CARE HOME ADULTS 18-65 Fairfield 40 Grainger Park Road Newcastle Upon Tyne Tyne & Wear NE4 8RY
Lead Inspector Glynis Gaffney Unannounced 17 and 24th May 2005 14:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Fairfield Address 40 Grainger Park Road Newcastle upon Tyne Tyne & Wea NE4 8RY 0191 273 4614 0191 273 4614 derekon6@aol.com Mental Health Matters Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Derek Malcolm CRH 11 Category(ies) of MD Mental Disorder (11) registration, with number of places Fairfield Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 5th October 2004 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 which 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 resdents kitchen area. There are 11 single bedrooms. En-suite facilities are not provided. Off street parking is available. Fairfield Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over six hours and 15 minutes. 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 Acting Manager was also interviewed. What the service does well: A detailed Business Plan was in place and it 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. The Plan also describes the systems and processes that will be put in place to support and develop the Home’s staff team. The Plan was in the process of being reviewed and updated at the time of the inspection. Residents spoken to said that they could approach the Manager and her staff team at any time and felt that they could visit the office without being turned away. Mental Health Matters conducts detailed monitoring visits to ensure that care and support provided in the Home is in line with the National Minimum Standards and internal policies and procedures. Residents expressed satisfaction with the care and support received at the Home. Fairfield Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairfield Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Fairfield Version 1.10 Page 8 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 standard(s) Standards 1, 2, 3, 4 and 5 were not assessed on this occasion. EVIDENCE: Fairfield Version 1.10 Page 9 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 standard(s) Standards 6, 7, 8, 9 and 10 were not assessed on this occasion. EVIDENCE: Fairfield Version 1.10 Page 10 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 standard(s) Standards 11, 12, 13, 14, 15, 16 and 17 were not assessed on this occasion. EVIDENCE: Fairfield Version 1.10 Page 11 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 standard(s) Standards 18, 19, 20 and 21 were not assessed on this occasion. EVIDENCE: Fairfield Version 1.10 Page 12 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 standard(s) 22 and 23 The complaints process in this Home is good and information about the complaints procedure is made available to residents. Adult protection issues raised by residents are properly investigated and action is taken to protect vulnerable adults from risk of further harm or abuse. EVIDENCE: Complaints and Whistleblowing Policies and Procedures were in place. A copy of the Complaints Procedure was available in the Home’s reception area. One complaint had been received since the last inspection. It had been investigated and resolved. Residents spoken with said that they had been made aware of the Home’s Complaints Procedure. They also stated that they were reminded of its contents at house meetings. One resident said that she would feel comfortable about raising concerns with any member of staff. This person also felt that staff listened to her and took note of her opinions and feelings. A draft Adult Protection Policy was available. It is presently subject to consultation within the Mental Health Matters Organisation. An adult protection investigation was ongoing at the time of the inspection. A female resident spoken with told the Inspector that she felt ‘safe at the home’ and did not have any worries about living at Fairfield House. Fairfield Version 1.10 Page 13 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 standard(s) 24, 25, 26, 27, 28, 29 and 30. The standard of the environment within this Home is good, providing residents with a safe, attractive, clean and homely place to live. The overall quality of the furnishings and fittings is good and does not put residents at risk of injury or harm. Residents’ bedrooms are large enough for their personal needs and lifestyles. EVIDENCE: On the day of the inspection, the Home was clean, tidy and free from offensive odours. There was a large and well kept garden. There was sufficient light, heating and ventilation, with the exception of bedrooms 1 to 3 which were cooler than other parts of 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. The Home is accessible to all residents and people using wheelchairs are not accommodated. The furniture and fittings were of a satisfactory standard. Some refurbishment of the Home has
Fairfield Version 1.10 Page 14 taken place since the last inspection. The Home complies with the requirements of the Fire Authority. A record of maintenance and repairs carried out was available. Residents have access to well maintained bedrooms. Single room accommodation is provided throughout and all residents have access to useable floor space sufficient to meet their individual needs and lifestyles. There are no en-suite facilities. Bedrooms visited had been personalised to reflect residents’ individual tastes. A resident spoken with told the Inspector that ‘he was very happy with his room and could not think of anything Mental Health Matters could do, to make it better.’ However, not all of the bedrooms contained the recommended furniture and equipment such as: a table to sit at; bedside lighting; lockable storage space. In some bedrooms, residents had purchased their own furniture, fittings and equipment. One resident said that she had brought her own personal belongings in with her when she moved into the Home. All of the bedrooms visited had privacy locks and one resident confirmed that he held his own door key. The Manager expressed concern about the cool temperature of three bedrooms and indicated that she thought supplementary heating was required. This option is currently being explored. The communal toilets, bathrooms and shower rooms were inspected and found to be clean and hygienic. Privacy locks had been fitted to all doors. There were no residents accommodated who required specialist toilet and bathing facilities. There were sufficient toilets and bathrooms for the number of residents accommodated. A range of shared space was available. Residents had access to a large lounge, a dining area, the main kitchen and a smaller residents kitchen, and a laundry. All of these areas were domestic in scale. Staff had been provided adequate sleep-in facilities. A partial refurbishment of the sleep-in room had been undertaken since the last inspection. Residents’ bedrooms and the newly refurbished office facilities provided a private area for consultations and treatment where required. The Home’s laundry is sited away from the main kitchen and is accessed by way of a separate corridor which 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. 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. Fairfield Version 1.10 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33. The Home has sufficient numbers of staff on duty to meet residents’ assessed needs. EVIDENCE: The minimum staffing levels as set out below have been agreed with the CSCI. 8am to 9am 1 9am to 5pm 2 5pm to 9pm 2 9pm to 8am 1 Following an examination of one week’s rota, it was confirmed that the above staffing levels had been met. It was also evident that extra staff were provided throughout the week to take account of residents’ needs and other demands placed upon the staff team. Residents’ opinions of staff were very positive and they appeared to value the support they received. The Manager felt that the Home was able to satisfactorily meet residents’ needs within the staff hours allocated. Mrs Milton stated that agency staff were sometimes used to cover shortfalls in the staff rota. A resident told the Inspector that he felt ‘enough staff were always around in the Home’. The Inspector observed an agency member of staff being given a detailed handover. The rota examined was satisfactorily completed with the following exceptions: it did not include the full names of staff or details of their position.
Fairfield Version 1.10 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 41 and 42. The Acting Manager is competent, experienced and in the process of studying for the required management qualifications and, as a result, is able to ensure that the Home meets its stated purpose, aims and objectives. Arrangements have been put in place to protect the health and safety of residents and staff. However, the workplace risk assessments were not being reviewed and updated on a regular basis. Otherwise, the selection of records examined was generally well kept. EVIDENCE: At the time of the inspection, the Deputy Manager was providing management cover for the Home. Mrs Milton had almost completed her Registered Manager’s Award and was about to commence her NVQ Level 4 in Care. Although Mrs Milton had overall responsibility for the Home in the absence of the Manager, she felt that she had received invaluable support and guidance from both her line manager and colleagues. Fairfield Version 1.10 Page 17 A selection of records was examined and generally found to be satisfactorily completed. For example: the Fire Log Book provided evidence that the required fire prevention checks had been undertaken. All staff employed at the Home had received fire instruction on two occasions over the last 12 months. However, it was not clear from the records examined, which staff had participated in each fire drill. The Accident Book was properly completed. There had been three accidents involving residents since the last inspection. No problems were noted. Service contracts and maintenance reports relating to such matters as gas and fire safety were available for inspection. For example: the Home’s clinical waste contract had just been renewed; tests of the Home’s electrical equipment had taken place in 2004; a Health and Safety Policy was in place; a gas safety certificate had been issued in 2005. The management team undertook weekly and monthly health and safety checks of the building. However, the selection of workplace risk assessments examined had not been reviewed since 1996. A file containing Safety Notice Alerts was available and easily accessed by staff. A record of checks of the temperature of hot water supplied to residents’ baths had been completed. However, the checks did not include the hot water supplied to the residents’ showers. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
Fairfield Version 1.10 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x Standard No 37 38 39 40 41 42 43 Score 2 x x x 2 2 x Fairfield Version 1.10 Page 19 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 24 Regulation 13(4) Requirement Carry out and implement a risk assessment in relation to any supplementary heat sources provided in residents bedrooms. Ensure that the names of staff participating in fire drills is clearly recorded. Review and update the Homes existing workplace risk assessments. Ensure that all of the required workplace risk assessments have been completed. Timescale for action 01/07/05 2. 3. 41 42 23(4) 13(4) 01/07/05 01/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 26 33 42 Good Practice Recommendations Provide all bedrooms with the recommended eqipment. Ensure that the Homes rota includes the following details: the full names of staff; details of their post. Ensure that regular checks of the hot water supplied to residents showers are undertaken and a record kept. Fairfield Version 1.10 Page 20 Commission for Social Care Inspection Northumbra house Manor Walks Cramlington, Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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