Inspection on 12/06/06 for Fairfield

This inspection was carried out on 12th June 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfield 20/10/05

Fairfield 17/05/05

Fairfield 05/10/04

Fairfield 24/05/04

Fairfield 18/06/02

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Cragston Court

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

CARE HOME ADULTS 18-65 Fairfield 40 Grainger Park Road Newcastle Upon Tyne Tyne & Wear NE4 8RY Lead Inspector Glynis Gaffney Key Unannounced Inspection 12th, 13th, 15th and 28th June 2006 14:30 Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 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 Fairfield DS0000000444.V290734.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 Adults 18-65. 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. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfield Address 40 Grainger Park Road Newcastle Upon Tyne Tyne & Wear NE4 8RY 0191 273 4614 F/P 0191 2734614 derekon6@aol.com 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) Mental Health Matters Mrs Constance Milton Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20/10/05 Brief Description of the Service: Fairfield is set in a residential street in the Grainger Park area of Newcastle. It consists of a large older style detached house that has been adapted to meet the needs of 11 adults with mental health care needs. Nursing care is not provided. A bus route, pub and local shops are within easy walking distance. Residents are able to access all parts of the premises, including attractive garden areas. The Home has a kitchen, laundry, lounge, dining room and a residents kitchen area. There are 11 single bedrooms. En-suite facilities are not provided. Off street parking is available. The Home currently charges £355 per place per week. Copies of the Commission’s Inspection reports were available to visitors, staff and residents. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 12 hours. The premises were inspected as were a sample of care and premise related records. Three of the staff on duty and three residents were spoken to. The Home’s Manager was also interviewed. Three resident survey questionnaires were returned and found to be generally positive. Examples of comments made are detailed below: “I have been here nearly 13 and a half years and have liked it a lot.’ “I would just like to say that I am very happy to be staying here at Fairfield House. I am well looked after all the time by the staff and other staff people at the Home are very good. I have nothing but praise for them, they are professional people of a very high standard.’ However, one person commented: ‘I have asked for the small kitchen to be checked during the night so that I could have something at that time but this was not allowed.’ Three relative survey questionnaires were returned and found to be generally positive. An example of a comment made is detailed below: “In my opinion Fairfield continues to provide excellent care.” However, one person commented: “My relative is concerned smoking is allowed in the eating areas – my relative does not smoke.” What the service does well: Residents said that the Manager and her staff team were approachable and always willing to listen. Mental Health Matters (MHMs) conducts detailed monitoring visits to ensure that care and support provided in the Home is in line with the National Minimum Standards and its internal policies and procedures. Residents expressed satisfaction with the care and support received at the Home. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 6 A detailed Business Plan was in place and set out the ways in which Fairfield House aims to improve the care and support it provides to people living at the Home. The Plan places particular emphasis on the need to ensure that residents and their families are given opportunities to influence the way in which the Home is run and managed. MHMs provides residents with a well-maintained environment within which to live. The Manager has put arrangements in place that allow residents to develop their independent living skills in areas such as food shopping and meal preparation. The Manager is willing to work with the inspection process in a very positive manner. Residents are provided with a copy of the Tenants Handbook which contains useful information about the services provided at Fairfield House. Residents are provided with an opportunity to read and sign a copy of the Home’s Licence Agreement. New residents felt that staff had handled their admission into Fairfield House in a supportive and helpful manner. MHMs has recently produced a pamphlet which sets out its commitment to giving residents and service users more control over their lives. A detailed decoration, maintenance, renewal and replacement rolling programme was in place. What has improved since the last inspection? What they could do better: Prospective residents should be provided with a copy of the Home’s Tenants Handbook prior to any admission taking place. This will ensure that Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 7 prospective residents have access to all of the information they need to make an informed decision about whether to accept a placement at the Home. Ensure that the Home’s pre-admission assessment document is fully completed prior to any admission taking place. This will ensure that the Home has sufficient information to allow it to make a decision about the appropriateness of the proposed admission. The Home’s workplace risk assessments need to be reviewed to ensure that they cover all of the required areas. This will ensure that staff and residents are protected from the risk of potential harm. The Home must ensure that all staff receive regular updates to their training in key areas. This will ensure that staff are equipped with the knowledge they need to ensure that residents’ needs are met in a safe and professional manner. 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. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3,4 and 5. Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this Service. Good quality information about the care and services provided at the Home was available. But, prospective residents had not been provided with all of the information they needed to make an informed choice about whether to live at the Home. Residents had been provided with a written Licence Agreement setting out the terms and conditions of their residency at the Home. This meant that they knew what to expect from the Home and what was expected of them. Suitable arrangements were in place to ensure that prospective residents’ needs had been assessed prior to admission into the Home. But, the Home’s internal admissions documentation had not been properly completed. This could result in staff not having access to all of the information they need to meet prospective residents’ assessed needs. Prospective residents had been encouraged to visit the Home prior to admission, which enabled them to form a view of the quality of care and services provided by Fairfield House. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 10 EVIDENCE: Newly admitted residents had been provided with a copy of the Tenants Handbook which clearly set out the objectives and philosophy of the service and provided good information about Fairfield House covering such areas as: the accommodation provided; qualifications and experience of staff; how to make a complaint. However, the Handbook did not include residents’ comments about their experiences of living at the Home. Residents interviewed commented that they would have preferred to receive a copy of the Handbook prior to admission. Residents said that they were able to understand the information contained within the Handbook and found it very useful. MHMs is currently reviewing the purpose and function of its services and this may result in changes to the way in which Fairfield House operates. Of the three resident survey questionnaires returned: • • Two residents said that they had received enough information about the Home before moving in; One resident said that they had not received sufficient information. Recently admitted residents said that they had been provided with an opportunity to read and sign a copy of the Home’s Licence Agreement. The Licence Agreement set out what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. It was jargon free, easy to understand and gave residents a clear understanding of what they could expect when living at the Home. Prospective residents are only considered for admission following receipt of a Care Management Assessment/Care Plan/Risk Assessment and a completed application form. Prospective residents are invited to attend an interview and an in-house assessment is conducted to ensure that the Home is able to meet identified needs. The first six weeks following admission are used to complete a more in-depth assessment and to familiarise the resident with the Home. Policies and procedures were in place and provided staff with guidance about the approach to be adopted when considering new admissions into the Home. A Care Management Assessment and Care Plan were available in each of the care records examined. However, the Home’s pre-admission assessment proforma had not been fully completed for the two residents most recently admitted into the Home. Two residents said that they had been consulted about their admission and that it had been handled well. They also said that they had been provided with an opportunity to visit the Home before moving in. One resident said that she had visited the Home on a number of occasions getting to know both staff and other residents living at the Home. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 11 The Home had a core of people who were experienced and qualified to work with people with mental health care needs. Arrangements were in place to enable staff to receive the specialist training required to meet residents’ assessed care needs. For example, during the last 12 months: all staff had undertaken Professional Boundaries training; all staff were in the process of completing a 12-week accredited medication course; one member of staff had just completed their qualifying training in Promoting Independence. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this Service. Residents received good support from staff allowing them to develop confidence in making both simple and more complex decisions about their lives at the Home. Satisfactory arrangements were in place to provide residents with the support they needed to take appropriate risks so that they could retain as much independence as possible. EVIDENCE: Residents were involved in planning for their lifestyle and quality of life. A range of care plans were in place for each resident and had been agreed with them. The care plans examined were written in plain language and easy to understand. Residents’ care records also included a range of risk assessments individually related to the needs of the person concerned. Residents’ care plans had been reviewed on a regular basis and updated to take account of Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 13 changing needs and circumstances. Residents said that they had been offered opportunities to attend their care plan review meetings. A member of staff demonstrated a clear understanding of the Home’s care planning system and the benefits of person centred planning to the resident for whom she acted as a Key worker. The Home had created real opportunities for residents to make decisions about their life at Fairfield House. For example, one resident said that she was: • • Responsible for her own private living space and that this involved keeping her bedroom in a reasonable condition; Encouraged to make decisions about her employment and how to spend her leisure time. She also said that this had given her ‘a new purpose in life and a reason to go on’. Another resident described how she was helped and encouraged to make everyday decisions such as: what time to get up in the morning; what to eat for lunch. This person also said that she liked the structure that the Home gave her and that this was helping her to move on. Of the three resident survey questionnaires returned: • • • Two residents said that they made their own decisions about what they did each day; One resident said that they usually did so; Three residents said that they could do what they wanted during the day, evening and weekend. Residents are also encouraged to participate in the daily life of the Home. For example, the Manager intends to offer residents the opportunity to sit on the Home’s staff recruitment interview panel in the very near future. Residents’ meetings had been held on a regular basis allowing opportunities for discussion over such matters as ‘House Rules’, the domestic chores rota and other events affecting the Home. The Manager confirmed that MHMs provides residents with opportunities to sit on a consultative forum that allows them to comment on how services are managed and developed. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 14 Residents are encouraged to take responsible risks as they go about their daily lives. Risks undertaken are carefully assessed and monitored by staff. Care Management information, and details of any risk assessments conducted, are obtained before an admission into the Home can take place. The MHMs preadmission interview is used to establish how identified risks will be managed within and outside of the Home. Risk assessment information obtained at the point of admission is integrated into a new resident’s care plan. In the care files examined, it was noted that: • • The Home had obtained copies of specialist mental health risk assessments prior to residents’ admissions; Risk assessments had been completed for each resident. For one person, risk assessments covering the following areas had been prepared: scalding; smoking and self-medication. Residents interviewed confirmed that they had been consulted about the risk assessment conducted and had been invited to read and sign them. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this Service. Residents were provided with satisfactory opportunities for personal development. This has enabled residents to take up employment and leisure opportunities in their local communities. Residents were encouraged to maintain links with people they knew before going into Fairfield House and to form relationships with staff and other people living at the Home, following admission. This provided residents with opportunities to develop their relationship building skills and to experience emotional well being and fulfilment. Residents were offered opportunities to develop and practice the food preparation and cooking skills they will need to live independently. Residents had been provided with opportunities to eat a healthy diet that promoted their physical and mental well being. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 16 EVIDENCE: The Home’s Statement of Purpose stresses that residents will be encouraged to ‘…develop, maintain and heighten their social and practical skills including daily living skills.’ A resident said that: • • • • • Staff had informed her of what was available within the local area such as “the whereabouts of local shops, bus stops and where to see the doctor”; It was nice to know she could get help with her shopping and going to see the doctor; Staff had mentioned that if she needed someone to speak on her behalf, the Home would put in her touch with an advocacy service; She thought the staff rotas were good “as there was always someone on duty to help her”; Staff had provided her with support over her finances and the management of her money. All of the residents interviewed said that visitors were made to feel welcome. One person said that it was up to her who she saw both in and outside of the Home. Staff are able to offer advice and support on personal relationships if requested by a resident. A resident commented that “staff were understanding and not pushy” when she needed support. Residents were supported and encouraged to build relationships, wherever possible, with other people living at the Home. House rules had been discussed in residents’ meetings and the household chores rota was negotiated between residents and staff. This rota has given residents responsibility for such areas as cleaning the small residents’ kitchen and setting the tables for the teatime meal. None of the residents interviewed objected to the part they were expected to play in looking after the house. Care records contained evidence that residents were: • Provided with assistance to access specialist support services as and when required. It was confirmed that most residents had a Consultant Psychiatrist who regularly reviewed their mental health and current medication. Residents were registered with local GPs and staff attended GP or hospital appointments on request; Encouraged and supported to access local facilities and amenities in accordance with their personal preferences; Supported to access whatever employment opportunities were available. MHMs provides staff and residents with opportunities to access its Employment Advice Service. A resident told the inspector DS0000000444.V290734.R01.S.doc Version 5.2 Page 17 • • Fairfield • that she had been supported to take up employment at a local café and had recently taken on a second job. She also said that she felt the Home was providing her with the support and confidence she needed to get a job after moving out of Fairfield House; Supported to plan their leisure time in the absence of paid or sheltered employment. Residents had been supported to become part of, and participate in, the local community. The Manager stated that over the years, core members of staff had acquired considerable knowledge about events and activities taking place within the local community. Residents said that staff respected their privacy and always knocked on bedroom doors before entering. Residents had the opportunity to hold their own bedroom and front door keys. Copies of the Home’s menus were displayed in the main kitchen and in the small resident kitchen. These set out the main meal choices for each day. Alternative choices are made available where requested by residents. The kitchen facilities were found to be clean, tidy and hygienic. Residents interviewed said that they were very happy with the food served at the main group meal times. There were no residents accommodated with specialist dietary needs or who needed support with eating. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this Service. Staff provided personal support in such a way as to promote and protect residents’ privacy, dignity and independence. Residents’ emotional health care needs were met which encouraged, and empowered them, to lead fulfilling and valued lives. The systems in place to support the safe administration, storage and disposal of medication were considered satisfactory and promoted residents’ good health. EVIDENCE: Residents said that staff supported and helped them in a manner which made them feel valued and respected. One resident said that staff did not make her feel “helpless” or like a “bad person who had lots of problems.” Residents also said that staff would meet with them in private if confidential matters needed to be discussed. There were no residents accommodated who required physical support with personal care. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 19 The Home had a medication policy which was accessible to staff. Staff had received accredited medication training, and were aware of, and appeared to understand, the Home’s Medication Policy. Monitoring visits carried out by the Provider confirmed that staff practice in this area reflected its policies and procedures. Staff had put arrangements in place to support residents who had been judged capable of keeping and taking their own medication. Resident identification photos were in place. A secure facility was available to ensure that medicines were safely locked away. There were no residents taking controlled drugs at the time of the inspection. Lockable facilities were available for these individuals to safely store their medication. Hand wash facilities were not available in the area in which medications were stored. There had been one mis-administration of medication since the last inspection. The Manager had taken immediate steps to prevent a re-occurrence. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this Service. The complaints process in this Home was good and information about the complaints procedure had been made available to residents. Adult protection arrangements were satisfactory and residents were protected from the risk of harm or abuse. EVIDENCE: The Home had a complaints procedure that was up to date, written in plain English and was easy to understand. The procedure can be made available in other formats on request. A copy of the complaints procedure was available in the Home’s main reception and in the Tenants Handbook. Residents demonstrated a good understanding of how to make a complaint and they were clear about what action would be taken by the Manager on receipt of a complaint. Of the three resident survey questionnaires returned, all said that they knew how to make a complaint. Staff had received training in the protection of vulnerable adults. The Home’s Adult Protection Policy was satisfactory and staff were very clear about what action they would take to protect residents from potential harm. The Registered Manager was clear about when external agencies would be involved following an adult protection incident. There had been no adult protection safeguarding concerns raised with either the Commission or the Home since the last inspection. Residents said that they felt safe and protected at the Home. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this Service. The standard of the environment within this Home was good, provided residents with a safe, clean, attractive and homely place to live. Minor improvements to the premises were required. The overall quality of the furnishings and fittings was good and did not put residents at risk of injury or harm. EVIDENCE: The Home generally provided a well maintained, safe, comfortable and an attractive environment. The layout and design of the Home was suitable for meeting the assessed needs of the people living there. Bedrooms visited were of varying sizes and residents interviewed were satisfied with the fixtures and fittings provided. There was sufficient light, heating and ventilation throughout the building. The Home had a selection of communal areas providing residents with a choice of where to meet with family and friends. Residents had access to a large lounge, a dining area, the main kitchen and a smaller residents’ kitchen. A range of bathing facilities, including showers, was available. There Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 22 were large well-kept and attractive gardens surrounding the building. The Home is close to a range of local shops, transport links, the general hospital, a dental practice, a health care centre and various leisure facilities. Fairfield House is in keeping with the local community and does not stand out as a care facility. The Home is accessible to all residents and people using wheelchairs are not accommodated. A record of maintenance and repairs carried out was available. The Home’s laundry is sited away from the main kitchen and is accessed by way of a separate corridor that means that soiled articles and clothing are not carried through areas where food is stored and prepared. Hand wash facilities were available and the floor and wall finishes meant that both could be easily cleaned. Residents are permitted to smoke in their bedrooms, but only on the understanding that they are prepared to respect the safeguards put in place to protect the safety of all residents. The Manager said that smoking risk assessments had been carried out and metal bins had been provided to reduce the risk of a fire breaking out. Staff had been provided with adequate sleep-in facilities. However, a number of concerns were also identified: • • The residents’ small kitchen: the Doorguard fitted to the fire door was broken; the radiator was grimy and had an unhygienic appearance; the walls were grimy and in a poor state of decoration; Ground floor bathroom: the bath panel was cracked; the skirting boards had rotted in places possibly due to water damage; the sealant between the bath and the wall tiles was black in places and looked unhygienic; the radiator was grimy and had an unhygienic appearance; the lagging to the water pipe was damaged; the floor covering was in a poor condition; First floor shower room: the sealant between the wall and the shower tray had a grimy appearance; the wall around the wash basin was in a poor state of decoration; The fire door into the main reception area was cracked and the paintwork was chipped; First floor shower room: the walls were in a poor state of decoration. • • • Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this Service. Suitable arrangements were in place to ensure that the minimum staffing levels agreed with the Commission were kept to. This had recently required the use of agency and casual staff, which could have consequences for the continuity, and consistency of care received by residents. Although residents were supported and protected by the MHMs Recruitment Policy, some of the staff files checked did not contain all of the required details. Staff had the opportunity to undertake training to develop their skills working with adults with mental health care needs. Improvement was required in the provision of refresher training in key areas. EVIDENCE: Minimum staffing levels previously agreed with the Commission were in place as follows: Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 24 8am to 9am 1 9am to 5pm 2 5pm to 9pm 2 9pm to 8am 1 There were also occasions when more than two staff were scheduled on duty. As a result of vacant staff positions, agency and MHMs casual staff had worked a total of 23 shifts during the eight weeks preceding the inspection. The Acting Deputy Manager expressed concern over the difficulties faced trying to ensure that experienced staff were always rostered on duty alongside agency and casual workers. Safeguards had been put in place to ensure that agency and casual staff received the necessary induction training. Arrangements had been made to fill the vacant posts as soon as possible. A member of staff commented that there were not always sufficient numbers of staff on duty to meet the needs of some residents who required support to take part in activities outside of the Home. Residents’ opinions of staff were very positive and they appeared to value the support they received. Of the three resident survey questionnaires returned: • • Two residents said that staff treated them well; Two residents said that staff listened to and acted upon what they said. A detailed employment policy was in place. Staff personnel records made available during the inspection process contained the required information with the following exceptions: • • There was no proof of identity for two members of staff; Original Criminal Records Bureau Disclosure Certificates were not available in some of the records examined. All care staff had obtained a relevant care qualification. However, in the three staff files examined, there was no evidence that some staff had received the required statutory training, and for others, that they had had their statutory training updated. For example: • • • Staff member A: there was no evidence of accredited medication training; the manual handling certificate was out of date; Staff member B: the manual handling certificate was out of date; there was no evidence of recent health and safety training; Staff member C: there was no evidence of certificated manual handling or accredited medication training; recent refresher training in the protection of vulnerable adults had not been undertaken. (A timescale to comply with a requirement set in the last inspection report, regarding the need to update staff training in key areas, had not expired at the time of this inspection. The Manager had made arrangements to ensure that staff received the required training updates.) Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this Service. Arrangements had been put in place to protect the health and safety of residents and staff. Satisfactory arrangements were in place to review and improve the Home’s performance. EVIDENCE: The Registered Manager had relevant and substantial experience in caring for people with mental health care needs within a residential care setting. Mrs Milton had obtained the required care and management qualifications and demonstrated managerial competence in the running of the Home. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 26 The Home had been through a period of significant change that had had a negative effect upon the staff team. However, the Manager displayed a commitment to improving the Home and was in the process of reviewing the Business Plan to set out her strategy for doing so. The Manager had a clear view about how she intended to manage the Home and how she hoped to do so in an open and transparent manner that would maximise staff involvement. The Manager showed a good understanding of the legal requirements underpinning her work and of what was required of her by the Commission. Arrangements were in place to review the Home’s performance against the National Minimum Standards for Adult Care Homes and MHMs internal policies and procedures. For example: • • A MHMs senior manager had visited Fairfield House on a monthly basis to review the Home’s day to day practice and performance again the National Minimum Standards; The Manager had produced a detailed Business Plan, which was being updated at the time of the inspection. This document contained targets aimed at developing the Home’s performance. Mrs Milton said she intended to provide staff and residents with an opportunity to comment on the contents of the Plan; Resident, Staff and Professional Survey Questionnaires had been distributed and the results analysed. • Residents confirmed that they had been told about the forthcoming inspection and that residents might be interviewed as part of the arrangements. Residents had been encouraged to think about the most recent inspection findings during a recent residents’ meeting. A recent fire inspection carried out by the local Fire Service confirmed that fire prevention arrangements within the Home were satisfactory. All staff employed at the Home had received fire instruction on two occasions over the last 12 months. Casual staff had received fire training during the last four months. A record of fire drills was in place. However, it was not clear from the records examined, which staff had participated in each fire drill. An up to date fire risk assessment was in place. Tests of the Home’s electrical equipment had taken place in 2004. A comprehensive Health and Safety Policy was in place. The management team had undertaken weekly and monthly health and safety checks of the building. A file containing Safety Notice Alerts was available for staff to access. A record of checks of the temperature of hot water supplied to residents’ bathing areas had been completed. Workplace risk assessments had been completed and covered areas of identified risk within the Home. The Home was in the process of preparing a ‘Lone Working’ risk assessment. Not all areas of potential risk within the Home had been assessed. Some of the risk assessments examined had not been fully completed. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X x 2 X Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 5 Ensure that prospective residents are provided with a copy of the Tenants Handbook prior to admission. 2. YA2 14 Ensure that the Home’s preadmission assessment document is fully completed prior to a prospective resident’s admission into Fairfield House. 3. YA24 16(2) 23(2) 01/11/06 Ensure that: • The residents’ small kitchen area: the Doorguard fitted to the fire door is either replaced or repaired; the radiator is cleaned; the walls are cleaned and redecorated; Ground floor bathroom: the bath panel is replaced; the skirting boards are repainted; the sealant between the bath and the wall tiles is replaced; the radiator is cleaned; the pipe lagging is replaced; Version 5.2 Page 29 Requirement Timescale for action 01/09/06 01/09/06 • Fairfield DS0000000444.V290734.R01.S.doc • • • 4. YA24 13(4) the floor covering is replaced; First floor shower room: the sealant between the wall and the shower tray is replaced; the walls are redecorated; The fire door into the main reception area: the door is repaired and repainted; First floor shower room: the walls are redecorated. 01/07/06 Carry out and implement a risk assessment in relation to any supplementary heat sources provided in residents bedrooms. (Timescale not expired at time of inspection visit) 5. YA33 18(2) Ensure that: • Agency and casual staff working in the Home are rostered on duty with an experienced MHMs member of staff; Regular staffing reviews are carried out to identify whether the level of staffing provided is sufficient to meet residents’ assessed needs both within, and outside of, the Home. 01/09/06 Ensure that: • • Each staff personnel record contains proof of identity; Criminal Records Bureau Disclosure Certificates are kept for at least 12 months or more, to enable CSCI Version 5.2 Page 30 01/08/06 • 6. YA34 9 17 18(2) 19 Fairfield DS0000000444.V290734.R01.S.doc • inspectors to see a sample at the next inspection. After the inspection, the Disclosures can be destroyed, whether held locally or centrally. Disclosures received post inspection should be kept until the next inspection; The staffing information required by the Care Homes Regulations (2001) is kept at the Home at all times. 01/07/06 7. YA41 23(4) Ensure that the names of staff participating in fire drills are clearly recorded. (Timescale not expired at time of inspection visit) 8. YA42 13(4) Review and update the Homes existing workplace risk assessments. Ensure that all of the required workplace risk assessments have been completed. (Information about what risk assessments should be carried out under the relevant health and safety legislation can be found under Standard 42 (National Minimum Standards for Adult Care Homes) and on the Health and Safety Executive website.) (Timescale not expired at time of inspection visit) 01/08/06 9. YA42 13(4) Ensure that copies of the following risk assessments are forwarded to the Commission for consideration: prevention of falls from windows and maintenance 01/11/06 Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 31 of window restrictors; prevention of Legionella; use of visual display equipment; Lone working. 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 OP1 Good Practice Recommendations Ensure that the Home’s Statement of Purpose and Service User Guide are updated to take account of any changes made to the purpose and role of Fairfield House. Fairfield DS0000000444.V290734.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. 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