Inspection on 12/04/07 for Fairfax House

This inspection was carried out on 12th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 07/03/06

Fairfax House 11/08/05

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 Ms Sally Walker Unannounced Inspection 09:30 12th April 2007 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 Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 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. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfax House Address 85 Castle Road Salisbury Wiltshire SP1 3RW 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) 01722 332846 01722 341716 Mrs Diana Butchers Mr Alan Butchers Mrs Diana Butchers Care Home 20 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (20) of places Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 20 No more than 6 service users with dementia, aged 65 years and over, may be accommodated at any one time 7th March 2006 Date of last inspection Brief Description of the Service: Fairfax House is a care home registered to care for 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 12 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 4 care staff during the morning with 2 care staff in the afternoons and evenings. There is one waking night staff and a member of staff sleeping in. All rooms have a call bell system. This is one of 2 care homes registered to Mr and Mrs Butchers. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key unannounced inspection took place between 9.30am and 6.05pm. Mrs Butchers was present during the inspection. Three residents were spoken with in detail and three staff. A tour of the building was made. The care records, staff personnel files, risk assessments and menus were examined. As part of the inspection process, written comments were requested from residents, relatives, care managers and healthcare professionals. Specific comments are to be found in the relevant part of the report. Other comments included: “Lovely and clean and my room”, “I’m happy here and content”, “I haven’t been in any other home apart from this one, but I am happy here”, “My room and other areas always clean and tidy”, “Very happy with my care”, “Doctor/Nurse called if I need them”, “My room is spotless, we have a good cleaner”, “Very happy at Fairfax House and with my room” and “Very happy and comfortable at Fairfax House. No problems what so ever”. A relative wrote that their family member “has been extremely well looked after by the staff who are very friendly and efficient – [the family member] is also very happy there [and] says the food is very good and varied – I can also verify this. I have also found Mrs Butchers to be helpful and kind to her residents. I would not hesitate to recommend Fairfax House to anyone.” Another relative wrote: “I have no complaints re. Quality of care: liquid intake is monitored and call system is efficient. More regularity in hairdressing and nail cutting could be improved. Accommodation is excellent.” One of the social workers wrote: “I am always impressed, firstly with the cheerful and helpful manner in which the staff always greet me, and secondly, by the care they give their residents. They are very tolerant of the idiosyncrasies of my clients with dementia, and seem to enjoy the challenge posed by some of their behaviour. The only thing that I would comment on is that residents often do not seem to be occupied and seem to be sleeping in their chairs. But as I am only there for short visits, the activities may well take place at other times. I know that they do take able residents for walks as staffing permits. On the whole, I feel that Fairfax is a well run home with good staff.” The monthly fees for Fairfax House are between £380.00 and £467.00. The home sets out a scale of additional weekly charges according to the level of dependency: from £31.50 for help with washing and dressing through to £283.50 for 24 hour constant care in exceptional circumstances, only for current residents who do not require nursing care. The home is not registered to provide nursing care. Full details of the additional charges can be gained Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 6 directly from the home. The fees do not cover hairdressing, foot care, taxis, dentist, toiletries or clothing. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 7 In order that staff can assess the early indicators of residents risk of developing pressure damage, tissue viability training was planned. The district nurse had assessed each resident’s risk and would be supporting staff to do their own assessments. Following a small fire, one bedroom has been totally refurbished. The fire procedure has been amended. As evidence of good practice, staffing levels have been increased at certain times to enable more support for those residents who were described as more frail. 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. The summary of this inspection report can be made available in other formats on request. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 8 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 Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that as much as possible is known about the residents care, social and medical needs before a place is offered. Information is gathered from a range of sources. Most of the residents already knew of the home, which had influenced their decision to live there. The home ensures they prepare for the new residents arrival. EVIDENCE: As part of the inspection process, comment cards were sent to the home before the inspection. Some of the comments regarding contracts and information available before moving were: “I think so, family might have contract”, “Not that I’m aware of my husband might have”, “family have the contract”, “Not personally due to being poorly, but family was informed”, “Came with my husband and looked round before I moved in”, “I can’t remember, I think my daughter dealt with it all”, “Can’t remember I think my husband dealt with it”. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 10 Although many of the residents who had completed surveys either could not remember or did not know whether they had received contracts, Mrs Butchers confirmed that all residents did have contracts and most families had Power of Attorney so contracts would be with them. Many of the residents said they knew of the home by reputation. One resident described their experiences of another care home and compared them with Fairfax House. They said that it had a more cosy feeling and that staff were very good at looking after them. Mrs Butchers carried out the pre-admission assessments and would visit prospective residents either at home or in hospital. The assessment covers all aspects of care and medical need. Social histories are requested from the resident or their family. Care management or healthcare assessments were also obtained before the home decided whether the assessed needs could be met. As part of the admission process the home has a checklist to make sure that everything is in place or ready for the resident when they are admitted. This includes making sure the bedroom is ready and paperwork in place. Mrs Butchers also carries out assessments with residents who may have spent time in hospital to determine whether the home can continue to meet their needs. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have all their care and support needs set out in a personal care plan. Residents had good access to healthcare professionals. None of the current residents were administering their own medication. Systems were in place to ensure the safe control and administration of medication. Residents’ rights for privacy, dignity and choice in who provides their care are upheld. EVIDENCE: Mrs Butchers said that some of the residents had become frailer and the staffing allocation had been increased to offer more support with eating and personal care. Care plans identified that these residents could continue to get up and come down to the sitting room or stay in their rooms depending on how they were feeling. Care plans also identified where these residents would spend some time during the day having a rest on their beds. The care plans identified that residents who did spend time in their rooms either through choice or frailty were to be regularly checked. Residents were encouraged to walk to the dining room but wheelchairs were offered when necessary. This was identified in care plans. Mrs Butchers said that although residents were Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 12 encouraged to be as independent as possible, there may come a time when residents could not walk or carry out their own personal care through increased frailty or ageing and this was respected. There is a general care plan with some detail of care needs and how the care is to be provided. The monthly evaluation sheets however show the more specific detail on the most current care needs and how they are to be met. Each residents preferred daily routines are documented. One resident said they preferred to have a bath once a week and this was confirmed in their care plan. Much of what this resident told the inspector was confirmed by their care plan. Each resident had an individual risk assessment identifying different needs, for example, using a kettle, using the lift or using the ensuite bath. Some assessments identified where some residents must never be left alone in the bath. All personal care was conducted in private. Residents were able to choose the gender of those staff carrying out intimate person care and their decision was recorded in their care plan. If the resident’s preference could not be sought, their representative would be asked to decide based on their knowledge of the person. The daily report showed a good picture of how the care was delivered. This included much evidence of discussion with residents about different subjects including how they are feeling that day. There was some good evidence that residents were consulted and decide what happened from day to day. Where residents’ nutrition was compromised, food and fluid charts were in place. The inspector advised that the daily totals should be recorded to aid monitoring. There were clear instructions in these residents care plans on how to support residents with eating and that they should eat at their own pace. Daily reports showed prompt referral to relevant healthcare professionals where necessary. Records were kept of all medical appointments and reasons for any tests. Residents’ preferences for getting up or staying in bed were varied. One resident said they got up and went to have their breakfast in the dining room but would return to bed for a time and then get up. They said that staff did not mind if they did this. All of the residents were well groomed. One resident showed off their newly painted nails. The requirement that care staff were trained in tissue viability in order to be able to assess the early indicators of residents’ risk of developing pressure sores was in progress. As there is no tissue viability specialist nurse in the area, arrangements have been made with one of the district nurses to provide the training. In the meantime the district nurse has carried out assessments for all residents risk of developing pressure damage. The nurse had used a recognised nursing tool for the assessments, which she would help staff to fill out when doing further assessments once they had received the training. Those residents who had been identified as at risk of developing pressure Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 13 damage had pressure-relieving equipment in place. Staff were recording when a resident’s lying position was changed to reduce continuous pressure. Moving and handling risk assessments were in place and residents were regularly weighed. Residents had good access to healthcare professionals. One of the visiting district nurses was asked for their comments about the home. They said that staff were ‘brilliant’ at bringing any concerns to their attention. They said that staff always acted on any advice given. They said the staff had good knowledge and skills. Staff would take residents to the hospital appointments. They said there was a continuity of staff with not much turnover. They found the staff to be helpful and caring to the residents. They said staff got upset when any resident died. They also described some of the activities they had seen including music sessions, communion, bible study and going for tea at Mr and Mrs Butchers other home. One of the GPs commented, “I find the attitude and care from the staff to be above average and of a very caring nature. I have no adverse comments to make and would indeed be happy for a relative to reside there.” One of the Consultant Psychiatrists commented that they had a good impression of the home. They said that staff were well prepared for their visit and always had a good description of the residents care needs, particularly how the residents may be feeling. They said that staff always acted on their advice and would carry out any medication regimes. One of the staff who had the responsibility for administering medication on that shift explained the system. The home uses a monitored dosage system put up by the supplying pharmacist. The medication was stored in a locked trolley in a locked room. No staff could administer the medication without having completed the home’s training pack which was externally marked. Another member of staff administering the lunchtime medication said that their ongoing competence to administer medication was assessed every 6 months. Residents could administer their own medication following a risk assessment, but none of the current residents were administering their own medication. A record was kept of all unused or unwanted medication returned to the pharmacist. The medication administration records were kept with the drug trolley. The controlled drug record was being kept in the kitchen. Staff said it was always kept there. These records must be kept securely. The inspector advised that where 2 different painkillers were prescribed when required, the care plan must record the triggers for administering each medication. One resident said that they had been ill for the previous few days and this was their first day up. They said that they had been looked after very well during this time by staff and had been offered a visit from their GP but had declined. They said that staff would administer their medication at the times for which it was prescribed. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 14 The requirement that the controlled medication records show the correct balance when medication is received into the home had not been actioned. These records did not show the medication on each record. There were gaps in these records where staff had not recorded an administration. Mrs Butchers said she would immediately address these issues with staff, particularly as it had not been noted in the monthly drug audit. The requirement that where any resident had swallowing difficulties that either a liquid or soluble equivalent medication was prescribed had been actioned. All but one of those residents who were visited in their bedrooms had their call bells within easy reach. This person knew where it was a pointed it out, but could not reach it from where they were so it was given to them. All of these residents had a drink within easy reach. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to follow their own routines both in the home and in the locality. Activities are provided every day both at the home and in the locality. The home consults residents about what they prefer to do. Residents are encouraged to have control over their daily lives. Residents enjoyed the meals and were consulted about the menus. EVIDENCE: Residents were able to follow their own routines and could spend their day where they wished, including those residents who had been described as more frail. Although there was no designated activities person there was an event of some kind taking place every day. Activities were allocated to members of staff each day in the daily shift organisation sheet. On the afternoon of the inspection a person had come to play music and percussion with the residents. One resident said they enjoyed the weekly Bible study. Residents made very positive comments about the range of activities that they could part in. Meetings had been held to discuss what residents would like to do for the next few months and many trips or entertainment had already been booked. The administrator was in the process of printing a poster of the plan. There was at least one trip out each week. One of the residents said they liked the trips to Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 16 the local theatre and meals out. Another had been to the Arts Centre for lunch. Written comments from residents included: “I don’t always wish to take part, so I don’t”, “fancy dress keep fit”, “I decide if I want to take part”, “Will be asked each time and I decide if I want to take part”, “I only take part in Bible Study, the only activity I enjoy” and “I take part in all activities and enjoy them”. Other activities included keep fit, reminiscence, music for health, a pub lunch, a trip to an army museum, a jazz band, a barbeque, quizzes and going into Salisbury for a cup of coffee. Some activities were one to one time with staff where the resident decided what to do, for example, a walk in the park, going shopping or having their nails done. There was a record of each resident’s involvement in activities with any comments on what they had got out of the activity. Relatives and friends could visit at anytime and could see the residents either in their bedrooms, the front entrance which was provided with a seating area or in the sitting room. There was a large flat screen television with video in the sitting room together with a music centre. All but one resident spoken with made very positive comments about the range and quality of the meals provided. Written comments from residents included: “Not very often I don’t like something”, “Don’t like every meal that’s put in front of me all the time”, “Staff and cook aware of likes and dislikes” and “No complaints about the food”. A complaint about the food had prompted Mrs Butchers to survey all the residents and their families about the food and the menus were changed. The three-week menu dated January 2007 showed a range of traditional meals with a cooked meal for lunch and supper. Further discussions with staff and the cook showed that in fact there were three choices for each serving at supper which were not identified on the menu. There was a separate list for what each resident liked for their breakfast. One of the staff said that breakfasts would be served between 6.00am and 8.00am. The lunch meal served on the day of the inspection was gammon in a cream and leek sauce with swede, cabbage, mushrooms and potatoes. The pudding was Christmas pudding with custard. The cook served the meal according to individual appetites. The meal was well presented and looked appetising. There were liquidised meals for some of those residents who had chewing or swallowing difficulties. The inspector suggested that, in order to make the meal more appetising, the individual ingredients could be mashed or liquidised so they retained their individual flavours rather than be offered a homogenised soup-like meal. Those residents who were supported to eat their lunch were given individual attention and staff explained what the meal consisted of. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 17 Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place for residents and their relatives to complain and make comments of the service provided. The home acts on comments and complaints and makes changes where necessary. The home followed the local policy and procedure for the reporting of abuse. EVIDENCE: The home has a complaints procedure which is given to residents and their relatives. A record is kept of all complaints together with any investigation, action plan and response to complainants. As a matter of good practice, some complaints have prompted quality assurance surveys. These were sent to either residents or relatives to find out their views on aspects of the service, for example, when a complaint was received about the food. Most of the residents knew how to make a complaint and many said they had no reason to complain. Written comments from residents included: “[I] speak to my friend”, “don’t know who to ask”, “speak to the boss”, “Tell someone in the office”, “I have nothing to complain about” and “Go to Mrs Butchers, Mandy or Sarah”. All staff were in the process of undertaking updated training in the protection of vulnerable adults with nearly half having received their certificates. Copies of the local safeguarding adults procedure entitled “No Secrets in Swindon and Wiltshire” were available to staff. Mrs Butchers was clear about when to Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 19 activate the process and would consult with the Safeguarding Adults Unit if concerns were noted. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Much effort has been made to ensure a safe, comfortable, warm and wellmaintained environment for residents. The home was cleaned to a high standard. EVIDENCE: All of the bedrooms are single accommodation, 12 having their own ensuite facility. Much effort has gone into ensuring residents can personalise their bedrooms. Residents may have keys to their bedrooms if they wish. Residents can easily access the level enclosed gardens to the rear of the property. Garden furniture and shade is available for residents to make good use of the garden. All of the entrances and exits to the home have ramps for wheelchair access. Mrs Butchers showed the plans for creating a new office where the conservatory was currently. She went on to say that the gardens were to be Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 21 re-landscaped and the fishpond moved to make the gardens even more accessible. A loop system was to be installed in the sitting room to enable those residents who were hard of hearing to hear the television better. One of the downstairs bathrooms was being made into a walk-in shower. All the beds had been replaced with new. Curtains, bed coverings and towels had been purchased for all the bedrooms. The entrance seating area had new chairs and settees and the sitting room had been re-decorated. A programme of redecoration of all the bedrooms was underway with residents choosing colour co-ordinations. Bedroom door locks had been changed and Mrs Butchers agreed to remove the old chain part of the locks as they served no purpose. The home had its own hairdressing room and a hairdresser came to the home three times in a fortnight. Mrs Butchers said that the local Environmental Health Officer had recently carried out an inspection of the kitchen and their recommendations for probe wipes and a sanitizer had been actioned. The home was cleaned to a very good standard including those areas not necessarily visible. Cleaning staff were employed during the mornings. There were no unpleasant odours detected at any time during the inspection. Staff were trained in infection control and Mrs Butchers regularly attended meetings with the local health protection agency. The home had an infection control policy. Residents said they were pleased with the laundry service and all of their clothing looked well maintained. Residents had their own laundry bins in their rooms which were emptied regularly. Soiled laundry was appropriately removed to the laundry. As a result of a small fire since the last inspection, one room has been totally refurbished. The fire procedure has been amended. The local Fire Brigade carried out an inspection of the building and recommended the fitting of smoke seals to certain doors. This was being carried out that week. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were adapted according to the current needs of the residents. Staff have good access to ongoing relevant training. The home has 50 of staff who have at least NVQ Level 2. The home has a robust recruitment procedure. Residents made very positive comments about the staff. EVIDENCE: The care staffing rota provided a minimum of 4 staff during the mornings and 2 during the afternoons and evenings. At night there was one waking night staff and a member of staff sleeping in. The waking night staff had been increased recently to 2 as some of the residents were becoming frailer. Also the afternoon care staff had been increased during this time from 2 to 3 as some of the residents required support with eating. All new staff were expected to undertake the home’s induction programme on commencement of duties. The induction pack covers all aspects of the work including care practice, policies and procedures, employment conditions, the ageing process and caring for people from different cultures or faiths. A new member of staff was completing their induction pending the receipt of a negative POVAFirst check and Criminal Records Bureau certificate. New staff have a designated member of senior staff to work through their induction with them. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 23 The staff recruitment files showed that no staff commenced duties without a negative POVAfirst check. The recruitment procedure was robust. Potential staff are required to fill out an application form, records were kept of interviews, at least 2 written references were on file and evidence of medical fitness was required. The home sought evidence of any reasons for the person leaving previous employment with vulnerable adults, work permits where necessary and evidence of qualification. There were however no photographs as part proof of identity save those photocopied from a passport or driving license. Mrs Butchers was advised that a recent photograph was required by schedule 2 of the Care Standards Regulations. Mrs Butchers was in the process of ensuring that staff’s training records were up to date. There was a list of core subjects which staff were expected to undertake, for example, first aid, food hygiene, fire awareness, risk assessment, moving and handling, administration of medication, protection of vulnerable adults and infection control. The Community Mental Health Team had provided training in dementia. Mrs Butchers is the homes trained trainer in moving and handling and first aid; she was due to provide an update in the training the following day. One of the staff said they had recently undertaken training in first aid and moving and handling. They said they were also trained in fire prevention, dementia care and had NVQ Levels 1 and 2. They said that staff meetings were held every month and that they could contribute to the agenda. They had group and individual supervision every three months. 50 of the staff had attained NVQ Level 2. One of the senior staff said they held NVQ Level 3. Staff have time whilst on duty to complete some of the training workbooks which are externally marked. One of the staff did not knock on a resident’s bedroom before being invited in. The resident immediately said it was unusual and the staff member was very apologetic saying that they usually knocked. Staff were seen to engage with residents in a respectful and friendly manner. It was clear that residents had good relationships with staff and Mrs Butchers. Comment cards from residents stated: “Always very good listeners”, “If not use my call button, someone always comes”, “would tell someone I wasn’t feeling terribly well”, “Everyone is kind, not keen on the younger staff though”, “if not [available] I use my call buzzer”, “Staff was always encouraging”, “very friendly and supportive”, “On occasions staff will call GP, when I don’t want one, but this is done, due to me being poorly and I don’t like causing problems. Staff being caring towards me”, “Staff always helpful”, “do have to look sometimes because staff are busy but always helpful”. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. However the way in which management consults with residents and acts on their comments is excellent. This judgement has been made using available evidence including a visit to this service. Mrs Butchers is qualified, competent and experienced in running the home. She keeps herself up to date with current good practice with regular relevant training. The home is run in the best interests of the residents. Significant efforts are made to ensure that residents’ comments on the service are taken into consideration and acted upon for the benefit of residents. Residents can keep small amounts of cash at the home and know that it is safe. Staff receive regular supervision. Systems are in place to ensure the health and safety of residents and staff. EVIDENCE: Mr and Mrs Butchers have run the home since 1999. It is one of two homes owned by them in Salisbury. Mrs Butchers is the registered manager. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 25 Although she is a nurse, the home provides no nursing care. Mrs Butchers holds the Registered Managers Award. Mrs Butchers said she would often work a shift to keep herself up to date with residents’ care and support. Mrs Butchers had recently attained a Certificate in Dementia Care Level 2. Mrs Butchers keeps herself up to date with current good practice with regular training. She had recently undertaken training in various management and employment issues. The home has a quality assurance system which includes residents meetings and surveys to residents and their relatives. Mrs Butchers said the next survey would include the visiting healthcare professionals. Mrs Butchers has collated the results of the last survey and was in the process of compiling an action plan. Some complaints have prompted Mrs Butchers to ask residents and their families about different aspects of the service and changes have been made. Accidents and incidents were being recorded on separate sheets that were monitored each month by Mrs Butchers. The records were very detailed and showed all actions taken together with any monitoring. Body maps showed more details of location of any wounds. The home had a health and safety policy which had recently been reviewed and revised. Records were kept of all maintenance and servicing of equipment and emergency systems. The environment and tasks had been assessed and there was a protocol for the use of hazardous substances. Residents were able to keep small amounts of cash in the home’s safe. Records were kept of all transactions and the accounts were regularly audited by the administrator or Mrs Butchers. Staff were regularly supervised with records kept of all meetings. Mr and Mrs Butchers had recently reviewed and revised all of the home’s policies and the majority of the procedures. They were available to staff who were expected to sign up to them and this was in progress. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 26 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement The person registered must ensure that records show where controlled medication is received and the correct balance shown. (Not achieved at 12th April 2007) Timescale for action 12/04/07 2 OP37 17(1)(b) 3 OP9 17(1)(a) Schedule 3 para 3(i) 4 OP9 15 The person registered must 12/04/07 ensure that the controlled medication administration record is kept securely. The registered person must 12/04/07 ensure that records are kept of all administrations of controlled medication including the name of the medication, who gave it and who witnessed the administration. The registered person must 12/04/07 ensure that where 2 different painkillers are prescribed to be taken when required, that the care plan clearly identifies what triggers each administration. Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fairfax House DS0000028678.V332552.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 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 © 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 DS0000028678.V332552.R01.S.doc Version 5.2 Page 30 - 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!