Inspection on 08/07/09 for Fairfield House

This inspection was carried out on 8th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfield House 02/07/07

Fairfield House 25/09/06

Fairfield House 30/01/06

Fairfield House 07/12/05

Fairfield House 08/02/05

Fairfield House 05/10/04

Fairfield House 08/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Fairfield House Ashcombe Road Dawlish Devon EX7 0QQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judy Hill     Date: 0 9 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Fairfield House Ashcombe Road Dawlish Devon EX7 0QQ 01626862173 01626868127 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Education & Care (Devon) Limited care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Bedroom F19 must be used for prospective students` assessment visits. Date of last inspection Brief description of the care home Fairfield House provides accommodation and care during term time for students attending Oakwood Court College. Oakwood Court College is a privately run educational service for students with a learning disability aged 16 up to 25 years old. The college offers courses lasting up to three years and is inspected by the Office for Standards in Education (OFSTED) and the Adult Learning Inspectorate (ALI). Fairfield House and The Cottage and Flat, which are in the grounds of Fairfield House and included in the registration are situated in the rural outskirts of Dawlish, but are within a mile of the town centre, train station and beach. Transport is provided for students to enable them to travel to and from college and to participate in activities outside their home. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 17 Brief description of the care home Information about the College and the care and accommodation services is available for students is available from Oakwood Court College in the form of a Welcome Pack, which will be given to prospective students and their representatives. Copies of inspection reports are available at the home and, or can be obtained on request from the service provider or accessed on the CQC website. The fees, which are LSC funded, cover the costs of college fees as well as student care and accommodation and range from 36,772 pounds to 67,775 pounds (term time). The fees do not cover care and accommodation during college holidays, personal items, such as clothing or a weekly personal allowance. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was concluded with a site visit that was carried out at Fairfield House on 8th and 9th July 2009. The first visit was held during the day when there were no residents or care staff on duty and the second visit was carried out in the late afternoon and evening so that we could meet and speak to some of the people who use the service and the people who look after them. The information used in this report was gained from an Annual Quality Assurance Assessment that had been completed and returned to us by the service providers, surveys, which had been completed and returned to us by fourteen residents and thirteen care workers, the Colleges Statement of Purpose and Welcome Pack, the last inspection report and other information that we had been given by the service or by other people since the last inspection. During the site visit we carried out a physical inspection of Fairfield House, The Cottage Care Homes for Adults (18-65 years) Page 6 of 32 and The Flat. We looked at some of the residents assessments and care plans and we looked at some staff recruitment records, medication records and minutes of meetings. We also spoke with some of the people who live at Fairfield House, two members of the management team, the staff on duty. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Although the individual care planning is good, the volume of information contained in the individual case files makes it hard for the staff to access the information they need to tell them how peoples individual care and support should be provided. More care needs to be taken to ensure that medicines that the staff help people take are administered safely and that clear and accurate records are kept. The staffing levels need to be reviewed to ensure that there are always enough staff on Care Homes for Adults (18-65 years) Page 8 of 32 duty to meet the individual needs of the people who use the service. Communication needs to be improved to ensure that the staff feel valued throughout the transition from the old to the new management systems. A manager, who will be responsible for the day to day running of the service needs to be registered. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective students and their representatives have the information they need to make an informed decision about whether the service will meet their needs. Evidence: We requested and were given a copy of a Statement of Purpose. This document contains information about Oakwood Court College, from both an educational and residential perspective. Fairfield House, The Cottage and a self contained flat are registered as Fairfield House because they are on the same site, and form part of the residential accommodation provided for students at Oakwood Court College. There is no Service Users Guide as such, but the students are given a Student Handbook which contains the information they need. This document is written in plain English and pictures are used to illustrate the words to make it easier for people to read and understand. The initial assessment process is very detailed and comprehensive as it needs to focus on the suitability of prospective students for three year college course as well as their Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: residential care needs. Referrals must be made through a referring authority, usually the local authority and must involve input from people with parental authority, as the majority of students will only be accommodated during term time, which is thirty-eight weeks a year. Prospective students must visit the college before they are admitted and are encouraged to spend three days at one of the residential homes attached to the college so that they can experience college life before deciding if they would like to take up the offer of a placement. This three day assessment period also gives the staff of the college and the residential unit the opportunity to assess whether or not the college would be suitable for the prospective student. In their individual assessments, the nature of the physical, emotional, social and psychological difficulties that the people using the service may experience in their daily lives is recorded in detail so that the staff that work with them regularly can gain an understanding their complex needs. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in making decsions about their lives and play an active role in planning the care and support they need. Evidence: We looked at the records of three of the students as part of a process of case tracking. The case files told us a lot about the individual needs of the people living at Fairfield House and provided a plenty of evidence to show that the students and their parents had been directly involved in both the assessment of the students individual needs and the development of their plan of care. Ten of the thirteen surveys that were completed and returned to us by the staff told us that up to date information was not always available about the needs of the people who use the service. The working plan of care should contain the information that the staff need to access on a daily basis to enable them to tailor the service they provide to meet the individual needs of the students. We found this not to be the case as although the relevant information was included, for example, basic details, the current Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: date care plans, risk management plans, goals and behavioural management guidance, the presentation of the files was poor and the relevant information was difficult to access. We did discuss the need to reorganise the files and to sift out any information that had been updated or was not needed by the staff to inform service delivery to a separate file with the person who was in charge of the home at the time of the site visit. Fourteen surveys were completed and returned to us by the people who live at Fairfield House. Twelve of the completed surveys told us that people could do what they wanted in the evening and thirteen said that could do what they wanted at weekends. Only seven said that they could do what they wanted during the day, but this is probably because they have to attend lessons at college. We spoke with three of the students who do not live in the main building. Each of the students received one to one care when they are at home during the day and evening. One of them told us that he did make decisions for himself about most aspects of his daily living and this was confirmed by the staff. We saw that the people who live at the home were free to do as they pleased in their free time. The staff said that people were usually asked to be in their bedrooms by 9.30pm but that they were not expected to go to bed until 11pm. We were told that the reason for this is that people have to get up reasonably early because they have to go to college. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The students are able to make choices about their lifestyles. Evidence: All of the people who live at Fairfield House are students at Oakwood Court College and attend classes on weekdays and return to their family homes during the college vacations. Most of the fourteen surveys that had been completed and returned to us by the students told us that people can do what they want during the evening and at weekends. Fairfield House is very well equipped with facilities to enable the people who live there to occupy themselves in their free time. There is a games room, with table football, a pool table, computers and a cupboard full of games. In the lounge there is a Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: television, video, DVD, books and a Wii console. There is a piano in the entrance hall, for students who want to play it. Student meetings are held on Sundays and these give people the opportunity to plan meals and put forward ideas about what they would like to do and where they would like to go. One of the students, who has one to one support, told us that he could go out when he chose to and that he liked to go out for a drink or to a disco. There are a number of social clubs nearby which are popular with the students. Oakwood Court College also organise extra curriculum social activities and on the evening of the first day of the site visit the students had attended their end of term prom. We were told that this had been an outstanding success, which was enjoyed by all. Some of the staff who completed and returned surveys to us said that the staffing levels were a little low and that this was having an impact of their ability to accompany the residents on outings. The person in charge at the time of the site visit confirmed that the main house had been short staffed on occasions and said that adverts had been placed to recruit more staff. Because most of the people who live at Fairfield House spend their vacations at their family home good links are maintained between the home and college, and the students families. Families and friends are welcome to visit. The students are able to choose and help to prepare their breakfasts and have their main meal of the day, which is lunch, at the college on weekdays. At the time of the last inspection each of the students were helped to do their own food shopping and prepare their evening meal. This helped them to develop their life skills. This has changed and a communal evening meal is now prepared by a member of staff and two students on a rota basis. On the second day of the site visit day of the site visit a member of staff was seen preparing pizza, which was one of the meal that had been chosen by the students at their Sunday meeting, one student was assisting but not for long. One of the people who does not live in the main house cooks his own meals and three people who live at The Cottage share a communal meal, which was steak and salad. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information about peoples individual health and personal care needs is recorded. The management of medication is poor and this could put people at risk. Evidence: Fairfield House is mainly used to provide accommodation and care for students who are in their first year of at the college or for students who are in their second and third year at the college and need a higher level of support then people who live on the college site or in supported living accommodation. The main house can accommodate up to fourteen people, but people who need extra care or may find it difficult to cope in a busy home environment can be accommodated in The Cottage, which is a self contained home for three people who need one to one support, or in a self contained flat one bedroom flat above the garage. All of the students are registered with a local GP but as the majority of them only spend thirty-eight weeks at the college, most people visit their own dentist and optician so that arrangements can be made for check ups and treatment during the college holidays. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: The AQAA tells us that annual health checks are carried out for all of the students by a professional nurse at the college. The staff at the home monitor the mental and physical wellbeing of the students through daily contact with them and arrangements will be made for them to receive professional healthcare support as and when necessary. The AQAA tells us that all of the people who live at Fairfield House have learning disabilities. Three people also have mental health needs and one has a physical disability. Six have impaired vision and four have specialist communication needs. In their individual assessments, the nature of the physical, emotional, social and psychological difficulties that the people using the service may experience in their daily lives is recorded in detail. This should enable the staff to gain a good understanding of their often complex needs, however, as previously stated, the information that needs to be accessed by the staff could be better organised to make it more accessible to them. None of the people who use the service manage their own medication. We were told that this is company policy and that individual risk assessments had not been carried out to assess the level of support that each of the residents would need to manage their own medication. The medication is stored in a locked cupboard in the office. Blister packs are not used, which would make it easier for the management to check that medicines are being given as prescribed. We looked at the medication administration records sheets and found them to be unclear and to contain a number of gaps, where the records had not been initialled to show that the medicine had been given as prescribed and the coding system had not been used to tell us that it had not been administered and why. The medicine that people take at lunchtime is administered at the college. Some of the records had not been initialled which indicates that the record sheets, which should be signed as the medication is seen being taken, may not have been taken to the college with the medicines. One item of medication, Eflalex, had not been given to a resident for three days because the supplies kept at the home had run out. This is not acceptable as repeat prescriptions should be ordered well in advance of any item of medicine running out. One item of prescribed medication was recorded as being needed as and when Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: necessary (PRN) in the record book but the pharmacy label did not say that it was to be taken on a PRN basis. There was no evidence to show that any checks had been made with the residents GP to indicate that this medication did not need to be taken as prescribed. Some of the residents had brought and are using medicines that have been brought over the counter, such as hay fever, vitamin supplement and pain killing tablets. These could and should be prescribed by their GP. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and their representatives are able to voice any complaints or concerns that they have about the service and these will be taken seriously and dealt with appropriately. The adults and child safeguarding procedures and practices protect the residents from the threat of abuse. Evidence: The complaints procedure is included in an easy read format in the Students Handbook and all of the residents are given a copy of this document. Although only eight of the fourteen residents that completed and returned a survey to us said that they would know how to make a complaint, twelve of them said that they would know who to talk to if they were not happy. The responses indicated that the students knew that if they were unhappy they could talk to the staff at the home, the college staff or their parents. The complaints procedure is not displayed in the home and it is suggested that it is displayed in an easy read pictorial format to remind people that if they are not happy with the care provided at Fairfield House they can talk to the manager, their key worker or any other member of staff at the home, someone at the college, their parents or their social service or care trust case worker. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: We also used surveys to ask the staff if they knew how to deal with a complaint or a concern that had been made by a resident, relative, advocate or friend. Eleven out of the thirteen people who responded said that they would know what to do. Two said that they would not know what to do so additional training may be needed. During the site visit we looked at the record of complaints made since our last visit to the home. Five complaints had been recorded, all of them had been made by students and all of them had been dealt with appropriately. The AQAA tells us that all staff have received or will be receiving updated Child Protection and Safeguarding Adults Training to supplement the training that they have already received. Policies and procedures are available at the home, including a Whistle Blowing policy, to ensure that the staff have access to the information they need to enable them to raise genuine concerns about the residents without fear of reprisal should they feel they need to. Since the last inspection two Safeguarding referrals have been made and these have both been investigated by a multi agency team chaired by the local Care Trust. In both cases the registered providers have been fully involved in the proceedings and have worked well with us and the other agencies to reach satisfactory conclusions. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With the addition of the self contained cottage and flat, Fairfield House is able to provide a suitable and comfortable home for people with a diversity of needs. Evidence: Fairfield House can a little difficult to find if you have not visited the home before as it is situated in the rural outskirts of Dawlish and approached through narrow country lanes. It is with approximately a mile away from the town, beach, railway station and Oakwood Court College. The main house is a period mansion which has been redecorated, both inside and out since we visited a year ago. The house has a well landscaped garden which is very private as it is surrounded by fields and woodland. There is a large car parking area to the front of the house for staff, visitors and the college minibus. Fairfield House is registered to provide accommodation and care for up to seventeen people. Up to fourteen people can be accommodated at the main house. A further three people can be accommodated at The Cottage, which is a self contained home for up to three people and one person can be accommodated an a self contained flat above the garage. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The main house has a large entrance hall which contains a piano and a computer, this allow it to be used as additional communal space. The lounge is large, attractively decorated and comfortably furnished. It has a large screen television, DVD, video recorder, music centre and a Wii console. The room also contains plenty of books for people to read. Off the lounge there is a games room with computers, a pool table, darts board and table football for people to use. There is also a large cupboard containing lots of board games. The dining room is accessed from the kitchen, which is accessible to and used by the residents, and the hallway. This room is again nicely decorated and furnished. We had a look at some of the bedrooms, all of which are single rooms, and saw that had been personalised by the people who use the rooms. Each room was suitably furnished and reasonably well decorated. The students are given keys to their bedrooms, although not all of them choose to use them. The bathroom, shower and toilet facilities were all seen to be adequate for the needs of the people who use the service. In our last report we stated that the staff sleeping in room was not fit for purpose and that the staff were choosing to sleep in the residents lounge instead. This room has not received the attention it needs to make it habitable but as additional accommodation has been provided through the development of the flat above the garage, a spare bedroom is being used by staff sleeping in. We were told that this arrangement is better for the staff and for the students as the old sleeping in room is in the attic and this one is closer to the residents bedrooms. The person who lives in the flat showed us around his home. He told us that he was a final year student and that he was currently looking at property close to his mums home to move into when he leaves college. The flat is small, but very well suited to the needs of the person who lives there. We also visited The Cottage and spoke with the staff and two of the people who live there. One person showed us his bedroom, which clearly reflected his love of football. The Cottage has a kitchen, dining room and lounge and a small private garden. A housekeeper is employed to do most of the housework but the students are encouraged to keep their own bedrooms clean and to keep the communal areas tidy. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: One of the people we met in the cottage likes housework and is helped to do as much or as little as he likes. We noted that some of the radiators had not been covered and this could place some people at risk of scalding themselves. The laundry facilities are in the main house and are assessable to the residents, who are encouraged to do their own washing, with as much or as little help as they need. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The planned increase in training opportunities, higher staffing levels and better communication between the management and staff should lead to an increase in staff morale which will benefit the people who use the service. Evidence: A change of the ownership and management of Fairfield House has led to a number of changes being made to the way the home is managed. Some of the staff who completed and returned surveys to us told us that communication between the company and the staff was sometimes poor and that this was having a negative impact on staff morale. This was discussed with the person in charge at the time of the site visit and she confirmed that communication could be improved. The staff surveys also told us that the home is often understaffed in the evenings and at weekends and that this was limiting the amount of time that they could work with individual residents on a one to one basis and their ability to go out with the residents, most of whom need to be escorted. Again we discussed this with the person in charge and she confirmed that staffing levels were sometimes low but said that the home was trying to recruit new staff to enable the staffing levels to be raised. The provision of staff training had also been raised as an issue of concern in the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: surveys but this situation does seem to have improved and staff we spoke with during the inspection said that they were attending relevant training courses. The person in charge acknowledged that training had been an issue of concern but said that an audit of training needs and achievements had been carried out, a new induction training programme was being introduced and that a programme of on-going training was being developed to ensure that all of the staff received training that covers the basic health and safety related requirements and specialist areas such as epilepsy, diabetes and working with people with Autism. It is suggested that as several of the people who use the service experience some difficulties communicating verbally, that all the staff are offered training in Maketon. The AQAA tells us that only seven of the nineteen people employed to work at the home have completed a National Vocational Qualification in Care at Level 2 or above. We were, however told that the Company is planning to arrange for some of the staff to complete the NVQ Assessors Award so that they can help more of the people who work at the home gain an NVQ and that a long term aim was to help and encourage all of the care staff to achieve a National Vocational Qualification in Care at Level 3. The AQAA tells us that a programme of staff appraisals is being introduced. We saw records of one to one supervision in staff files. During the site visit we looked at some of the staff recruitment files and these showed us that safe practices are being used to recruit new staff. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The changes taking place should bring long term improvements to the management of the home. Evidence: There is currently no registered manager in post although we were told that an experienced residential manager had been appointed and would shortly be submitting an application to be registered. The duties of a manager are currently being carried out by a residential support coordinator and the vice principle of care. The people who use the service have weekly meetings to ensure that they can have their say about how the home should be run on a day to day basis. We saw minutes of these meetings which showed that menu plans and activities are discussed. We were told that the people who use the service are also involved in the recruitment of new staff to work with them. Quality questionnaires and surveys are being used to gain feedback on the quality of the service provided for the people who use the service. These are being sent to the Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: residents, their parents or carers and relevant professional people. The people who use the service and their families are involved in developing their plan of care and reviews. The Annual Quality Assurance Assessment tells us that most of the required and recommended policies, procedures and codes of practice are in place. We understand that these will be reviewed by the new management team and that any missing policies will be written up as part of the review. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered providers 14/08/2009 must ensure that medication kept at the home and administered by the staff is handled safely. This is to reduce the risk of errors being made that could put people at risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The working care planning files need to be reorganised so that the staff have easy access to the information they need to tailor the service to meet peoples individual needs. Display the complaints procedure in an easy read, pictorial format in the home. All radiators should be covered to ensure that none of the people living at the home can scald themselves on them. At least fifty percent of the care staff should hold a National Vocational Qualification at level 2 or above. Staffing levels should be raised to a level that is high enough to meet peoples individual and collective wishes Page 30 of 32 2 3 4 5 22 29 32 33 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and needs. 6 35 The plans to improve induction and on going training, covering specialist areas as well as health and safety related topics should continue to be put into place. Better communication measures need to be put into place to ensure that the staff feel better informed and feel that they are being consulted on the changes that are being implemented. The person responsible for the day to day management of Fairfield House should be registered. 7 36 8 37 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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