all key standards have been inspected on this occasion, where they were met at the first visit. This report should therefore be read in conjunction with the inspection report dated 17 May 2005. What the service does well: What has improved since the last inspection? The majority of requirements and recommendations made at the last inspection have been complied with. This includes the installation of additional hand wash sinks in the laundry and residents’ toilet. Having appropriate hand washing facilities minimises cross infection hazards. The manager strives to encourage care staff to continue to build on to their improved record keeping skills. This is important, as care records provide the Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 6 information staff need to deliver appropriate care and support, as well as evidencing the care has actually been given. 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. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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 Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 The home’s statement of purpose needs to be amended to ensure prospective residents and their advocates are sure the home can meet their needs. Residents are appropriately assisted in transferring to other care homes where there is a change in their condition for which Fairby Grange is not registered to provide care for. EVIDENCE: A detailed Statement of Purpose and Service User Guide are available for prospective and current residents. A couple of points in the Statement of Purpose which require amending were discussed with Mrs Brent, including the correct title of the Commission and a reference to dementia care, for which the home is not registered. As these documents provide essential information to prospective residents Mrs Brent said the points would be brought to the proprietor’s notice for his attention. Prospective residents and their advocates are either assessed in their current environment or indeed invited to visit the home prior to a decision of admission being made. The home is registered for personal care only. Where a Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 9 resident’s condition changes the home makes appropriate arrangements involving all relevant parties to find a more suitable care home. This ensures residents receive appropriate care. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents are potentially at risk because their medications are not always administered as per the prescriber’s instructions. The content of care plans has improved. However, staff must make sure the plans and associated records contain all current information so residents’ complete needs are met. EVIDENCE: Three care records were inspected as part of the case tracking process. Care plans contain much more information and generally reflect the information obtained during the pre admission and admission process. Plans are dated as having been reviewed. However, in one case the nutritional and mobility needs of one resident were not reflective of their current situation. Only one of the three care records included a moving and handling risk assessment, and this was not reflective of the current situation. Additional documents are also maintained to support the care plans including daily reports, records of GPs and other health professionals’ visits and residents’ weights. Although nutritional risk assessments are not routinely undertaken on residents, a record detailing a particular resident’s nutritional needs was available on a separate sheet of paper. However, this information Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 11 had not been crossed referenced to the care plan. It was also identified that six of the current residents are not being regularly weighed because they are unable to use the stand-on scales. This situation potentially places these residents at risk, as their nutritional condition cannot be appropriately monitored. Details of residents’ food preferences are kept in the kitchen. In a particular case the information was not as that described at the inspection. The kitchen record list was undated. The corresponding care records did not contain this information either. Residents are assisted in attending medical appointments and arrangements are in hand for residents to have their eyes tested by a visiting optician. It is intended the optician will also provide a staff training session in respect of eye and spectacle care. This is an important aspect of care for those residents with impaired vision. A District Nurse has agreed to provide a talk on caring for residents with diabetes. As well as care staff two residents have indicated they also wish to attend to learn more about their condition. The manager now undertakes general risk assessments on residents with regard to the chair lift and various steps around the home. This is good practice and assists in identifying and reducing potential risks. A review of five medication administration record charts identified some residents not receiving their regular dose medication; one resident receiving two doses as opposed to one dose of once a week medication; daily dose medication being given at night; and details of actual quantity administered of variable dose medication not being recorded. This situation presents a potential risk to residents. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Not all residents and or their advocates are aware of the actual availability of drinks and meals because the menus do not sufficiently provide this information. The range of activities does not meet all residents’ needs. EVIDENCE: It has not been the home’s practice to obtain comprehensive biographical details of residents. Having this information would assist in the development of activity programmes, which currently offer limited occupation. Indeed one resident said it gets boring and a comment card respondent added the additional comment “…what activities are used to stimulate the [residents]. I know bingo, but wonder what else”? An appetising lunchtime meal had been prepared and served during this inspection. Residents spoken with during the inspection said the food is good; second helpings and larger portions are available if asked for and hot milky drinks, biscuits and sandwiches are available during the evening and night if they want them. However two comment card respondents indicated this was not their view. The current layout of the menu may give the impression residents must choose one item and a sweet at suppertime and does not inform residents of the availability of additional snacks and drinks. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 13 It was identified on this visit that it has not been the home’s practice to present residents who require soft diets (pureed or liquidised) with their meals in a manner, which is attractive and appetising in terms of texture, flavour and appearance. To ensure residents’ appetites and nutritional requirements are maintained portions should be separately blended and presented. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents may not be totally protected from abuse. EVIDENCE: The two members of staff interviewed said they had not received training in adult protection or abuse. The manager said some staff had received adult protection awareness training as part of their NVQ course. The manager is aware all staff must receive competence-based training for this important aspect of care. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 22 and 26 Fairby Grange provides and clean and homely environment to live in. Improvements in toilet facilities for wheelchair bound and physically disabled residents would enhance their quality of life. EVIDENCE: The home was found to be clean, tidy and odour free. Indeed a visitor said the home is always in this condition when they visit. The domestic staff should be congratulated in keeping the home in such a condition. Following a recommendation made at the last inspection the proprietor has fitted an additional handrail at the foot of the stairs to assist residents in safely accessing the chair lift. Some corridors are narrow, dark and have a number of steps. Mrs Brent said staff have been instructed to keep lights on in these areas at all times to assist residents in moving safely around the home. A comment card respondent commented “Problems often arise with the toilet. [Wheelchair residents] sometimes have to wait a long time to use disabled Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 16 toilet if it is being used for bathing. A second disabled toilet has no useful rails for people in wheelchairs and is very awkward to use. This is also used for bathing”. Because of the age and design of the home, toilet facilities for residents who are physically disabled or wheelchair bound are limited. To ensure the home’s facilities are appropriate for current and future residents with physical disabilities, expert advice from a suitably qualified person such as an occupational therapist should be sought. This may assist in identifying areas and facilities, which could be improved to better serve less able residents. The College of Occupational Therapists retains a list of private Occupational Therapists. The College can be contacted on 0207 357 6480. To minimise the hazards of cross infection amongst residents and staff, additional hand washbasins have been installed in the laundry and residents’ toilet. During this visit it was noted that one of the residents’ toilets does not have a call alarm for residents to use if they require assistance. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 The manager and proprietor recognise the importance of ensuring care staff receive appropriate training. EVIDENCE: Mrs Brent said there have been no new employees since the last inspection. Standard 29 will be assessed at the next visit. The pre inspection questionnaire document states 50 of carers are now trained to NVQ level II or equivalent in care. Mrs Brent has identified training needs of staff and is making arrangements for the necessary training to be accessed. Indeed since the last inspection some care staff have completed infection control training. Moving and handling training has been arranged for next month and accredited medication administration training is being arranged. The Chef has many years experience of preparing meals in schools and hotel environments. Indeed she attained various City and Guilds qualification in respect of catering over forty years ago. Although she has a current food hygiene qualification she has not actually attended any update catering or nutritional courses to ensure her knowledge reflects current good practice with regard to older people. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 The new manager is committed to ensuring the home continues to build on its improvements. EVIDENCE: The manager who was appointed about five months ago has successfully completed the management part of her Registered Manager’s Award course and is on track to complete the outstanding units of the care component. The manager continues to receive appropriate support from the proprietor and staff, which assists in the continued development of the home. Records and cash balances in respect of monies kept at the home for three residents were audited. Two of the three records could not be reconciled with the cash balances. Although these were small amounts, staff must ensure that records of monies held on behalf of residents are accurately maintained. Introducing counter-checks and signatures may assist in this. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 19 Mrs Brent maintains records of fire checks, which are regularly carried out to ensure the home is kept safe. The home has just been notified that it is to receive a fire audit by an Inspecting Officer of Kent Fire and Rescue Service to ensure compliance with the Workplace Fire Precautions Legislation. The pre inspection questionnaire indicates 12 members of staff hold current first aid certificates. This ensures appropriate action is taken if a resident or indeed a visitor to the home requires first aid assistance. It was difficult to establish from the document held at the home the service details of the chair lift. The manager confirmed a legible copy would be sent to the Commission. The pre-inspection questionnaire form indicates the last environmental health inspection was carried out at the home in July 2003. However, the Chef said an inspection was carried out this year. The manager agreed to clarify the position and forward a copy of the resultant report to the Commission, for record purposes. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 20 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 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X 2 2 X X X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 X X 3 Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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. 1 Standard OP27 Regulation 18 Requirement CRB clearance must be obtained by the home in respect of new staff. (No new staff have been appointed since the last visit. This will be assessed at the next visit. Staff must receive infection control training. (Timescale 31/08/05 almost met). Statement of Purpose must be regularly reviewed to ensure it is current and accurate All residents must be weighed on admission, regularly thereafter and nutritionally risk assessed Medications must be administered as per prescriber’s instructions All residents must be able to access toilets to meet their assessed needs Timescale for action 31/10/05 2 3 4 5 6 OP30 OP1 OP8 OP9 OP21 18 4 and 5 17 13 13 31/01/06 31/12/05 31/01/06 11/10/05 31/01/06 Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 22 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 4 5 6 7 8 9 10 11 12 Refer to Standard OP7 OP7 OP8 OP12 OP15 OP15 OP18 OP22 OP30 OP31 OP35 Good Practice Recommendations Care plans must be reflective of residents’ current condition. All residents must be assessed in respect of moving and handling Details of residents likes and dislikes with regard to drinking and eating must be recorded in their care plans and regularly reviewed Residents’ biographical details should be obtained, recorded in their care records and used as a basis to develop the activities programme. Liquidised and pureed meals should be presented in a manner to maintain texture, flavour and appearance. Menus must inform residents of the availability of all meals, drinks and snacks. All care staff must receive competence based adult protection training. Expert advice should be sought from an appropriately qualified person on the suitability of the home’s facilities for wheelchair bound and physically disabled residents. Staff, including the chef, should receive update training for their designated roles. Mrs Brent must successfully complete the outstanding care units. Records and cash balances of residents’ monies must reconcile at all times. Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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 Fairby Grange Rest Home DS0000023941.V251850.R01.S.doc Version 5.0 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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