Inspection on 21/06/06 for Fairfield House

This inspection was carried out on 21st 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfield House 09/11/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Fairfield House Bleathwood Nr Ludlow Shropshire SY8 4LF Lead Inspector Jean Littler Unannounced Inspection 21st June 2006 10:30 Fairfield House DS0000064842.V295698.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 House DS0000064842.V295698.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 House DS0000064842.V295698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfield House Address Bleathwood Nr Ludlow Shropshire SY8 4LF 01584 711878 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) Winslow Court Limited Mr Stephen Macdonald Nicolson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: Fairfield House is registered to accommodate six people with learning disabilities who may display some challenging behaviour. The Home is situated on the outskirts of the village of Bleathwood in a very rural location on the border between Herefordshire and Shropshire. There is a spacious garden with attractive views. All residents have a single bedroom with an en-suite and they share a lounge dining room and conservatory. In the grounds is a detached wooden building that provides additional space for activities and meetings. The Home was opened and registered in August 2005. It is owned by Winslow Court Ltd. a company that comes under the umbrella of an organisation called the SENAD Group. The Home retains close links with Winslow Court, which is a larger Care Home in the area. The company training, health and safety, and human resources departments are based at Winslow Court. Information about the Home is available on request from the Home or from Winslow Court. The fees range between £1600 and £2000 a week depending on the resident’s assessed needs. The residents have to pay for their own personal items or services e.g. hairdressing or chiropody, toiletries and clothes. A contribution is expected towards holidays and vehicle hire for the holiday if costs exceeds £500. The residents’ DLA money is paid in full to the providers to fund the vehicle provided at the Home. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine Key unannounced inspection was carried out on a weekday between 10am and 5.30pm. All of the six residents were at Home for part of the inspection and some were observed interacting with the staff. One showed the inspector his bedroom as part of a tour of the house. A sample of records and care plans were seen, medication was audited. The manager assisted with the inspection and two permanent support workers were interviewed. The manager had completed a pre-inspection questionnaire to provide additional information, which was received by the Commission on 13th June 06. The residents, their representatives and some professionals involved were given feedback questionnaires, several of which were returned. The residents were helped to complete theirs by the staff. Comments were positive particularly about the activities they take part in e.g. ‘I like using the trampoline at Fairfield House’. Some of the residents may not have fully understood the purpose of the questionnaire or the inspection process. Those returned from families were generally positive, although some felt more staff and a second vehicle were needed to give the residents more personalised activity plans. One relative commented ‘Overall, the staff are very caring and I know that on many occasions they go the extra mile’. A professional who has visited the Home to work with residents reported ‘The Home is very proactive in dealing with any issues that arise’. The manager has been open with the Commission about any difficulties and developments in the Home since the last inspection. This information and the monthly provider’s monitoring reports have also been considered as part of the inspection process. What the service does well: The service provides a comfortable and attractive family style home for the residents. They have personalised bedrooms and use them to have private time in. The needs of the residents have been carefully assessed and clear documentation is in place about how staff can meet their needs. A good quality of life is being provided through personalised support, the variety of activities provided and the links with relatives that are supported. Suitable staffing levels are being maintained and a good range of staff training provided. Health care needs are being given priority and links are in place with relevant specialists. Robust arrangements are in place for managing health and safety risks. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. Information about the Home is available, but the format used to convey this to the residents could be made more personal. Prospective residents’ needs and their compatibility with other residents are assessed prior to admission. EVIDENCE: A Statement of Purpose and Service User’s Guide were developed prior to the Home being opened. These have been given to the residents’ representatives as part of the admissions process. A version of the Guide, called the Residents Handbook, using Widget symbols and simple text has been given to each resident. This is being reviewed to see if it can be made meaningful to the residents now their communication needs are better known. Detailed assessments have been carried out prior to the admission of a new resident. In some cases residents have been admitted from Winslow Court and their needs have already been known to the providers, the manager and some of the staff. A professional support team are available including a psychologist and nurse. Their input has been used to assess the needs of new residents. Potential residents have been encouraged to visit the Home to see if they like it, and move in on a trial three month basis. All placements are arranged through a funding authority who carry out an assessment. The social worker, and where available, the resident’s relatives are involved in the transition Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 9 arrangements. In some cases the relatives have helped personalise a resident’s bedroom. Unfortunately since the Home opened one resident has had to return to Winslow Court. This decision was taken by a multi-agency group following a level challenging behaviour being displayed that was unexpected. The move back into a more structures environment with higher staffing levels was assessed as being in the best interest of the resident. Although this is not a positive outcome for the resident it was not as a result of poor assessment processes. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 10 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, 9. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents’ needs are well documented and with the support of professionals they are being kept under constant review. Where possible the residents are being supported to make decisions and take risks as part of ordinary living. Some areas of how support is managed should be reviewed to see if improvements for the residents can be made. EVIDENCE: Two care plans were sampled. These contained detailed guidance under appropriate headings to guide staff about how to meet the residents’ complex care needs. Where professional support is being accessed the purpose of this is explained e.g. the speech therapist is involved with one resident with the aim to reducing anxiety. Efforts are being made to get more family history information from residents’ relatives to help build up their personal profiles. Risk assessments are in place and these and the care information are being kept under review. Regular review meetings are being held with relatives and the professionals who are involved in each resident’s care. Daily notes are being recorded on a form that allows staff to record a wide range of relevant Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 11 information quickly on each shift e.g. family contact, the person care given, activities, goals achieved, health. Intervention strategies are in place to assist staff to respond positively to the residents’ behaviour. These have been developed with input from the psychologist. For some residents specific sanctions are used to at appropriate times e.g. a resident may be asked to go to their bedroom to calm down if they become agitated. Physical intervention is also used with one resident who at times will damage property and hit out at others. On these occasions an incident report is completed and a record made in specific logbooks, which are seen by the manager. Some entries showed restraint has used for up to 30 minutes. A de-briefing should take place, and be recorded, with the staff involved with restraints that go on for a significant period to ensure that best practice has been followed. It is positive that a recent increase in the frequency of incidents had been identified and the consultant informed. The resident’s medication had been changed and the situation is now improving. The auditing of incidents can be further improved if more detail is included in the monthly care summary reports e.g. changes in the frequency restraint or sanctions are being used, the frequency any other residents are involved in an incident. The strategies being used with one resident have recently been revised at a team meeting with the psychologist. Staff were using several approaches that differed from the current guidance during the inspection. The manager reported that the new interventions had not yet been added to the care plan and that once they had been consistency would be established. Staff meeting minutes showed that residents’ needs and consistency of approach are discussed. Because of their behaviour patterns some of the residents demand more frequent interactions from staff than others. During the handover period three members of staff were involved in planning the shopping list with one resident. Two other staff were nearby in the same room when an incident occurred between two other unsupervised residents in another room. A worker instructed one resident to go to their bedroom as a sanction. Once informed the manager came to reassure the resident who had been pushed and grabbed, but staff had not done this. Consideration should be given to the benefits of specific staff being allocated to one or two residents each during their shifts. Risk assessments are appropriately balancing the need for residents to enjoy a good quality of life by partaking in activities, and putting in reasonable measures to protect them. An example is the residents use the kitchen with support but it is locked at other times. Goals are in place and some of these link to them developing independence skills. This is an area that could be further developed. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 12 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, 14, 15, 16, 17. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are being offered opportunities to take part in appropriate activities both outside and inside the Home. Their rights are being respected. They are being well supported to maintain personal relationships with friends and family. A good variety of meals are being provided and the residents’ food preferences are taken into account. EVIDENCE: A relaxed homely routine has been developed where freedom and choice are being promoted e.g. residents chose where to spend time in the house, what indoor activities they do, what food they eat. Where restrictions have been implemented these are on the basis of a risk assessment e.g. for her own safety one resident has been prevented from leaving the grounds without staffs’ knowledge. Staff reported that freedom is given about times to get up and go to bed. As the evening care shift ends at 9.30pm the manager should ensure this does not lead to residents missing out on normal adult evening routines e.g. staying up or out later at weekends. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 13 Each resident has a personalised activity plan that has been developed around what they like to do and what activities are assessed as being of benefit to them. It is usual for each resident to leave the house daily. Some of the offsite activities being accessed are trampolining, pottery, environmental studies at college, horse riding, and snozelem sessions at Winslow Court. Several staff drive the Home’s vehicle to facilitate outings. The manager plans to adjust activity plans to take account of the newest resident’s routines and to get a better balance of outings and vehicle use across the week. Although the manager uses his car to take residents to medical appointments consideration should be given to a second vehicle being provided to provide greater flexibility with outings as the residents all have such different needs. Community facilities are being accessed including local shopping, walks, pubs, the swimming pool. Access to integrated activities is an area that could be further developed through person centred planning. Day trips of interest and holidays are arranged. Some residents also go to stay with their families and go on holiday with them. Staff reported that the afternoon activity plans are not disclosed to residents in the morning in case staff go off sick and the plans change. This practice should be reviewed and the information should be provided to them in line with the their ability to manage information. Strategies can be developed to assist residents to develop the life skill of coping with anxieties caused by plans changing. A variety of in-house of activities are available including personal music, TV and DVDs in bedrooms, communal entertainment equipment, football nets, a pool table, a Bar-B-Q, swing ball. During the inspection some residents were at planned activities and health appointments, those at home were seen to get involved with table top activities e.g. lego, colouring, or were spending time in the lounge or their bedrooms. A computer is available for the residents to use with a ‘Widget’ symbol programme. One resident has been supported to use this to write a letter to her family. One resident spends private time with her relatives in the training and activity building in the garden. They use the kitchenette facilities to prepare meals to share together. Efforts from the team have resulted in one resident recently having contact again with his family. This is very positive for the resident concerned. Efforts have been made to make positive links with neighbours. Links with people the residents have lived with and liked in the past are maintained through visits to Winslow Court and some shared trips out. Communication aides are being used daily including symbol systems, signing and specific verbal prompts. The organisation’s speech therapist has been involved in the development of these aides and programmes based on each resident’s specific needs and strengths. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 14 Menus are in place that show a good variety of healthy meals are being offered to the residents. A vegetarian option is offered or an alternative if a resident does not like the main choice. Plenty of fresh fruit and vegetables are being provided with seasonal options are considered. The meals are arranged in a flexible manner depending on what the residents choose and what activities they are taking part in. A lighter meal is usually provided at lunchtime and the main meal in the evening. Recent changes have been introduced to help prevent residents gaining unwanted weight e.g. smaller portions and a reasonable limit on accessing snacks. A record of the food eaten is kept as part of residents’ daily records. The meals are eaten with staff in a relaxed and family style arrangement. Residents are encouraged to help in the kitchen e.g. washing up. As part of quality assurance arrangements consideration should be given to how an annual nutritional review could be arranged. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 15 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, 20. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are having their personal care and health needs met in a sensitive and proactive manner. Medication is being safely stored and generally well managed. One area needed to be addressed as a matter of urgency. EVIDENCE: Care records showed that residents were bathing or showering daily and their other personal care needs are being met. Arrangements are in place to meet specific cultural needs e.g. hairdressing. Appropriate gender care is being given whenever possible. Some residents are able to lock themselves in their bedrooms for privacy and one holds a key and locks her room when she goes out. Links with local health professionals are now established and all residents are registered with a GP and dentist. Appointments are prioritised and the manager often attends these with the resident to keep informed. Annual health checks are being provided by the site nurse based at Winslow Court. Additional health support is accessed through the team of specialists based at Winslow Court that includes a psychologist and speech and language therapist. External links with health professionals are also in place e.g. the consultant psychiatrist. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 16 The care plans include clear details about the residents’ health needs and how these will be met. Health concern records are used to log any issues that arise. The medication is being stored securely in an appropriate cabinet. Each resident has a medication profile indicating what medication they are on and why. Photos are in with the records to help avoid administration errors. The administration records showed that doses are being given as prescribed. A system is in place where a second worker signs a separate record to show they witnessed the medication being administered. One error had been noted when three residents did not receive their medication at a time when an incident was occurring in the Home. This should have been reported to the commission. The manager agreed to report any future errors. It is positive that corrective action had been taken to help prevent any future similar errors. Where hand written entries have been added to the pre-printed administration charts two staff have signed these entries to show who wrote and checked the accuracy of the instructions. The returns book is being used appropriately and signed by the pharmacist. Returns should be kept separately to keep the cabinet well ordered. The doctors involved are keeping all residents’ medication under review. Some residents are prescribed medication to be given only under certain circumstances. A protocol needs to be in place in these instances to ensure staff know when to administer a dose. A new medication had been prescribed six months ago for one resident but although staff training had been provided no protocol is in place. The nurse has responsibility for writing this in line with the consultant’s instructions. The manager agreed to ensure this is put in place as a matter of urgency so an immediate requirement notice was not left. Since the inspection he has confirmed this has been actioned. A medication policy is in place and staff are not permitted to administer medication until they have shadowed a colleague giving medication 15 times and received training from the site nurse. She then observes them giving medication before they are deemed competent. Staff are also being provided with a training course from the supplying pharmacist about the monitored dose system that is used. The providers are considering how accredited medication training can be provided. Audits should be arranged with the supplying pharmacist as a quality assurance measure. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 17 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, 23. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. Complaints are welcomed and dealt with in a positive way. Arrangements are in place to try to ensure residents are protected from abuse, however recruitment and monitoring procedures need to be more robust to fully achieve this aim. EVIDENCE: A suitable complaint procedure is in place. No complaints have been received directly by the Home since the last inspection, however some neighbours have raised concerns with the Commission since the last inspection. These were in relation to two incidents when a resident left the grounds of the Home without being seen by staff. After the first occasion steps were taken to make the perimeter fence less easy to climb over. After the second occasion, when this measure had obviously not been effective, other more robust arrangements were put in place. It is positive that throughout the correspondence about this issue the manager asked the inspector to encourage the neighbours to make direct contact so their concerns could be resolved directly. Members of the Parish Council did visit the Home afterwards. They have given feedback that they were made welcome and were reassured about the arrangements in place. As the manager is aware of these concerns a complaints record should ideally have been made to note these and the positive action that was taken. The staff spoken with reported that they are encouraged to report any concerns promptly and felt the standards of care in the Home is high. Staff training is provided in Adult Protection. An Abuse and Whistle Blowing policy are in place and these areas are covered in the induction and during supervision sessions. Guidance is in place about how to respond to residents’ Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 18 complex behaviours and relevant training is being provided. There have not been any Adult Protection concerns since the last inspection. As detailed elsewhere the SENAD Group needs to ensure that staff recruitment procedures are robust to fully protect residents. The level of incidents where restraint is used for a prolonged period, or where one resident hurts or threatens to hurt another resident or should be monitored more closely to ensure their wellbeing is safeguarded. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28, 29, 30. Quality in the outcome area is excellent. This judgement has been made using available information and a visit to this service. The residents have a comfortable and clean home that is suitably equipped and well maintained. They have access to a pleasant garden and communal facilities, and their bedrooms have been nicely personalised. EVIDENCE: The house is detached and has a large attractive garden. It is situated in a very rural location, which is beneficial to the residents in terms of the quietness. The location does not easily facilitate the residents becoming part of a local community or give them the option of using public transport for outings. The exterior of the home is in good condition and the interior has been well maintained following its initial refurbishment. A responsive repairs service is in place with an on-call system and staff and residents are assisting with outside developments e.g. putting up a shed and poly-tunnel, starting a vegetable plot. There are six bedrooms with en-suite facilities. Those seen were clean, comfortable and had been nicely personalised. Two residents had recently ordered new bedroom furniture that would better meet their storage needs than those provided by the Home. One has had new flooring to meet his Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 20 needs. The lounge and dining room/conservatory are attractive and appropriately furnished. These rooms are close together and all relatively small to accommodate ten or eleven people including the staff. Fortunately some residents choose to spend time in their bedrooms and during the day some residents are usually out for part of the day. Additional communal space is available in a large wooden building in the grounds. This has been fitted out with a lounge, dining/activity area and kitchenette. It is used for meetings, training and for residents to spend time in private with their visitors. Some steps are being put in place to safeguard equipment and fixtures to prevent continual damage e.g. pictures are being screwed to the walls. Communal bathrooms, toilets, a laundry and a kitchen are also provided. These areas are modern, clean and suitably equipped. The care staff do the cleaning and laundry and cleaning schedules are in place. Staff try to engage the residents in helping with domestic tasks e.g. tidying their bedrooms. The residents are all fully mobile and so no aides or adaptations for physical disabilities are needed at present. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 21 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, 35, 36. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are being supported by a competent staff team in sufficient numbers to meet their needs. Staff recruitment needs to be made more robust to fully protect the residents. Effective training and support systems are in place for staff. EVIDENCE: A minimum of four staff are on duty during the day and when the manager is in the Home there are five, unless he is covering a gap on the rota. This level of staffing provides reasonable flexibility for residents to access their activities, outings or health appointments. A full staff team is in place, but three staff have been on long term sick leave, and one team is leaving soon. Gaps on the rota are being covered by staff doing overtime and by relief and Winslow Court staff. As detailed above the main staff team is supported by a team of specialised staff. Staff training arrangements are managed centrally. A rolling programme of core and basic training is provided at Winslow Court that new staff attend during their two week induction period. Existing staff who need refreshers are called to attend these sessions as required. New staff are gaining their Learning Disability Award Framework foundation through this process. A specific certificate for this was not being issued so the manager agreed to Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 22 enquire about this. Once they are established in post staff are encouraged to enrol on an NVQ course to gain a qualification in care. Currently 47 of staff are qualified and five staff are working towards an award. Unfortunately the two staff who have left since the home opened both held an NVQ. Some specialised training is routinely provided for staff e.g. Autism Awareness, Adult Protection, and Epilepsy. Positive Approaches to Challenging Behaviour and Physical Intervention training are also provided with annual refreshers to help ensure good practice is maintained. A training plan for the year ahead is in place and clear training records for each worker are being kept. There is some indication that keyworker training to clarify the role would be beneficial. Two staff were spoken with. Both reported that the residents are being provided with good care from the staff team. They had attended appropriate training and found their supervision sessions helpful. Both had ideas about how the service could be further improved. Staff on duty interacted with the residents in a friendly and appropriate manner for the most part. They demonstrated an awareness of their needs and agreed boundaries. When responding to residents to reinforce boundaries some staff sounded sharp and disapproving in their tone. If this is needed to help the resident listen to the instruction this should be made clear in the guidance. The staff handover was observed. This was held on the patio and residents near the residents’ communal area. Two residents came over during this process and could overhear the information being shared. One became over excited and grabbed at staff at the end. The other was pacing and when she came over she was quickly instructed to move away. Consideration should be given to holding the handovers in the training room for privacy and to keep the communal areas calm and un-crowded. The residents can be appropriately involved afterwards in telling the new staff about their day so far. Recruitment records for two staff were sampled. Recruitment is managed centrally from Winslow Court where a personnel (HR) officer is based. Appropriate procedures are in place and applicants are required to complete an application form, provide evidence of their identity and attend an interview. Job descriptions are in place, and contracts and training agreements issued. The manager had interviewed applicants with the support of the HR officer and records made. The required checks for both workers had not been fully completed prior to both staff taking up employment. One employee had started work at Winslow Court, as Fairfield House had not yet opened, a clear CRB or PoVA First check had not been received at that point. The other worker started before any satisfactory written references had been obtained. Four references had been requested and only one written response had been received following the start date. The manager was not fully informed about the difficulties the HR officer had encountered and had assumed all checks were in place. A checklist is attached to each recruitment file that had not been signed off by the manager. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 23 Staff are being provided with supervision sessions with a line manager at least bi-monthly. Staff spoken with said these were helpful and their training needs were discussed. Staff are supported in other ways e.g. new staff work seven shadow shifts where they are supernumerary before working directly with the residents, back to work interviews are held following periods of sickness. Staff meetings are held periodically. The way these are managed has just been reviewed to improve arrangements. Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 24 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, 38, 39, 40, 41, 42. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. The residents are benefiting from a well run home focused on their right to lead a fulfilling life. Procedures and record keeping systems are in place to safeguard their best interests. Their health and safety is being promoted. Quality assurance systems are in place but these need to be made more robust to ensure high standards are consistently achieved in all areas without intervention from CSCI. EVIDENCE: The manager was registered with the Commission as part of the overall registration of the service prior to it opening. He has relevant experience from working at a senior level within Winslow Court and managing another small care home for a short period. He has attended appropriate short management courses such as staff supervision, and in February 06 successfully completed the NVQ4 in Care and the Registered Managers Award. The manager reports to the registered manager of Winslow Court, who provides him with supervision sessions at least bi-monthly. There is evidence that the manager is Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 25 approachable and open to ideas. e.g. staffs’ idea to build steps between the patio and the activity building has been implemented. Some quality assurance systems are in place e.g. monthly provider monitoring visits and health and safety checks. Some areas where closer scrutiny would be beneficial have been identified elsewhere in the report i.e. residents’ financial, medication management, and recruitment records. No formal quality assurance system is in place that includes consultation with residents and/or their representatives and other stakeholders. Regulation 24 has been amended to clarify the responsibilities of registered persons to monitor quality and continually improve their service. The manager should refer to this and Standard 39 when considering what to implement. Currently there is not a development plan in place for the coming year. Staff should be involved in developing aims to ensure their feedback and ideas are incorporated and they support the plan. Company policies and procedures are in place and the manager reported that these have been kept under review. Records are being stored securely and the information is being kept up to date. Records relating to the resident’s finances were sampled. Two signatures are required when money is withdrawn from residents’ accounts on their behalf. Records showed that appropriate items are being purchased by or on behalf of the residents. Expensive purchases are being discussed with the resident’s family and the social worker. Attempts to open savings accounts have unfortunately failed due to the requirements of the banks and building societies. Receipts are being kept and inventories are in place. A system needs to be put in place to ensure these are updated as new purchases are made. The cost or value should also be included. The monitoring carried out during the regulation 26 visits usually only covers checking the balance of cash held against recent expenditure records. The manager is planning to have an internal audit carried out by a member of staff. As the senior staff in the organisation are also the signatures for three residents, quality assurance would be improved if an annual audit was carried out by an independent person. The manager attends the company Health and Safety meetings to stay informed about developments and changes in legislation. Essential safety checks are being carried out e.g. the fire alarm, hot water temperatures. The fire assembly point is clearly marked in the grounds and regular drills are being held. Door closure mechanisms have now been fitted to communal rooms to allow the residents the freedom to move around unrestricted without compromising fire safety. The manager agreed to complete a risk assessment about the level of First Aid cover provided in the Home as currently there is not always a fully qualified First Aider on duty, (as described in N.M. Standard 42). The manager and four senior staff are qualified. The need to have a risk assessment in place was brought to the attention of senior staff based at Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 26 Winslow Court in 2005 and should have been considered by the providers across the group. Accidents and incidents are being recorded and monitored through the monthly providers visits. Serious incidents involving staff have been appropriately reported under RIDDOR. Risk assessments are in place relating to the environment, work tasks, and the residents’ care needs. These are being kept under review and action taken when risks are identified e.g. a worker fell outside and a loose paving slab was identified as the cause and re-set. Fairfield House DS0000064842.V295698.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 3 2 4 3 3 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 4 26 4 27 4 28 3 29 N/A 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 X 3 3 2 3 3 3 x Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 28 NO 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 YA20 Regulation 13 Timescale for action A protocol must be in place for 31/07/06 all ‘as needed’ medication that is prescribed. (Confirmed as actioned on 20-7-06). The manager must ensure 21/06/06 recruitment practices are robust and all legally required checks have been carried out before a worker takes up employment. Implement a quality assurance 30/09/06 programme to ensure all aspects of the service and records are thoroughly monitored, and stakeholders are consulted periodically. Requirement 2 YA34 19 3 YA39 24 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 Refer to Standard YA1 YA6 Good Practice Recommendations Consider if information about the Home can be presented in a format more suitable for each resident. (Brought forward, work ongoing). Review how monthly care summaries are used to review DS0000064842.V295698.R01.S.doc Version 5.2 Page 29 Fairfield House incidents and intervention strategies including restraint. De-brief staff involved with serious incidents and when restraint has been used for a prolonged period. Closely monitor incidents between residents and ensure residents are adequately protected. Consider linking staff to residents in each shift to ensure all residents are supervised and engaged with equally. 3 4 YA13 YA20 Review if care shifts should always end at 9.30pm. Provide a second vehicle to enable greater flexibility to be provided for activities. Provide staff with accredited training in medication administration. Arrange audits of the medication system with the supplying pharmacist. Review how staff handover periods are managed to ensure the low arousal environment is maintained. Engage staff and stakeholders in developing a service improvement plan for the coming year. Complete a risk assessment about the level of First Aid cover provided in the Home and address any shortfalls if they are identified. 5 6 7 YA33 YA39 YA31 YA42 Fairfield House DS0000064842.V295698.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Office The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 DS0000064842.V295698.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!