Inspection on 16/02/09 for Fairfield Manor

This inspection was carried out on 16th February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fairfield Manor 10/02/10

Fairfield Manor 25/09/07

Fairfield Manor 20/02/07

Fairfield Manor 20/01/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JU Lead Inspector Mary Cochrane Unannounced Inspection 16th February 2009 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairfield Manor DS0000065787.V374204.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfield Manor Address Fairfield Road Broadstairs Kent CT10 2JU 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) 01843 860715 01843 868516 fairfieldmanor@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Manager post vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 36. Date of last inspection 25th September 2007 Brief Description of the Service: Fairfield Manor Nursing Home is situated in a residential area on the outskirts of Broadstairs, approximately one mile from the nearest shops and other amenities. It is owned by Southern Cross Healthcare, who are well known as providers for many nursing and personal care homes. It is adjacent to another care home (Woodlands), which is owned and run by the same company. There is ample car parking at the front of the building and garden areas where service users can sit out in good weather. Fairfield is an old manor house, which is not ideal for meeting nursing needs, as many corridors are rather narrow for wheelchair users. However, some adaptations have been made, and include a passenger lift, which provides access to all floors. Ramps are in place to facilitate wheelchair users. Accommodation for residents is provided on three floors and comprises rooms for single use only. Thirty rooms have en-suite facilities. The lower ground floor is used only for staff, and includes the kitchens. The building includes a five bedroom flat which is let to staff. These facilities are entirely separate, so that they do not encroach on residents’ facilities. Fees range from £500.03 to £743.04 per week, depending on the need for residential or nursing care, and taking into account residents’ dependency levels. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 5 Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The last inspection on this service was completed on 25th September 2007. This visit to the service was an unannounced Key Inspection which took place over one day. The manager was available throughout the day. We also spent time with qualified nurse on duty and the area manager. The people living at the home and the staff on duty were helpful and cooperative throughout the visit. The visit included talking with people living in the home and the care staff. General observations were made during the day of how people are supported. We had a look around the home and various records were inspected. We observed how staff supported residents during the day and when offering care. We looked at and discussed residents individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff training records and the homes quality assurance. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also looked at information we have about concerns and complaints and how these have been managed. We also took into account the things that have happened in the service, these are called ‘notifications’ and are a legal requirement. What the service does well: People who wish to stay at the home have access to information, which tells them about the service and the care they will receive if they decide to live at Fairfield Manor. The manager and the clinical lead who is a nurse make sure that peoples needs have been fully assessed before they come to stay. This will ensure that the service can give them the support and care they need. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 7 Health professionals and specialist services are contacted promptly if there are any concerns about a person. The nurses make sure that people receive their medication safely and on time. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. Any complaints or concerns are taken seriously and acted on promptly. People living at the home told us they feel safe. Each of the residents have their own room. If people want to they can bring their personalised belongings to help them feel more comfortable and at home. Since the last inspection we have received some complaints about the home and there has also been a safe guarding vulnerable adults alert at the home. This means that a complaint made about the home was looked at by the local social services safe guarding adults’ team. The management of the home responded positively and have been pro-active in dealing with the issues. The alert has now been closed and complaints have been investigated and the appropriate actions taken. The company have provided the staff with the necessary training to do their jobs and staff receive regular supervision. Staff recruitment procedures are robust and protect the people living at the home. What has improved since the last inspection? What they could do better: The manager needs to make sure that all the personal care needs of the residents are met. We found that the care staff team are not adhering to Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 8 procedures with regards making sure that all people are receiving the personal care that they need. People are not being offered sufficient choice about how they would like to live their lives. People are not asked whether they would like a bath or shower, or how they would like to spend their time. A record needs to be kept of the amount of food people are eating so any problems can be quickly highlighted and the appropriate action taken. The manager needs to check the competency and abilities of the staff to make sure that have the necessary skills, abilities and attitudes to look after people in the best possible way. The home needs to provide more accessible space so people can eat their meals in a comfortable and conducive environment. We found that there were strong unpleasant odours in 3 areas of the home. These need to be addressed to make sure that all the residents live in a pleasant and fresh environment. There are still bathrooms at the home that are not usable. The home needs to have robust procedures in place to make sure that the home is being effectively managed with regards it being registered as a nursing home. Quality assurance systems need further developing to make sure the people living at the home and stakeholders views impact on the improvement and development of the service. 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. The summary of this inspection report can be made available in other formats on request. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 People who use the service experience good quality outcomes in this area. The home provides information about the service for prospective residents. Prospective residents can be confident that their needs will be assessed, and that they will not be admitted unless the home can meet these needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the homes statement of purpose and service users guide. These documents have not been updated to let people know that the home has a new manager in post. They should include the information that the manager will receive support from a staff member who is a qualified nurse before any clinical decisions are made at the service. We were told that these documents Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 11 will be updated. When we spoke to residents, relatives and staff they were aware of some of the changes. All prospective residents are assessed prior to coming to stay at the home and joint assessments are obtained from care managers if there is one. The manager and the clinical lead visit prospective residents in their own home, in hospital, or in their existing placement to carry out a pre admission assessment. The assessment covers the prospective residents physical and mental health, personal care, and cultural and religious needs. The manager told us the assessment continues after the person arrives at the home so they can get a better picture of their needs The home will not accept any resident unless they are confident that they can meet their assessed needs. The home does not offer intermediate care Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8.9 and 10. People who use the service experience good quality outcomes in this area. Residents have an individual plan of care. They cannot always be sure it will be used to effectively meet all their personal needs. Health care needs are met by the home. People can be sure they will receive their prescribed medication on time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were looked at during the visit and some shortfalls were identified in different areas of the care planning system. Each person living at the home has a care plan. We found that it was difficult to find some information in the plans and they did not flow. This meant that it Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 13 was difficult to follow and trail that people are receiving the care that they need in the way that best suits them. On the whole the plans did address most of the needs that were identified during the initial assessments, but some support needs had been overlooked. One person had been assessed as having some mental health needs but there was nothing written to tell staff how these would be recognised and what to do if they were. Another person was identified at being at risk of choking when they ate but there was no risk assessment in place to guide staff on how best to prevent this happening and what to do if it did. The staff we spoke to were able to verbalise what they would do. There are some risk assessments in place. These need to be further developed and more individualised to make sure each person is receiving all the support and care they need in the safest possible way. This will make sure all risks have been identified and kept to a minimum. Nutritional assessments were in place which identified some peoples dietary intake would need to be closely monitored. But there was no plan in place to show that this was being done. At the time of the visit the service was not recording the dietary intake of the residents living at the home. Therefore we cannot be sure people are receiving an adequate diet nor can we be sure that any dietary issues or concerns are quickly highlighted and dealt with. We did see that people are being weighed at regular intervals. Plans are being reviewed monthly and then updated to reflect any changes made to care. Daily records are kept but they do not give a clear picture about how residents spent their time and do not relate to the individual care plans. They are task orientated. The manager and qualified nurse on duty told us that they had made a start in developing more person centred planning and we saw one plan that had been started. We spoke to other professionals who had visited the home and they reported that there had been some improvements in the care and support planning. The service does have a tick chart system which care staff use to evidence that personal care has been delivered. We found that some personal care needs had not been met. We found that although all the residents had been assisted to wash and were clean a lot of people had not received a bath or showers for a long period of time. Most people were having bed baths or strip washes. There was no evidence to say that they had been offered alternatives to this and this is what they had chosen. We also found that some people had not had their finger nails cut or cleaned. A requirement has been made with regards the personal care of the residents. These issues will be discussed later on in the report under ‘staffing’. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 14 The home does need to develop a more person centred approach to care. Key working needs to be developed and promoted. At present care needs are met in a task orientated way. Plans focused on what residents could not do instead of promoting independence and self- esteem. The service does make sure that all the health care needs of the residents are met. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. There was evidence of GP visits and also visits by the specialist services. The residents have regular appointments with opticians, a chiropodist and dentists. There is good planning with regards the ‘nursing’ aspects of peoples care. Ongoing assessments include moving and handling assessments, continence assessments, nutritional assessments and falls risk assessments. There was clear direction in place with regards epilepsy, diabetes and pressure areas. Medication is stored safely at the home, only trained nurses administer medicines. A sample of prescription sheets was seen. All prescriptions sheets had been signed to indicate that residents had received their medication on time. Robust policies and procedures are in place. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. Controlled drugs are disposed according to legal requirements. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a when required basis. There is no written instructions and guidance for staff to make sure that the medication is administered consistently and the effects monitored. Staff do sign when they have applied topical creams. We saw that some creams were left out in people’s rooms. This is not safe practise. Through observation and from talking to the residents and staff there was evidence to show that privacy and dignity is up-held. Residents are well dressed in clothing appropriate for the season. We did find that the manger had sent a memo to say that residents should wear tights or socks. On the day of the inspection a lot of people were not wearing tights or socks. The manager said she would address this. The majority of staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good quality outcomes in this area. The home does provide the residents with some opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an activities organiser working at the home 20 hours per week. He oversees a two-weekly activities plan, which includes in-house activities such as videos, mobile shop, bingo and quizzes; entertainment twice per month (singers etc). He also told us that he does one to one work with people who do not wish to come to the communal areas. We saw some activities taking place during our visit and people were joining in with support from staff. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 16 The manager told us that they are in the process of employing another person to do a further 20 hours of activities a week. She also told us that now the weather is improving they will be planning more trips out. The home keeps record of the activities they have done. They record in individual’s files whether of not they participated. One lady told us, ‘there are things to do if you want to’. Another said ‘I would like to go out more’. Visitors are welcome within the home at all reasonable times and no restrictions are imposed. Residents are able to see their visitors in the privacy of their own rooms or in the communal areas. The staff were observed making visitors welcome and involved. The new manager has already had a relatives meeting which was positive. She told us she will be acting on suggestions made at the meeting. One person said, They are all very kind and helpful. They make you feel welcome. The people we spoke to felt they are able to have some limited choice in regards to their day-to-day lives. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. The home does need to evidence and demonstrate more how it offers more diverse choices to people so they are encouraging them to be independent and in control of their lives. Residents are encouraged to bring their own personal possessions into the home. The majority of residents reported that they receive the care and support they need from the staff and they are treated well. One person told us ‘the staff will do anything for you, I feel safe with them”. The daily menu is displayed in the home. We were told that the home offers three meals a day with drinks and snacks available at any time. People are offered a choice of meals and the residents told us the food is good and there is plenty to eat. Likes and dislikes are recorded in peoples care plans. We observed a lunch time meal. We were told that people are asked if they want the main menu and if they do not alternatives are offered. The meals are nutritious varied and well presented. The dining area has recently been moved from the lower ground floor to a room on the ground floor. This room is very cramped and cluttered and we saw that people in wheel chairs have difficulty accessing some of the tables. The manager and area manager said they would be looking at how to address this Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 17 issue. We also saw that some people were left in their wheel-chairs to eat their meals instead of being offered a dining room chair to sit on. The manager told us that this was not common practise. A recommendation has been made to address this issue. People can chose were they want to eat their meals. Some people prefer to eat in their rooms and others in the lounge. We did see that staff offered respectful and discreet assistance to those people who needed it. There are no records kept of meals eaten or not eaten by residents. The manager said she would rectify this. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. The people who use the service are confident complaints will be listened to and dealt with appropriately. Arrangements in place to ensure that the people who use the service are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available within the home. Some of the residents we spoke to were able to tell us what they would do if they wanted to make a complaint. They said that they felt the manager would listen to them and act on what they said. There have been complaints made about the service since the last inspection some of which have been made via the commission. The service have dealt with these according to the homes policies and procedures. We were able to Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 19 see how the complaints were managed and the outcomes that were reached. Practices within the home had changed as a result of 1 of the complaints. This shows that people are being listened to and their complaints taken seriously One of the complaints led to a safe guarding vulnerable adult’s alert being raised. This means that the complaint was looked at by the local social services safe guarding adults’ team. This was dealt with through safe guarding procedures and the alert has been closed. The service has been active in dealing with the alert. All staff have received training in safe guarding vulnerable adults. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. Residents are encouraged and supported to look after there own finances and there are systems in place to make sure that monies and other valuables are safely kept. The service does need to make sure that the residents can access their money whenever they want to. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 People who use the service experience adequate quality outcomes in this area. There have been some improvements made to the premises since the last key inspection. It is important that the ongoing programme of redecoration and refurbishment continues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked around some areas of the home. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 21 The home is working towards meeting the requirements identified at the last inspection, however there is still a way to go. The manager told us they have maintenance and renewal plan but this is kept by the maintenance person who was on holiday at the time of the visit. A copy of this should be available at the home. New carpets have been put in the hallway and lounge area and some decoration has taken place. The second lift at the home has been repaired. Some beds have been replaced. The home has four bathroom/shower rooms. One of the bathrooms is out of use as it is unsuitable and in a poor condition. This was highlighted at the last report but so far no progress has been made. The area manager told us they are looking at ways make this bathroom into a usable facility. There is a usable ground floor shower/wet room. The bathroom on the first floor was in the process of having worked completed and was not being used. The second floor has a bathroom with a Parker bath. This room is also in need of refurbishment, but is currently functional. The recommended number of bathrooms is one for every eight residents. A requirement has been made that the services provides enough bathroom facilities for the number of people living at the home. As mentioned earlier in the report people are not receiving showers or baths regularly. The bathrooms are under used. As previously mentioned the dining room is very cramped and cluttered. Residents were sat at dining tables in wheel chairs. There was no room to move freely. People have the necessary aids and equipment to assist them in maximising their abilities and improving their comfort and health. These including pressure relieving equipment, specialist chairs, walking frames and wheel chairs. The service told us that the kitchen and laundry rooms are suitable for purpose with adequate equipment in place. Residents said that the laundry service was good and they had no complaints. The service has policies and procedures in place to make sure that soiled laundry is transported correctly. Staff have received infection control training, however on the day of the inspection we observed staff putting clean laundry over the side of a container with soiled laundry. The manager did address this immediately. There is a sluice room on the ground floor. Policies and procedures are in for the safe handling and disposal of clinical waste, dealing with spillages and provision of protection clothing. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 22 Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate quality outcomes in this area. There are enough staff on duty to look after the residents. Staff are receiving training but there are shortfalls in competencies of the staff team. These need to be monitored and checked to make sure staff are meeting the needs of the resident’s. Recruitment practises protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit there were 28 people living at the home. We looked at the duty rota and saw that there are usually 2 registered nurses and 4 to 5 carers on duty throughout the day and one registered nurse and 2 carers at night. There is usually only 1 nurse at weekends, as the home is not so busy. This situation must be kept under review to make sure that the Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 24 nursing needs of the residents can be meet in a timely manner at all times. An activities person works 20 hours per week. There are also 2 cleaners, 1 cook and assistant and maintenance man on duty. We were told that this level of staff is enough to meet the needs of the residents. The people that we spoke to said that staff are good and when they usually do not have to wait too long if they ring for assistance. One lady said “they come as quickly as they can”. The residents told us that the majority of staff are very kind and thoughtful. The staff reported that they work well together as a team. Staff are flexible and told us they will cover extra shifts when there is a shortage. We saw that some staff are working at lot of hours to make sure the duty rota is covered. Staff told us they were happy to do this. We discussed the safety aspects of this with the manager. She told us they are in the process of recruiting 6 new carers and 1 qualified staff member. She said that this situation would be resolved within the next few weeks. The home works closely with the companies other nursing home which next door. The home has an NVQ programme for care staff and the service told us that they have over 50 of care staff who have NVQ level 2. The home has a training matrix and the majority of staff are up to date with mandatory training. Training has been planned to make sure any gaps are filled. Training is on-going. Registered nurses do the training required by them to make sure they can reapply for their registration. There is extra training in wound care, dementia, continence and medication. All new staff do have an induction programme in place this is done over a 3 month period. The induction is linked to Skills for Care. We did observe that although staff are receiving the necessary training they are not putting into practise what they have learnt and are not following the company’s procedures. We found that some staff were not signing in for duty, so it was difficult to see how many people where working in the home. We saw that some staff were breeching infection control procedures and were risking contaminating clean linen. We saw that some aspects of people’s personal care were not being met in the way that it should. These shortfalls were pointed out to the manager. She needs to make sure that staff are doing adhering to procedures and meeting all the needs of the residents. We looked at 3 staff files including those of more recently employed staff. We saw that the home has thorough recruitment practices. Files contained all the necessary information and safety checks to ensure that the residents are Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 25 protected. There was evidence of POVA and CRB checks, two written references and proof of identity. Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. People who use the service experience good quality outcomes in this area. The new manager is aware of the shortfalls with in the home. There are quality assurance systems in place to improve the service and for auditing and recording purposes. The health, safety and welfare of the service users is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 27 The manager had only been at the home for 3 weeks when we carried out the inspection. She has been the registered manager of a residential home before she came to work at Fairfield Manor and she has an NVQ4 and Registered Manager’s award. Fairfield Manor is registered to provide care for people with nursing needs and the new manager does not have a nursing qualification. Therefore the company must make sure they follow the guidance for appointing a manager to a nursing home who is not a nurse. There needs to be an appointed person working at the home as a clinical lead to make sure that all the peoples nursing needs have been identified and met from the time of the initial assessment. At the time of the visit someone was undertaking this role on a part-time basis, but this does need to be developed and extended. The new manager also needs to apply to the commission for registration as soon as possible. The home only deals with resident’s pocket money, and only stores small amounts. There are systems in place to make sure the residents monies is managed safely and people get the help that they need with their finances. . The manager is supported on a regular basis by the area manager of the company. We saw that some monthly checks had been done by the area manager but some had been missed. The area manger told us she would address this shortfall The Company has a quality assurance programme in place but it has been over a year since the questionnaires were sent to residents, relatives and other people who have an interest in the service. Regular audits are done to ensure that standards are maintained and with the aim to identify shortfalls. The results of questionnaires and audits should be collated so that the strengths and weaknesses of the service can be identified. The results of the survey then need to be published and made available to the people who are involved and use the service. The people who use the service and staff have regular meetings and some staff supervision has taken place. Staff told us they had received supervision and we also saw that staff received immediate supervision if any shortfall was identified in their practise. A maintenance person is employed and he ensures that all fire safety and health and safety checks are carried out in a timely manner. We found a fire assessments had been done for the home. We also looked at the fire equipment checks. These had been done up to the week before the inspection when one had been missed. We were told that this was because the Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 28 maintenance man was on holiday. The manager needs to make sure that checks are covered when people are away. Water temperatures are taken at regular intervals. The manager does inform us any unusual events that adversely affect the residents. The home provides a safe environment for people to live in and staff to work in. The home has informed us in the AQAA that other safety and maintenance checks of equipment are up to date. . Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 12 Requirement The service needs to make sure all personal care needs of the residents are monitored and met. To ensure that the home provides sufficient numbers of bathing and shower facilities for the numbers of residents in the home. The service needs to make sure that staff have the competency to undertake the task they have been asked to do. Timescale for action 31/03/09 2. OP21 23 (2) (j) 30/04/09 3 OP30 18(1)(a) 30/04/09 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 OP8 OP14 Good Practice Recommendations There needs to be a record kept of food eaten or not eaten by residents. To make sure people are offered a choice about how they live. DS0000065787.V374204.R01.S.doc Version 5.2 Page 31 Fairfield Manor 3. 4. OP15 OP19 To make sure that dining area has enough space for people to eat there meals comfortably and that they are offered a dining room chair at meal times. To have access to a copy of the maintenance programme and to continue with the programme for refurbishing the home To complete the programme for refurbishing the second floor bathroom; and to make the unused first floor bathroom into a useable facility. To make sure the home is free from any offensive odours. To keep the number of nurses employed at weekend mornings is kept review The service need to demonstrate and evidence that the home is being effectively managed to meet the conditions of its registration. To continue to develop quality assurance systems to ensure that the service continues to improve and achieve its aims and objective. 5. OP21 6. 7. 8. 9. OP26 OP27 OP31 OP33 Fairfield Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Manor DS0000065787.V374204.R01.S.doc Version 5.2 Page 33 - 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. 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