Inspection on 19/04/06 for Fairfield House

This inspection was carried out on 19th April 2006.

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

Fairfield House 06/08/07

Fairfield House 28/11/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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 Fairfield House Charmouth Road Lyme Regis Dorset DT7 3HH Lead Inspector Mike Dixon Unannounced Inspection 09:15 19th April 2006 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 Fairfield House DS0000066189.V291049.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. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fairfield House Address Charmouth Road Lyme Regis Dorset DT7 3HH 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) 01297 443513 Fairfield House Healthcare Limited Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of four (4) bedrooms/suites measuring 15.5 square meters or more, may be used for double occupancy at any one time. 10th August 2005 Date of last inspection Brief Description of the Service: Fairfield House is a residential care home for older people; it is situated approximately ¼ mile from the seaside town of Lyme Regis. It was first registered as a care home for plder persons in July 1986. The home is established in an early Victorian mansion set in its own grounds with panoramic views of Lyme Bay and Lyme Valley. The home is on a bus route to the town centre. The home is currently registered to accommodate a maximum of 34 service users in single and double bedrooms, available at ground and first floor levels. The communal facilities include a spacious lounge, smaller quiet lounge, dining room and two conservatories. A passenger lift enables access to the first floor of the home. The front entrance to the home comprises a large parking area, while the side and back gardens are mainly set to lawn with mature trees and seasonal borders. In November 2005 Fairfield House was purchased by Fairfield House Healthcare Ltd and Mrs Sue Heybourne was registered as the Responsible Individual, representing the Directors of the Company. Mrs Heybourne is also the Director of Personnel Solutions, the Management Company that oversees the day-today running of the home. Mr John Railton was the registered manager of the home until he ceased employment on 14th April 2006. An acting manager is now in post. The home has a Service User Guide which is available to all prospective service users or their representative. A copy is ordinarily located in the front hall, together with a copy of the most recent inspection report. Fees range from £425 to £550 per week for a single room. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection visit was carried out as part of the Commission’s regulatory duty to inspect all care homes. The purpose was to assess the home’s compliance with key National Minimum Standards for older persons and also to review the home’s progress in implementing the requirements from the previous inspection report. The inspection commenced with a site visit on 19th April 2006, which lasted from 09.15 to 18.45 hours and was completed two weeks later when information requested of the home during the course of the visit was received by the Commission. There were 24 service users living at the home at the time of the inspection. The inspection included looking around the premises, talking with seven service users, the acting manager and eight staff members and looking at records that related to the running of the home. Eight survey forms were handed to service users during the visit of which two were returned to the Commission. Prior to and following the site visit the inspector spoke by telephone with two social care professionals and seven relatives of service users. What the service does well: The home ensures that only those service users whose needs can be met are admitted to the home. This is achieved by carrying out a pre-admission assessment and by consulting with the service user in question, their relatives and health and social care professionals. Service users are generally happy with the way they are cared for. They say that the staff for the most part understand their needs and respect their individual wishes. The following comments reflect the views of service users who spoke to the inspector: • • • Can’t find fault with the way they look after me The staff are pretty good Can’t speak highly enough of the staff, they’ve been very kind The staff approach and interact with service users in a kind and considerate manner, they communicate clearly and take account of hearing, sight or mobility difficulties that service users might have. They take time to assist service users during mealtimes. The home has the necessary facilities in place to transfer service users safely and to promote continence. Most aspects of the administration and recording of medication comply with recommended guidance. Friends and relatives of service users are made welcome by the staff. Service users are encouraged to “personalise” their bedroom by bringing in their own Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 6 furniture or other items of interest. The home takes steps to arrange for an advocate if a service user has nobody to visit him/her or act as a representative. Overall, the accommodation provides a light, spacious and comfortable environment. The home has managed to achieve sufficient staffing levels to meet the care needs of the service users. What has improved since the last inspection? The home has implemented in full thirteen of the twenty-four requirements from the previous inspection report and has partially implemented a further eight. The home has addressed two of the eight recommendations from the same report; a further two recommendations are no longer relevant in view of the change of ownership of the home. The Commission acknowledges the progress that the management has made in addressing some of the areas of concern that have been raised in previous inspection reports. The recommended amendments to the home’s Statement of Purpose have been made. The management now informs prospective service users in writing of the outcome of the pre-admission assessment. All areas of service users’ care needs are recorded in the care plan. In some cases there is evidence that service users or their representative have been consulted regarding their care plan. Risk assessments are now being conducted where the behaviour or conduct of a service user potentially poses a threat to others. The home has taken appropriate action to liaise with external professionals and to keep the Commission informed where there are concerns about the safety of service users. The recording of the content of meals provided has improved. There has been some development of the home’s activities programme. The cleanliness of the kitchen, food storage areas and the laundry room is now better, following the implementation of a revised cleaning schedule. Several projects have been implemented to ensure a more comprehensive approach to maintenance of the building and facilities. There has been some improvement to the home’s fire precaution measures, including the compiling of a more detailed fire risk assessment and the carrying out of fire drills. Comprehensive risk assessments have been completed with regard to unguarded radiators. One aspect of the staff recruitment procedure has improved: the obtaining of a full previous employment history. Some staff training has taken place, including fire, manual handling and food hygiene. Work has been undertaken to update the induction and foundation training programme for newly appointed staff. The Commission has received some monthly reports on the conduct of the home from the Responsible Individual. Progress has been made with the implementation of a quality assurance system by making use of questionnaires for service users and/or their representative. Cleaning products are now safely stored in accordance with regulations. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 7 What they could do better: There are eighteen requirements and nineteen recommendations arising from this inspection visit, including those that have been brought forward from previous reports. In view of the high number of requirements, including some that have been made on repeated occasions, the home is required to produce an improvement plan which must be agreed with the Commission. Should there be continuing shortcomings that compromise the health and safety of service users, serious consideration will be given by the Commission to taking enforcement action. Each service user must be provided with a copy of the home’s contract so that they have all the information they might need regarding the terms and conditions of residence. Service users or their representative must be consulted regarding the content of the care plan and there should be the opportunity to review the care provided with all parties concerned at periodic intervals. The home should produce an action plan where assessment has indicated that a service user’s health or safety is at risk and ensure that the monitoring of service users’ weight is carried out consistently. The recommended improvements to medication practice should be implemented in order to provide better protection for service users. Service users should be asked about their preferences with regard to the frequency and timing of their baths and the home should endeavour to meet their expectations. Staff should be reminded to knock on service users’ bedroom doors and, whenever feasible, await an invitation to enter. The activity programme should be developed further so that it meets the needs and expectations of all service users, in so far as this is feasible. Consideration should be given to the introduction of residents’ meetings or other means by which service users and/or their representatives may participate in decisionmaking. The management should continue to review the catering arrangements in order to bring about a sustained improvement to the food quality. The management should ensure that a copy of the complaints procedure is made available to all service users and/or their representatives. Staff should receive training on the topic of the prevention of abuse so that they might gain a better understanding of the subject. The hall carpet outside the main lounge and bathroom must be straightened to minimise a potential tripping hazard to service users and staff. Where assessment has identified that the position of particular unguarded radiators presents a high risk to service users, remedial action must be taken to minimise the risk. All staff members, including agency staff, must receive fire instruction every six months and a record of the session must be maintained. The management must produce evidence that the passenger lift has been serviced in accordance with recommended guidance. The management must ensure that the Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 8 necessary measures are in place to enable staff to respond effectively to any future outbreak of infection in the home. Action should be taken to ensure all items of service users’ clothes are labelled to minimise the risk of items going missing. There should be a review of the carpet cleaning equipment to ensure that the necessary facilities are in place to maintain a clean environment. There must be substantial improvements to the home’s staff recruitment procedures in order to give service users full protection. The staff training programme must be developed so that all staff have the necessary knowledge and skills to promote service users’ welfare and meet their care needs. The Responsible Individual must consistently send monthly reports to the Commission, in accordance with Regulation 26, so that the Commission is kept informed of developments at the home. An application to register a new manager must be submitted to the Commission. The management should develop the quality assurance system in order to demonstrate how the home is adapting to the expectations and needs of the service users. Care staff must receive one-to-one planned supervision so that their progress can be monitored and their training needs can be reviewed. All records required by regulations must be kept on the premises and be available for inspection. 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 House DS0000066189.V291049.R01.S.doc Version 5.1 Page 9 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 Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 10 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): 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some service users do not yet have a copy of the home’s contract which means that they do not have all the information they might need regarding the terms and conditions of residence. The home ensures that it only admits service users whose care needs it can meet by carrying out a thorough pre-admission assessment. EVIDENCE: A revised set of terms and conditions of residence has been drawn up since the change of ownership came into place in November 2005. The Responsible Individual reported that not all service users had yet received a copy of the current terms and conditions of residence. The manager conducts pre-admission assessments on prospective service users in order to determine if the home is able to meet their care needs. The process involves meeting the service user and talking with relatives, health Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 11 and social care professionals, where appropriate. The assessment is recorded and signed by relevant parties; the service user and/or their representative are informed of the outcome in writing. Two assessments were seen by the inspector and the necessary documentation was in place. A service user who spoke to the inspector was able to confirm that he had been consulted about his needs and expectations prior to coming to the home and that the staff had the necessary arrangements in place to look after him following his arrival. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 12 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans, reviews of service users’ needs and risk assessments are in place but they are in need of improvement in order to provide better protection for service users. The staff’s capacity to effectively monitor and promote the health care needs of service users is compromised by the lack of a consistent approach to the weighing of service users. Whilst the arrangements in place for the storage, administration and recording of medication mainly accord with recommended guidance, a few aspects are in need of attention in order to fully safeguard the well being of service users. For the most part staff assist service users in a way which promotes their dignity and privacy but there are measures which the home could take to enhance privacy and the range of choices available to service users. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 13 EVIDENCE: Each service user has a care plan. The inspector looked at four examples; there has been some improvement since the previous inspection but a number of shortfalls are evident. It is not consistently demonstrated that service users are consulted about what information is contained in the care plan or that they are included in any subsequent review of their care needs. Discussion with service users and relatives indicated that they generally felt that staff were understanding of and attentive to service users’ needs. However, none were aware of any arrangement for a review. One point that emerged was that service users ordinarily just have one bath each week and no choice has been offered to service users regarding this subject. There are recorded risk assessments that relate to prevention of falls, skin integrity and health and safety issues. The assessments are in need of some improvement. Where a high risk has been identified there should be an action plan to minimise or reduce the risk. The monitoring of service users’ weight is happening but there has been a lack of consistency in recent months. Service users with whom the inspector spoke who were able to articulate a view were content with the arrangements that the home had in place for the provision of healthcare. They considered that staff assisted them when they were ill and called the doctor if he/she were needed. One relative was concerned that on occasions she had had to call a doctor on a service user’s behalf, including on a recent occasion (albeit prior to the arrival of the new manager). Similar concerns were reported by another relative in discussion with the inspector. However, all relatives with whom the inspector spoke who had met the new manager were impressed by the measures that she had already implemented to improve the quality of the provision. Through observation and discussion with staff it was evident that the facilities and equipment that were in place to assist with meeting service users’ needs (e.g. promotion of continence and transferring service users) were for the most part suitable. Shortfalls relating to the home’s infection control measures were identified by staff and are considered later in the report. The inspector observed staff assisting service users with such tasks as mobilising and feeding and this was carried out in a manner which supported their independence. Service users told the inspector that the staff were helpful and respected their privacy and dignity when assisting them. The inspector observed staff taking time to communicate clearly with those service users who had hearing difficulties or who required additional time or effort on account of mental frailty. From observation and discussion with service users it was apparent that staff ordinarily knocked before entering a bedroom but this did not happen Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 14 consistently, nor did staff wait for an invitation before entering. The following comments reflect the views of service users with whom the inspector spoke: • • • Can’t find fault with the way they look after me The staff are pretty good Can’t speak highly enough of the staff, they’ve been very kind. The home has a policy/procedure for the storage, administration, recording and disposal of medication. The staff who administer medication have received accredited training on the safe handling of medication. Secure storage arrangements for all types of medication, including controlled drugs and items requiring refrigeration are in place. Two service users currently look after their own medication, in accordance with their wishes, and suitable storage facilities exist for them. The inspector spoke to one of these service users who was happy with the arrangements. Other service users with whom the inspector spoke confirmed that they received their medicines at the appropriate times. A randomly selected sample of medication and records of administration were checked and found to be in order. In situations where medication is prescribed to be taken on an “as and when” (prn) basis there is no note on the MAR chart as to the circumstances for the giving of the medication. There are risk assessments for self-medicating service users but they have not been reviewed recently and they do not reflect the individual circumstances of the people concerned. The inspector also advised that a periodic audit of the system be conducted. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Stimulation is provided through an activities programme which is in need of further development in order to meet the needs and expectations of service users. The home makes visitors welcome and thereby helps service users maintain contact with the local community. Service users are enabled to retain control over their lives but there is scope to develop their participation in decision-making about the running of the home. The home provides a nutritious and reasonably varied diet; the quality of the meals does not yet consistently meet service users’ expectations. EVIDENCE: No service users currently living at Fairfield belong to an ethnic minority or to a religious group outside the mainstream Christian faith. There are regular Communion services and visits to the home by members of the Christian Fellowship for those service users who wish to participate. The home’s policy regarding care principles and core values confirms the management’s Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 16 commitment to enabling service users to live a fulfilled life and to ensuring that service users’ individual preferences and life-styles are respected. An activities programme operates on five days of the week and includes topical discussions, quizzes, word games, exercises to music, “singalongs” and periodic entertainment, e.g. from a visiting musician. Each service user is provided with a copy of the programme. The activities coordinator is relatively new in post and is currently ascertaining the individual interests and expectations of service users. Comments received from service users on the day of the inspection regarding activities were generally positive. The main shortfall identified was the absence of outings which have been a popular feature in the past. The management is actively pursuing the purchase of a suitable vehicle with a tail-lift for wheelchair users. Two relatives expressed a view that stimulation had been lacking in the past and they were hoping that this would be an area which the new manage would develop. Visiting arrangements are “open”; friends and relatives of service users are encouraged to visit when they wish and they are made welcome. Service users informed the inspector that their visitors were well received by the staff. This positive impression was confirmed by all the relatives with whom the inspector spoke. Service users have the option of receiving visitors in their bedroom or in one of the lounges, where the opportunity for private discussion is available. There is informal discussion between staff and service users about matters affecting the running of the home, e.g. during activity sessions or at mealtimes, but there is no formal way in which service users may participate in decision-making. The inspector recommended that consideration be given to the setting up of residents’ meetings. Service users have taken the opportunity to discuss issues of interest with the management on an individual basis, such as expressing a wish for outings and raising concerns about the food quality. Service users are able to decide on the layout of their bedroom (within limitations imposed by the size or shape of the room) and to bring in their own furniture. A sample of bedrooms was seen by the inspector during the course of the visit. Bedrooms were “personalised” in accordance with service users’ wishes and included pictures and items of interest. Service users evidently felt comfortable in their familiar surroundings. The manager reported that with one exception all service users had a representative to act on their behalf if the need arose. The one person without a representative has an advocate who visits. Information on advocacy services appears in the home’s Service User Guide. Meals and hot or cold drinks are provided at regular intervals during the course of the day. Account is taken of particular likes and dislikes of service users and of specific dietary needs. At present a small number of service users are Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 17 diabetic or need their food liquidised. There have been a number of recent changes to the home’s catering arrangements, following the departure of the two chefs. Prior to the commencement of work of a new chef there is reliance on agency chefs. The menu is currently under review and one development so far has been the introduction of a choice of two main dishes at lunchtime. There has been some disquiet amongst service users about the food quality which the new manager and her catering staff are seeking to address. Views expressed to the inspector were varied and included the following: “the food is fair”, “the food is good”, “the food is not always hot when served”, “the food is not consistent”. All confirmed that they were offered a choice of items at meals. The inspector observed the serving of lunch which was conducted in an unhurried way. The food was presented attractively and staff assisted those service users who needed help. Service users who were unwell were given their meal in their room. Good stock levels, including supplies of fresh fruit and vegetables, were evident. The record of meals provided is logged in a designated diary; this record has improved since the previous inspection, although there are still a few gaps from earlier in the year. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel able to express any concerns that they have to the management but the home needs to ensure that all service users and/or their representative are aware of the complaints procedure. The home takes the appropriate action in response to adult protection matters but staff training on the subject would ensure a better level of protection for service users. EVIDENCE: The complaints procedure contains all the necessary information, including the details of how complaints will be responded to. At the time of the inspection there was no copy of the complaints procedure or Service User Guide (containing the complaints procedure) in the front hall. Service users with whom the inspector spoke were not aware of any formal complaints procedure, but they said that they would feel free to voice any concerns that they might have to the manager. As far as it was possible to ascertain from the records, no complaints have been logged. However, it is the case that some service users have made complaints about the food quality; there should be a record of these complaints and a note of how the matter has been addressed. The home has an adult protection policy/procedure which complies with guidance and a copy of the “No Secrets” guidance. The management has been following recommended practice in relation to one service user about whom Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 19 there have been some concerns, by liaising with the local Social Care and Health Office and the matter in question has been successfully addressed. There was no discernible evidence that the staff had received training in adult protection. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The accommodation overall provides a pleasant environment for service users to enjoy; the condition of some carpets falls below a good standard and one presents a potential tripping hazard. The maintenance of fire precaution and food safety measures for the most part comply with guidance, but some further work in relation to fire safety is necessary in order to provide better protection for service users. The home is being maintained in an odour-free and reasonably clean condition, benefiting service users and their visitors. Shortfalls with infection control measures in the recent past have put service users at unnecessary risk. The laundry arrangements are mainly in accordance with service users’ expectations; some improvements could be made to minimise the risk of items going missing. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 21 EVIDENCE: The inspector looked at all communal rooms and a selection of bedrooms. The home provides a light and comfortable environment which includes spacious sitting areas. Some bedrooms are of a good size, whilst others provide limited space. Some of the accommodation at first floor level is more suited to service users who retain good mobility, owing to the existence of steps to access certain areas. There is an on-going maintenance and replacement programme which is addressing the areas where most attention is needed. Several projects have been implemented to ensure a more comprehensive approach to maintenance. A full refurbishment programme, including redecoration and re-carpeting of most areas of the home, is planned in principle but has yet to be implemented. Some carpets are stained and/or looking “tired”. The carpet in the hall outside the main lounge and bathroom is “rucked” and poses a potential hazard from tripping. Fire precautions are mainly being maintained in accordance with regulations and guidance, including the servicing of the system on a regular basis. Instruction to staff is taking place and a record to that effect is kept. One staff member did not attend the staff training session held earlier in the year, a matter which needs to be followed up. Some staff members were able to confirm with the inspector that they had received training. The inspector recommended that a fuller report of the outcome of fire drills were made. The electrical installations were checked earlier in the year and a certificate dated 17/3/06 confirming the outcome was in evidence. The inspector was informed that electrical appliances had been tested recently and documentary evidence was sent to the inspector subsequently. Service records for some of the facilities and equipment were not available for inspection, including hoists, passenger lift and gas boiler/central-heating system. For the most part these were subsequently sent by post. A food safety check was conducted by the Environmental Health Officer on 15/12/05 and no matters of serious concern were noted. Minor points that were drawn to the management’s attention have been addressed. The chefs keep a log of fridge and freezer temperatures and a record of food serving temperatures. A revised cleaning schedule of the kitchen and food storage areas is in operation and all areas seen by the inspector were in good order. Service users informed the inspector that their rooms were cleaned regularly and that their linen and clothing were suitably laundered. Service users were generally happy with the laundry arrangements; there was some comment that on occasions items went missing but ordinarily these items subsequently Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 22 appeared. The inspector spoke with the laundry assistant who said that not all clothing was labelled which sometimes created a problem. There were two cleaners on duty on the day of the inspection and the home was in a reasonably clean condition. The cleaners considered that the carpet cleaning equipment was not sufficient to do the work comprehensively (e.g. there was only one properly functioning vacuum cleaner). It was subsequently reported to the inspector that a new vacuum cleaner had been ordered for the home prior to the inspection visit and that the home had only been “short” of one vacuum cleaner for a week. Suitable infection control measures have not consistently been in place: a few weeks prior to the inspection there was a suspected viral infection which affected several service users. The home did not have the necessary resources to respond swiftly to the situation. The new manager is taking steps to improve infection control measures, including the reviewing of current procedures for all aspects of hygiene promotion. This is also a topic where staff training is indicated. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 23 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, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. After a difficult period the home is now in a position to meet the care needs of the service users with the staffing levels that are in place. The home is making progress towards achieving a staff group which has attained nationally accredited qualifications in care. The staff recruitment practice at the home continues to put service users at risk because some of the necessary checks are not being completed prior to the appointment of new staff. Whilst some staff training has taken place there are shortfalls in the provision which means that staff are not fully equipped to carry out their work effectively and safely. As no assessment of the staff training needs has been completed the management is not in a position to determine the relative strengths and weaknesses of the team. EVIDENCE: The home has experienced difficulty in recent months in sustaining a full complement of care and catering staff. Very recently some staff members left when the manager departed. There has been a lot of reliance on agency staff which has contributed to an unsettling effect on service users. However, the agency staff who mainly attend now are familiar with the home and the service users. This was the case on the day of the inspection; the two agency carers Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 24 on duty in the morning were confident about the tasks that they had to perform and the resources available to them. Both service users and staff members said that there had been a shortage of staff on occasions, a situation which was now beginning to improve. The new manager and her partner are taking a proactive and “hands-on” approach, supporting the staff group in the day-to-day work of the home. The management are actively seeking to recruit new staff members. The care staff levels that are currently in place are sufficient to meet the care needs of the service users. Throughout the day (until 8 pm) there is a senior carer on duty, supported in the mornings by three care assistants and in the afternoons/early evenings by two carers. They are assisted by the activities coordinator on weekdays. The plan is to employ an additional staff member to work in the early evening period. For the period 8pm-8am two wakeful care staff are on duty, supported by the manager on call. Seven members of the staff group have achieved National Vocational Qualification (NVQ) at either level 2 or 3 and a further four are preparing for the award. The home is in a relatively strong position to meet the target of having fifty percent of the staff group that are involved in care with an accredited qualification within the relatively near future. Comments received by the inspector from service users about the competence of the staff were for the most part positive. Service users praised the hard work and kindness of the staff, working under difficult circumstances. The home has a recruitment procedure which ordinarily includes the completion of an application form, the conducting an interview, the taking up of two references and the carrying out of a police and Protection of Vulnerable Adults (POVA) check through the Criminal Records Bureau. There have been shortfalls with the manner in which the three most recently employed staff members have been recruited: initial POVA checks have not been consistently completed prior to the people concerned commencing work at the home. In one example the recorded evidence indicates that references were taken up after the person had commenced employment; in this case there was no completed application form or health declaration (although a curriculum Vitae was submitted). In another case no interview was conducted prior to the appointment. None of the required documentation in respect of recruitment was on the premises; it was subsequently sent to the inspector by the Responsible Individual. There is an induction programme for newly appointed staff. A care assistant who had just commenced work at the home on the day of the inspection was engaged in induction during the course of the day. Some staff training has taken place in the earlier part of the year, including fire safety, manual handling and food hygiene. Not all aspects of health and safety, including first aid and infection control have yet been covered. The home does not have a record of the training undertaken by agency staff who work at the home. No individual training assessment has yet been completed on each staff member and copies of certificates were not consistently in place. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 25 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): 31, 33, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Shortfalls with some aspects of the management of the home, including the promotion of health and safety, mean that service users are not adequately protected. The management should develop the quality assurance system in order to demonstrate how the home is adapting to the expectations and needs of the service users. Service users’ interests are safeguard by the home’s approach to dealing with financial matters. Staff do not receive regular supervision and therefore it is not possible to determine what progress they are making in their performance. There are substantial weaknesses with the record-keeping systems and therefore the home is not able to demonstrate measures that may be in place to keep service users and the physical environment safe. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 26 EVIDENCE: Since the recent departure of the registered manager, the home has been run by an acting manager, who has previous experience in managing care homes, in conjunction with Ms Heybourne, the Responsible Individual. An application to register the new manager has not yet been submitted to the Commission and therefore no assessment of her suitability has been made. There are longstanding issues about the management of the home, some of which have not been resolved since the change of ownership that took place in November 2005. In particular, these relate to staff recruitment, training and supervision. The Responsible Individual is required by law to report on the conduct of the home each month and send a copy to the Commission. These reports were submitted for the period from November 2005 until January 2006; the reports for February and March were not received by the Commission until after the inspection visit on 19/4/06 and therefore this body was not kept informed of developments at the home. Questionnaires were distributed to service users by the previous manager, seeking their views on the quality of the service provision. Some analysis of the findings was made and action was taken to address an issue that was of concern to some service users: the food quality. At present, there is no other formal evidence of monitoring of the home’s progress other than the Regulation 26 reports referred to in the previous paragraph. The home does not have an annual development plan, reflecting aims and outcomes for service users. All service users look after their own finances or have a representative to assist them. The home has no involvement with managing service users’ financial affairs. There is a lockable facility in each bedroom to enable service users to store items of value safely. At present staff members do not receive regular formal supervision. No records were available to demonstrate whether or not staff supervision had been taking place, in accordance with recommended guidance, prior to the recent departure of the registered manager. Staff are receiving guidance and support from the acting manager and the Responsible Individual on a day-today basis and this was confirmed to the inspector by the staff on the day of the inspection. Some of the records required by legislation, principally service users’ care and medication records, were in place and were readily available. Some records were in disarray and were hard to locate, others, notably staff recruitment records, were not on the premises. Records relating to staff training were Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 27 incomplete. The record of meals provided has improved since the previous inspection, but some gaps remain. The management conducts weekly and monthly health and safety checks and a record is made of the outcome. An accident record book which complies with legislation is in place but none of the individual sheets with details of accidents that have occurred were available for inspection. No audit of accidents was in evidence. From observation during the course of the visit care staff appeared to be taking suitable precautions when assisting service users to transfer and mobilise. The physical environment was for the most part free of potential hazards; one problem concerning a carpet was noted by the inspector, as reported under Standard 19. A number of shortfalls with regard to health and safety have been identified earlier in the report, including aspects of staff training. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 28 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 2 3 x x x 2 x x x x x x 1 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 1 1 2 Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 29 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. Standard Regulation Requirement Each service user must be provided with a copy of the current terms and conditions of residence document. Previous timescale of 30/09/05 not met. There must be documented evidence that service users and/or their representative have been consulted about the content of their care plan. This requirement has been partially implemented, original timescale of 30/6/05 not met. Regular monitoring of service users weight must take place, in accordance with service users wishes, in situations where a nutritional assessment has indicated a risk to the service users health. This requirement has been partially implemented, previous timescale of 30/9/05 not met. The record of meals must give sufficient detail of meals provided to enable an inspector to assess the variety of the provision made. DS0000066189.V291049.R01.S.doc Timescale for action 1 OP2 5(1) 30/06/06 2 OP7 15 31/07/06 3 OP8 12(1) 30/06/06 4 OP15 17(2) sched 4 31/05/06 Fairfield House Version 5.1 Page 30 5 OP19 13(4) 6 OP19 23(4) 7 OP19 23(2) 8 OP26 13(3) 9 OP29 19(1)(5) 10 OP29 19(5) 11 OP29 19(1) This requirement has been partially implemented, original timescale of 28/2/05 not met. The hall carpet outside the main lounge and bathroom must be straightened to minimise a potential tripping hazard to service users and staff. All staff members, including agency staff, must receive fire instruction every six months and a record of the session must be maintained. Evidence that the passenger lift has been serviced in accordance with recommended guidance must be submitted to the Commission. The registered persons must ensure that the necessary measures are in place to enable staff to respond effectively to any future outbreak of infection in the home. All necessary measures and checks on prospective staff members must be completed prior to the person in question commencing work at the home, including the receipt of two satisfactory references, a “POVA first” check, prior to taking up appropriate supervised employment according to guidance. Original timescale of 31/12/04 not met. An interview of all prospective staff members must be conducted and recorded in order to ensure that the person concerned is suitable for the post. Written references must be obtained in respect of each prospective staff member in situations where a telephone reference has been recorded DS0000066189.V291049.R01.S.doc 15/05/06 30/06/06 30/06/06 31/05/06 31/05/06 31/05/06 31/05/06 Fairfield House Version 5.1 Page 31 12 OP30 18(1) 13 14 OP30 OP31 13(3) 8 15 OP31 26 16 OP36 18(2) 17 OP37 17 18 OP38 13(4) prior to his/her appointment. Each care staff member must be provided with training in first aid, and health & safety. A record of the training supplied must be kept. This requirement has been amended to reflect that it has been partially met. Original timescale of 3/12/02 not met. Staff must receive training in infection control. The Responsible Individual must submit an application to register a new manager. The Commission must receive monthly reports from the Responsible Individual in accordance with Regulation 26. This requirement has been partially met. Original timescale of 26/8/03 not met. Care staff must be provided with individual supervision and have training development plans agreed. Original timescale of 31/8/03 not met. The registered person must ensure that all records required by regulations are kept on the premises and are available for inspection. Where assessment has identified that the position of particular unguarded radiators present a high risk to service users, remedial action must be taken to minimise the risk. This requirement has been amended to reflect the fact that it has been partially implemented. Previous timescale of 31/10/05 not met. 31/07/06 31/08/06 30/06/06 31/05/06 31/07/06 31/05/06 31/08/06 Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 32 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 The registered persons should implement a system of holding in-depth reviews of service users at periodic intervals (e.g. every three or six months) in order to give all relevant parties the opportunity to thoroughly look at the care “package” that is being provided. This recommendation is made for the fourth time. When a risk assessment identifies that a service user is at a high risk of coming to harm there should be an action plan in place to indicate how the risk is to be managed. The risk assessments for self-medicating service users should be improved in order to better reflect the individual circumstances of the service users in question. These assessments should be kept under regular review. The circumstances in which prn medication is to be given should be recorded on the MAR chart. The registered person should carry out a periodic audit of the medication arrangements at the home. Service users should be asked about their preferences with regard to the frequency and timing of their baths and the home should endeavour to meet their expectations. Staff should be reminded to knock on service users’ bedroom doors and, whenever feasible, await an invitation to enter. The activity programme should be developed further so that it meets the needs and expectations of all service users, in so far as this is feasible. Consideration should be given to the introduction of residents’ meetings or other means by which service users and/or their representatives may participate in decisionmaking. The management should continue to review the catering arrangements in order to bring about a sustained improvement to the food quality. The management should ensure that a copy of the complaints procedure is made available to all service users and/or their representatives. A record of all complaints made should be logged, together with a note of how the DS0000066189.V291049.R01.S.doc Version 5.1 Page 33 1 OP7 2 OP7 3 4 5 6 7 8 OP9 OP9 OP9 OP10 OP10 OP12 9 OP14 10 OP15 11 OP16 Fairfield House 12 OP18 13 OP19 14 15 OP26 OP26 16 OP30 17 OP33 18 19 OP33 OP38 matter in question has been resolved. Staff should receive training on adult protection, preferably from an external provider who has expertise in this topic. The record of fire drills should be expanded to include a fuller description of the nature of the exercise, the extent to which service users were involved, the time taken and the outcome, identifying any points for attention. Action should be taken to ensure all items of service users’ clothes are labelled to minimise the risk of items going missing. There should be a review of the carpet cleaning equipment to ensure that the necessary facilities are in place to maintain a clean environment. Each staff member should have an individual training assessment and a complete training record, including one for agency staff members, together with copies of training certificates. The registered persons should produce an annual development plan based on a systematic cycle of planningaction-review, reflecting aims and outcomes for service users. This recommendation is made for the tenth time. The registered person should attempt to include external professionals in conducting an annual survey of views from stakeholders regarding the home’s performance. This recommendation is made for the third time. There should be a periodic recorded audit of accidents. This recommendation is made for the second time. Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Fairfield House DS0000066189.V291049.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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