Inspection on 11/08/05 for Fairfax House

This inspection was carried out on 11th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Fairfax House 12/04/07

Fairfax House 07/03/06

Fairfax House 11/02/05

Fairfax House 16/09/04

Fairfax House 08/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Fairfax House 85 Castle Road Salisbury Wiltshire SP1 3RW Lead Inspector Sally Walker Unannounced 11 August 2005 th 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 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. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fairfax House Address 85 Castle Road Salisbury Wiltshire SP1 3RW 01722 332846 01722 341716 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Diana Butchers Mrs Diana Butchers Care Home 20 Category(ies) of DE(E) Dementia - over 65 (6) registration, with number OP Old Age (20) of places Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 20. 2. No more than 6 service users with dementia aged 65 years and over may be accommodated in the home at any one time. Date of last inspection 11th February 2005 Brief Description of the Service: Fairfax House is a care home registered to care from 20 older people 6 of whom may have dementia. The registered providers are Mr and Mrs Butchers and Mrs Butchers is the registered manager. The home is on the outskirts of Salisbury on the main Salisbury to Amesbury road and is within walking distance of the city centre. The home is situated opposite Victoria park and all the first floor rooms at the front of the property look out across the park. The property is spacious and has been extended to give single room accommodation to all service users. There are 3 en-suite bedrooms, a bathroom, a hairdressing room and a passenger lift included in the extension. The home has a range of communal areas and a large paved seating area has been developed in the garden. The staffing rota provided for a minimum of 3 care staff during the morning with 2 care staff in the evenings and, at night, one waking night staff and one sleeping in. All rooms have a call bell system. This is one of 2 care homes registered to Mr and Mrs Butchers. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place between 9.50am and 5.00pm. Mrs Butchers was on leave and Mr Butchers came from the other home to assist with information and access to some records. Six residents and one member of staff were spoken with. The care records, monitoring forms, fire logbook and accident records were inspected. The inspector made a tour of the building. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 7 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 standard(s) 3, 4 & 5 The home carries out thorough assessments of potential residents in order to establish whether their needs can be met. Residents and their families can be assured that the home will tell them that they can meet their needs. The home welcomes potential residents and their families so they can get a feel for the home and the service before they decide. EVIDENCE: One resident said they had come for a week before deciding whether they wanted to stay. Many of the residents said they knew of the home by reputation. Other residents said their family had looked at a number of homes in the area before deciding on this one. Pre-admission assessments had been carried out with good detail of residents care needs as well as social profiles and medical history. The home also carries out assessments when residents have any time in hospital. There were letters on file confirming that the home could meet potential residents needs following assessment. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 8 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 standard(s) 7, 8 & 10 The care plans are very detailed and identify all aspect of residents’ care and social needs. The care plans direct the care. Residents’ healthcare needs are fully met. Residents’ privacy is upheld and they feel they are treated with respect. EVIDENCE: All of the residents had very detailed care plans which were regularly reviewed every month. Outcomes of reviews were detailed in a written over view of residents care needs with specific markers for staff to take into consideration when delivering care. All aspects of residents care needs were identified and staff were expected to report on monitoring residents mood, mobility, health, activities and personal care interventions. Residents were asked if they were happy for personal care to be carried out by male staff and this was documented in their care plans. The daily reports showed that the care plans directed the care with good detail of residents preferred routines. Mr Butchers said that one day a month all the care staff would be on duty and a review was carried out with each resident. It was clear from the daily reports that staff talked to residents about how they were feeling, what they wanted to do and encouraged to make choices. All residents were well groomed. There were some very detailed social histories either written by the residents or their families. One resident said that the district nurse was providing wound care Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 9 and that the GP was monitoring the wound progress. Residents with diabetes had details of diet and medication in their care plan, but no record of monitoring of their condition. Mr Butchers said that the district nurse was monitoring blood sugar levels and details would be in their notes. The inspector advised that the home should also keep their own notes on monitoring management of diabetes. The requirement that tissue viability training was provided in order that residents’ risk of developing pressure sores could be assessed had not been actioned. Mr Butchers said that the tissue viability specialist nurse for this area was only part time and the home had experienced difficulty in obtaining the training. He went on to say that Mrs Butchers would inform the Commission of the progress in meeting this requirement when she returned from leave in 2 weeks. It was noted that pressure-relieving equipment was in place for some residents and that nutritional monitoring was being carried out. No formal assessments were being carried out, but none of the residents had pressure sores. Mr Butchers reported that residents’ risk of developing pressure sores was discussed at the monthly staff meetings. The requirement that residents’ weights were regularly monitored was actioned. The weights were kept in a separate file which had not been available at the last inspection. Staff noted any significant weight loss and concerns were referred to the GP with food supplements prescribed as necessary. All of those residents who were in their bedrooms had juice or water within their reach. Residents said they could have a bath when they wished and one said they could lie in the bath for a soak. This resident’s care plan did not identify that this was the case and the inspector advised that where residents are assessed as being safe in the bath with out staff support, then the length of time needs to be identified for the protection of residents. The requirement that records were signed and dated had been actioned. One resident explained how their health and quality of life had improved since coming to live at Fairfax House sufficient for them to be returning to live with their family at the end of the month. They were very pleased with the care and support from staff for them to achieve this. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 10 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 standard(s) 12, 13, 14 & 15 Residents follow their own routines and good contact with relatives and family are maintained. There is a good range of activities provided both in small groups in the home or individually in the locality. Residents are encouraged to retain control over their lives. Residents were please with the quality and range of meals provided. EVIDENCE: One of the residents said they loved living at the home and explained how they had been supported by staff. Several of the residents said they attended the bible study classes held in the home on a Tuesday. Several residents said they enjoyed the visits to a nearby supermarket where they would also have refreshments. Residents said they had their breakfast delivered to their bedrooms at different times between 7.00am and 8.00am. They said they could then get up in their own time. Residents said they did what they liked during the day; they could join the others in activities or spend what they described as quiet time in their bedrooms. Some residents visited others in their rooms for a chat. Residents talked about family visiting the home or taking them out for meals. One resident said that staff would post letters. Some of the residents described recent activities and one showed the inspector the minutes of a meeting to discuss where residents wanted to go on trips. One resident said a man had come and played his guitar and sang the day before and a group of residents had been to Longleat for the day with a picnic lunch in the grounds. Another resident said a person had come to the home Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 11 that week to give an interesting talk. They said another trip was planned to gardens near Bournemouth. Other residents talked about a barbeque, an evening of poetry reading with sherry, story telling and exercises. One resident said that Mrs Butchers had gone to India to help with the support for the Tsunami victims. They said the home had raised money and 3 of the residents were knitting blankets to raise more money for the appeal. Activities were identified in residents care plans together with the benefit to the residents of each activity, for example, dexterity or keeping fit. There was a published plan of activities for each month and a record is kept of which activity was provided and who attended. All of the residents spoken with said they enjoyed the quality of the food provided. They said they did not always know what the lunch was going to be but it was usually to their taste; if they did not like the meal they could have an alternative. Residents said that the evening meal was a choice and staff came round to ask them what they wanted; it was usually a hot meal. Residents said they had a hot milky drink with a biscuit at about 8.00pm. The care records showed evidence of any nutritional monitoring. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 12 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 standard(s) 16 & 18 Systems are in place to enable residents or others to express any concerns they may have about the service. The home is aware of the process of reporting any suspected abuse of residents. EVIDENCE: Residents were asked about making complaints and comments. Most residents were aware of the complaints procedure and said they would talk to Mrs Butchers or their family. They also said they discussed and were asked if there was anything they were not satisfied with at the monthly meetings. One resident showed the inspector the minutes of the last few meetings. The home is familiar with the process of reporting concerns under the vulnerable adults process and the local vulnerable adults unit has visited the home to provide training to staff. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 13 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 standard(s) 19 & 26 Residents live in a well-maintained, clean and comfortable environment. EVIDENCE: The home was quiet and residents were up and planning their day. Residents bedrooms were comfortable light and airy and residents were able to bring some items of their own furniture to personalise their bedrooms. Residents made use of the garden at different times of the day. There was a large accessible paved area which had been set out with garden furniture and sunshades. One of the double glazed windows in one of the bedrooms had degraded. The resident said they could not see out of it anyway when it was pointed out. Mr Butchers said that there was a plan to replace a number of windowpanes which were degrading and agreed to inform the Commission of his action plan. All the residents in their rooms had their call bells within reach. Residents said that staff were quick to attend when the bell was activated at any time during the day or night. One of the bedrooms had been fitted with a sliding chain lock on the inside, released with a key. It is of concern that this resident would not be able to get out of the bedroom in an emergency. The inspector has requested advice from Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 14 the Wiltshire Fire Brigade as to whether this type of lock is approved. Two of the bedroom doors were being held open with a wedge; one of these doors was already fitted with an automatic self-closing device. Mr Butchers was advised to check that the device was fully functioning and ensure that fire doors were never wedged open. Mr Butchers was investigating why television reception was poor to some of the bedrooms on the ground floor and checking the function of the aerial. The home was cleaned to a high standard and no unpleasant odours were detected at all during the inspection. Particular attention was given to ensuring those areas which were not visible, for example, the undersides of commode surrounds and bath hoists. Staff are commended for their cleaning to infection control standards. One resident said they did a small amount of cleaning when they were feeling up to it and liked to help in the kitchen as well. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Residents are supported by skilled, well-trained and experienced staff. Staffing levels allow residents to be supported with the needs identified in their care plans as well as being able to access the locality. EVIDENCE: The care staffing rota provided for 3 staff during the morning, 2 staff during the afternoon and evening, one member of night staff and a member of staff sleeping in. All of the residents spoken with made very positive comments about the staff and Mr and Mrs Butchers. Some comments were that staff always had time for a chat, that nothing was too much trouble and residents never felt that they were a burden. The daily records showed that staff spoke to residents on a regular basis and in particular when events occurred. Mrs Butchers provides much of the training as she is a qualified trainer in moving and handling and first aid. The home has its own training room. There was a record of each staff’s training undertaken since Mr and Mrs Butchers have run the home. These record confirmed that staff were well trained in relevant subjects including caring for people with dementia and NVQs as well as the core safety training: health and safety, fire prevention, infection control and moving and handling. There is a plan for the year so staff receive regular training. One member of staff told the inspector about their new role and how they felt they had good access to training, good supervision and was well supported by management. They said there were staff meeting every month and yearly appraisals. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 37 & 38 The home is run in the best interests of the residents. Although the record keeping is generally very good, lack of some pressure risk assessments and diabetes monitoring makes residents vulnerable. Systems and checks are in place to ensure the health and safety of residents and staff. EVIDENCE: As Mrs Butchers was on leave at the time of the inspection, these standards were not assessed in full. Mr Butchers had come from the other home to assist with some access to documentation. Mrs Butchers has set up a quality monitoring system for the two homes although this was not examined at this inspection; only the discussion about implementation in the other home. The fire logbook was generally being satisfactorily maintained. However there were many different formats being used and it was not easy to establish if some tests and checks were carried out. The inspector has supplied a full set of the forms required to be completed. The accident book was well maintained with good detail of any witnessed events, resident’s position if a fall was no witnessed, the resident’s account of the event and staff interventions. As Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 17 highlighted in the section of this report on health and personal care, assessments must be carried out on residents’ risk of developing pressure sores, once the training has been implemented. The home must also keep a record of monitoring of any resident’s diabetic conditions. Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x 2 3 Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? 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 OP 8 Regulation 13(4)(c) Requirement Timescale for action 1st September 2005 2. OP 19 23(4)(b) The registered person must inform the Commission of the progress to ensure that care staff are trained in tissue viability in order that risk of developing pressure sores can be assessed. The person registered must 1st ensure that where residents September require their bedroom doors to 2005 be locked that the lock is of a type approved by the Fire Authority so the resident can get out of the room without the use of a key. 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. Refer to Standard Good Practice Recommendations Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 20 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Fairfax House D51_D01_S28678_FairfaxHouse_V200042_110805_stage4.doc Version 1.40 Page 21 - 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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