Inspection on 07/03/06 for Fairfax House

This inspection was carried out on 7th March 2006.

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 12/04/07

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 09:25 7 March 2006 th 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.V276408.R01.S.doc Version 5.1 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.V276408.R01.S.doc Version 5.1 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.V276408.R01.S.doc Version 5.1 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 11th August 2005 Date of last inspection 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 11 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 DS0000028678.V276408.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.25am and 4.30pm. Mrs Butchers was present during the inspection. The inspector spoke with 4 residents and inspected the care records, staff personnel files, fire logbook, environmental risk assessments and medication records. A tour of the building was made. Four comment cards were received as part of the inspection process. Three responded to the set questions but made no other comments. One person who gave no name commented that they had found staff over stretched and that they were not happy with the food at teatime. These comments were shared with Mrs Butchers who said she was sorry that the person could not discuss these issues directly with her. What the service does well: What has improved since the last inspection? A new call bell had been installed with clear instructions for its use at each location. A lock to a bedroom door has been risk assessed to ensure that it complies with fire regulations. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 6 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 DS0000028678.V276408.R01.S.doc Version 5.1 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 Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 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): None of these standards were inspected. EVIDENCE: Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 9 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 & 10 All residents personal, social and medical care needs are set out in a care plan. The care plans direct the care. Residents had good access to healthcare professionals. Staff respect residents and their need for privacy. EVIDENCE: All residents had a care plan giving full details of their daily needs. The salient points of the plan were highlighted in a resume at the front of the file. There was good guidance to staff on how residents preferred their care to be delivered. Residents’ social and medical history were included in the plans. Any potential risks had been assessed and actions to be taken were clearly documented. Attention is paid to communication, nutrition, leisure activities, personal care, any behaviours and preferred routines. The risk assessments showed that residents were encouraged to remain as independent as possible and these assessments did not restrict them from continuing to do things they had done before. All residents were weighed on admission. Care plans were reviewed every month with a 6 monthly review carried out with the resident, their keyworker and other interested parties who the resident wished to invite. The daily reports showed that the care plans directed the care. The daily reports showed good evidence that staff were communicating with residents and that residents made choices about their daily lives. Female residents had Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 10 been asked whether they had any objections to having their care provided by a male carer. Residents had good access to healthcare professionals and the inspector saw that a GP visited at staff request, one resident who said they were not feeling very well. The requirement that staff were trained in tissue viability has been difficult for the home to achieve as there is no tissue viability specialist nurse in the area. The tissue viability nurse in another area is in the process of trialling a risk assessment document which can be used by care staff and it is expected that training will be provided at the launch of the document in Wiltshire. The requirement remains although the home is making assessments of residents and any concerns referred to the district nurse with pressure relieving equipment in place where necessary. Some of the residents said that staff brought their medication usually at mealtimes. The medication administration record was being satisfactorily completed. A daily and weekly audit of the medication was carried out. One residents medication was being crushed; although there was written agreement from the resident, the inspector advised that written agreement must be obtained from the GP as crushing may render the drug unlicensed. The inspector advised that when controlled medication was received, it must be recorded in the log and the new balance shown. All of those residents who were spending the morning in their bedrooms had their call bells within reach and a drink near them. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 11 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, 13, 14 & 15 Residents had access to a range of different activities both at the home and in the locality. Residents were encouraged to retain control over their lives. Residents said they enjoyed the variety and quality of the meals provided. EVIDENCE: The inspection started at a busy time of the day and it was noted to be a quiet atmosphere with some residents sitting in the sitting room watching a cookery programme on the large new television. Mrs Butchers said she had purchased a digital television as there were a better range of programmes that residents were interested in including history and films. The home offers a good range of activities to residents both at the home and in the locality. Residents were asked where they wanted to go. They planned to go to Exbury gardens, out for a pub lunch and to Bournemouth including a restaurant meal. Musicians regularly came to the home to give concerts and residents could play some of the instruments. There was a group who came to sing hymns and a keep fit group. All of the coming events were advertised on the notice board in the dining room. That day a group had come to offer residents a prayer meeting. One resident said they regularly went to their local church. Another resident said they chose which activities they joined in with but preferred to paint in their bedroom. Another resident said there was usually something planned to do each day. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 12 The home has a designated hairdressing room set up as a salon with comfortable chairs. The majority of the residents said they enjoyed the range and quality of the meals provided. It was clear from talking to Mrs Butchers that she regularly consulted with residents about the food and continued to address any comments from residents about the quality of the meals. The lunch and supper meals were written on a notice board in the dining room. One resident said they had all their meals in their bedroom. Food supplements were available for some residents. One resident had tea and coffee making facilities in their room and said they enjoyed making visitors drinks as they would do in their own home. This resident had an accompanying risk assessment in their file. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 13 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): 16 & 18 Systems were in place to ensure that residents, their relatives and staff could report on anything they were not happy with; including concerns or allegations of abuse. EVIDENCE: The home had a complaints procedure and kept records of any action taken to address any issues. The format allows for a review of the outcome to ensure the complainant is satisfied with any action taken. All of the residents spoken with said they would go to Mrs Butchers if there was anything they were not happy with. One residents said they did have a complaint in the past but they could not remember what it was about but they did remember that Mrs Butchers addressed the matter to their satisfaction. Mrs Butchers regularly met with residents to discuss issues, with in a group meeting or individually. The home is familiar with reporting concerns under the vulnerable adults procedure. Staff have received training in the policy and procedure. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 14 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): 19 & 26 Residents live in a comfortable, quiet and clean home that is very well maintained. EVIDENCE: The home was warm and comfortable and all the rooms were decorated to a good standard. Residents’ bedrooms were personalised with their own possessions and one residents showed the inspector their own furniture. A new call bell system had been installed and each bedroom had clear instructions and a diagram for its use. It was noted that when one resident who said they were not feeling very well activated the alarm, the staff responded very promptly. The requirement that where residents require their bedroom doors to be locked that the key was of a type approved by the Fire Authority so the resident could get out of the room without the use of a key has been addressed. The advice sought from the fire authority by the inspector was sent to the home and a risk assessment was in place for one lock. There was also guidance to staff on management of the lock in the event of a fire or having to gain access to the Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 15 room in an emergency. The home has been advised to remove the lock when the resident no longer occupies the room. The environmental risk assessments were up to date having been reviewed in August 2006. Each room was considered and included all the furniture and equipment. The home was cleaned to a high standard and there were no unpleasant odours noted at any time during the inspection. Attention was paid to high standards of cleanliness in the bathrooms and toilets with particular attention to the undersides of toilet surrounds and bath seats. Alcohol gel, gloves and protective clothing were available to staff. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 16 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): 27, 29 and 30 Residents are supported by a well-trained and experienced staff group. Recent appointments were not thoroughly vetted before commencing care duties. EVIDENCE: The staffing rota showed a minimum of 4 care staff working during the morning, 2 care staff in the afternoon and one waking night staff and one staff sleeping in. Staff were about to commence training in dementia care. Senior staff and Mrs Butchers were undertaking an advanced course in dementia care. Staff personnel records generally showed a robust recruitment process with potential staff having to complete an application form. Concise records were kept of interview. Other records required by regulation were on file. However it was noted that some recently recruited staff had commenced duties at least 7 days before a satisfactory POVA confirmation. The Department of Health guidance on Criminal Records Bureau checks and POVA has been sent to the home. Mrs Butchers confirmed that any new staff would not commence care duties until this was received, however some new staff may start some induction training during that time. Mrs Butchers said she had employed a personnel assistant to ensure that employment procedures were in place. Staff had good access to a range of relevant training. All of the residents spoken with said the staff were very kind. Staff were seen to work in a professional, respectful and friendly manner with residents. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 17 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): 33, 35 The home is run in the best interests of the residents. Mrs Butchers is keen that residents and their relatives can comment on the service. Residents can be confident that any money held on their behalf if properly managed. EVIDENCE: Mrs Butchers regularly sends questionnaires to residents and their relatives to gain their views on different aspects of the service. Mrs Butchers said she took action to address issues in negative comments and published good comments. There were regular residents meetings and Mrs Butchers met individually with residents to discuss issues. Staff had just completed fire training which included some practical experience of dealing with a real fire. The fire logbook was examined and was being satisfactorily completed. Mrs Butchers said the home had recently achieved the Investors in People award. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 18 Residents can keep small amounts of cash in the home’s safe. Records were kept of all transactions. Balances were regularly audited every month. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 4 X 3 X X X Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 20 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 OP8 Regulation 13(4)(c) Requirement Timescale for action 30/06/06 2 OP9 13(2) 3 OP9 13(2) 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 07/03/06 ensure that records show where controlled medication is received and the correct balance shown. The registered person must 07/03/06 ensure that if residents have difficulties in swallowing tablets that either a liquid or soluble equivalent is prescribed. Written agreement must be obtained from the GP if medication is to be given in any way that could render it unlicensed. Fairfax House DS0000028678.V276408.R01.S.doc Version 5.1 Page 21 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.V276408.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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 DS0000028678.V276408.R01.S.doc Version 5.1 Page 23 - 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. 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