Inspection on 20/02/07 for Fairfield Manor

This inspection was carried out on 20th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 16/02/09

Fairfield Manor 25/09/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JU Lead Inspector Mrs Susan Hall Key Unannounced Inspection 20th February 2007 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.V315054.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.V315054.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 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Post Vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability over 65 years of age (3) of places Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 36 beds 26 are registered for nursing patients and 10 for residential clients. All residential clients must be aged 65 years and over. Date of last inspection 20th January 2006 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 purchased the previous company (Ashbourne) during the past year. 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 fine 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 service users is provided on three floors (ground, first and second), 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 service users’ facilities. Fees for service users range from £469.98 - £661.98 per week, depending on their assessed needs. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection, which included assessing information obtained since the last inspection in January 2006. The home was purchased by Southern Cross Healthcare in April 2006, and a decrease in the number of beds was agreed, changing the registration from 40 to 36 beds. The company appointed a new manager during 2006, who has not yet been registered with CSCI. The Inspector amalgamated information including notifications about accidents and incidents, and letters regarding changes and complaints. CSCI has received two complaints since the last inspection, and one of these is still being investigated. The site visit lasted for eight and a half hours, during which time the Inspector had meaningful conversations with five service users, and observed staff interacting with other service users. She also talked with five relatives and seven staff members, as well as the manager. Most of the National Minimum Standards were assessed, using information gained prior to the inspection, as well as the visit on the day. The Inspector examined a variety of documentation, (including care plans, servicing records, staff files and medication charts); and viewed most rooms in the home. Service users said that the staff were kind and caring, and were mostly content with their standard of care. Comments included “they look after me well”; “I like it here”; “everyone is always very friendly”; and “the staff work hard”. However service users, staff and relatives all expressed their concerns that “there are not enough staff”. This was expressed in nearly every conversation. Other concerns were voiced about the toilet and bathroom facilities, which were felt by some to be insufficient. Most thought that the food was satisfactory, and others said that they liked their rooms, and enjoyed the activities and outings. What the service does well: The staff work well together as a team, and have caring and respectful attitudes. They provide a friendly and pleasant atmosphere in the home, and are committed to carrying out good standards of care. The home’s activities co-ordinator oversees a two weekly programme of activities which includes visiting entertainers as well as in-house activities. When the weather is reasonable, regular outings are arranged to pubs, the seaside, and nearby towns, as well as drives in the countryside. These are much appreciated. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 6 There is good opportunity for feedback and discussion, as the manager has an open door policy, and is a visible presence in the home. Relatives and residents’ meetings are held on a monthly basis, and the minutes of these are available to view. Survey forms are provided at least yearly, and the results are publicised on the home’s notice board. What has improved since the last inspection? What they could do better: The Inspector was concerned about the low levels of staffing, particularly for nursing and care staff, but also for maintenance and domestic staff. Levels of care staff had been consistently low for some time (according to staff rotas, and corroboration from staff and service users). The Inspector gave an immediate requirement for this matter to be addressed, notifying the manager and senior management before leaving the home. She received a response within two days, which included contingency plans for a supply of agency staff, while more care staff are recruited. The inspector also voiced her concern that medication is not being given at the prescribed times, due to the length of the medication rounds. This needs to be reviewed in regards to numbers of nursing staff available. The building has four floors, and is quite spread out. Only two domestic staff are employed from Mondays to Fridays, and only one at weekends. The building was a credit to their hard work to keep it clean, but additional domestic staff are needed to carry out cleaning jobs such as cleaning behind beds, lampshades, skirting boards etc. The building requires extensive refurbishment in many areas. These include: Redecoration and refurbishment for many bedrooms, corridors, toilet and bathroom facilities. Much of the bedroom furniture is in poor condition, and needs replacing. Many carpets are old, worn and stained, and need replacing. More nursing beds are needed in place of divan beds. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 7 Hot pipes in bedrooms and corridors should be risk assessed, and then covered or boxed in for safety. Risk assessments will show which are the highest priority. The kitchen should be reassessed for the state of the walls and the fly screens, which are difficult to keep clean. The carpet in the clinical room is dangerously rucked, and is old and dirty. A clinical room should have flooring which can easily be cleaned, to meet infection control standards. The exterior paintwork of the building would be improved with repainting. Other matters for consideration are: More maintenance hours. Reassessing the numbers and quality of toilet and bathroom facilities. The possibility of repairing the second passenger lift, which has been boarded up. The controlled drugs cupboard is too small for the amount of medication for this number of service users. 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.V315054.R01.S.doc Version 5.2 Page 8 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.V315054.R01.S.doc Version 5.2 Page 9 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): 1-5 (standard 6 is not applicable in this home). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are provided with sufficient information to enable them to make an informed decision about staying in the home. The management need to ensure that service users with specialist needs are properly assessed, and not admitted to the home out of category. EVIDENCE: A copy of the Statement of Purpose and Service Users’ Guide are kept in the entrance hall and are easily available for viewing. The statement of purpose contained all the required information, including the details of the organisation, staffing, admissions procedures etc. A schedule of accommodation is included, and this had previously been the subject of a requirement. The complaints procedure was satisfactory, but the details for CSCI were inaccurate – still showing the Ashford office, which has been closed Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 10 since September 2006. The manager stated that she would ensure that this is changed, to include up to date information. The service users’ guide is well produced and easy to read, and contained the required information. However, the complaint procedure details again had the wrong information for the local CSCI office. No service users’ views were included either, and this is a missed opportunity to share service users’ comments about the home. Requirements given at the last CSCI inspection were displayed in the front entrance hall, but not the whole inspection report, which should be easily available for visitors to view. Service users (or next of kin if applicable), are given a contract on admission, and terms and conditions of residency. A copy is included in the service users’ guide. Terms and conditions of residency include relevant information such as: additional costs, visitors, religious services available, phone availability, getting up/going to bed as wanted, etc. The manager or deputy carry out a pre-admission assessment prior to agreeing admission. They also obtain joint assessments from hospitals/social services. Two pre-admission assessments were viewed, and these had been well completed with comprehensive information. The manager ensures that a draft care plan is drawn up prior to admission, and is amended accordingly after admission assessments have been completed. There were a number of service users with dementia, Alzheimers’ disease, and mental health needs. These had mostly been admitted prior to this manager’s appointment. The Inspector stressed the importance to the manager of only admitting service users that staff are trained to care for. The manager has a background of psychiatric nursing, but this is not sufficient for caring for service users in this category, as other nursing and care staff are not trained in this field, there are no RMN nurses, and the home is not registered for this category. The manager was being proactive in arranging reassessments for service users as necessary. Service users may be admitted as an emergency, and an initial care plan will be drawn up in the first 2 days. All service users have a trial period of 4 weeks, and either party can terminate the placement within 24 hours at this stage. A placement review is carried out within 6 weeks. Records of reviews are retained in the care plans. Service users may occasionally be admitted for respite care, but the home does not have a category of registration for rehabilitation or intermediate care, and so standard 6 is not applicable in this home. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 11 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): 7-11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health care needs are mostly met, but some care planning is incomplete. There is insufficient space in the CD cupboard for safe storage of controlled drugs; and medication administration is not given to all service users at the prescribed times. EVIDENCE: The inspector viewed three care plans in detail, and one additional care plan for wound care. Assessments and care plans had been well written, and were mostly completed up to date. These included detailed assessments for care needs such as: dependency, nutrition, continence, pressure ulcer risk assessment, moving and handling, weight recording, falls risk and general risk assessments. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 12 Care plans are reviewed monthly, and had sufficient details. For example, moving and handling care plans clearly stated if service users needed one or two care staff to assist them, if they needed a walking frame or hoist, and the type of hoist or sling to use. The Inspector noted that one plan did not have a specific care plan in place for a service user who had wounds, just a monthly assessment. However, another care plan had good wound evaluation, showing each wound separately, and with an evaluation for each dressing change. This plan also showed the dressings to be used. Another plan was identified as missing for a specific need, and this was discussed with the manager. Daily reports are written by the care staff who have carried out the personal care, and additional information is added by the nurse on duty. These records were sufficiently detailed. The care plans also include a tick chart, showing the details each day for personal care needs such as bath or shower, bed bath, denture care, shave etc. One plan stated that the service user liked a bath once per week, but had not had a bath since admission some weeks before. The manager said that she would find out the reason for this. Records of professional visits showed that there is suitable referral to other health professionals, such as GP, dentist, physiotherapist and speech and language therapist. The home has equipment available for pressure relief, and care plans clearly specified their use, and 2-3 hourly turns for pressure sore prevention. The Inspector identified quite a high number of accidents and incidents in the home over the last year, and specifically checked the risk assessments. Those viewed had good risk assessments in them. Staffing numbers had been consistently low, so service users may have been left unattended for long periods of time, and this could be a contributory factor to additional falls and accidents. The medication is stored in a large clinical room, which was rather untidy, and would benefit from sorting out. There was an old and damaged carpet on the clinical room floor, which was both unsafe, and unhygienic. This should be replaced with washable flooring for management of infection control. The home uses the “Boots” monitored dosage system, and medication was suitably stored in different cupboards, which were clean and in good order. There was no over stocking, and there was evidence of good stock rotation. The clinical room and drugs fridge temperatures are recorded daily. There are good systems in place for the receipt and disposal of medication. One nurse has the responsibility to oversee all the medication receipt, storage, administration and disposal. The Medication Administration Records (MAR charts) were inspected and had been well completed. No errors were evident. Handwritten entries are correctly signed by two staff. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 13 The Inspector was informed that medication rounds can take over two hours, and this is an area of concern, as it means that service users are not getting their prescribed medication at the correct times, and this needs to be addressed. Nurses have a special tabard to wear to remind care staff not to interrupt them when administering medication, but as there is only one nurse on duty, they have no one else to ask for advice. The controlled drugs cupboard appeared to meet the specifications for storage, but was too small for the amount of medication. There is a requirement to address this issue. Service users looked well groomed and appropriately dressed. The Inspector observed that care staff were assisting service users with a caring and gentle attitude, and were mindful of retaining service users’ privacy and dignity. Care plans included information where possible, about service users’ preferences if they are dying. Staff ensure that they can have visitors at any time, and try to ensure that they are kept as comfortable and pain free as possible. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 14 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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a good choice of activities, and opportunities to go out. Nutritional needs are being met. EVIDENCE: There is a 2-weekly programme of activities, overseen by an activities coordinator, who has worked at the home for several years. He works 4 days a week, and has implemented activities on his day off mid-week, and at weekends, which are easy for care staff to administer. The activities programme allows for some one-to-one time with service users who do not wish to join in with group activities. Group activities include videos, quizzes, bingo and music afternoons. The activities co-ordinator runs a weekly mobile shop for service users to purchase small items. Outside entertainers are booked once per fortnight. Outings are arranged every 2 –3 weeks. These are decreased or increased according to the time of the year and the weather, so although these times are included on the Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 15 programme, they cannot always take place at the specified times. Outings include drives in the country, visits to local pubs/restaurants, the sea front, and local towns/cities such as Canterbury and Herne Bay. The home uses a bus service called “Dial a Ride”, where the vehicles are fitted to include wheelchair users. Service users are accompanied by care staff and/or relatives. Service users and relatives have opportunity to discuss the activities programme at residents’/relatives meetings, which are held at the home every month. The manager had arranged for a cheese and wine party for the next occasion, to give some additional variety. Visitors are made welcome in the home, and can take part in activities, and stay/help at meal times if they wish. A church service is held in the home every month; and the manager will arrange for local clergy to visit if required. Service users’ rooms included lots of personal items – photographs, ornaments, books, pictures etc. Some choose to have their own television/radio, and individual phone lines can be arranged on request. Care plans included statements showing that service users’ preferences are taken into account, such as when they like to get up or go to bed, and what name they like to be called by. The kitchen is situated in the basement, and although not very large, has additional rooms for serving trolleys, food storage and freezer/fridge storage. The chef said that the Environmental Health Officer had visited in the past year, and had identified that the cooker hood needed to be replaced. This had not yet been done. The Inspector noted that large items of equipment such as the dishwasher, are set into the floor, making it very difficult to clean the floor underneath them and next to them. The walls and fly screens at the windows were badly stained, in spite of a regular cleaning programme. (This is further mentioned in the section on “Environment”). Most services users spoke highly of the food, saying there was sufficient choice, and that the cooking was good. Food served at lunchtime was seen to be of good quality and sufficient quantity. One relative stated that service users who need a soft diet are not always offered appropriate soft diets, but are given burgers or sausages which they cannot manage, and this information has been passed on to the manager. A record is retained of service users’ choices. Service users can have a cooked breakfast if they want. The chef and kitchen assistant commences duties at 07.30, and the chef will prepare cooked breakfasts if required. Care plans showed that service users have their weights recorded monthly, and have a nutritional assessment. This includes their BMI, and any specific information. Menus are drawn up by the chef, who also helps to serve out the meals. This enables him to build up a working knowledge of service users, and to get to know their specific preferences. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 16 Fridge and freezer temperatures are recorded daily. Food temperatures are checked at the end of cooking, and prior to serving. Van temperatures are checked for food deliveries. The chef said that the Environmental Health Officer had visited last year, and had recommended that he carry out further training for NVQ 2 or 3 in catering. This is in the process of being arranged by the company. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to voice their concerns and complaints, and know that they will be attended to. Adult protection training could be given a higher priority. EVIDENCE: Service users and relatives confirmed that they are able to voice any concerns with the manager or care staff. There are regular meetings, which service users, and relatives are invited to attend. The Inspector viewed the complaints record, which showed six complaints since the last inspection (over a year ago). One of these has been investigated by the home’s senior management, and is still under investigation by the CSCI Complaints team. The complaints log showed that complaints and concerns are taken seriously, and are appropriately investigated. The complaints procedure is on display, and is included in the statement of purpose and service users’ guide. It has already been highlighted in section 1 (Choice of Home) that the complaints procedure needs to be amended for CSCI details. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 18 Risk assessments are appropriately carried out for service users. Staff are trained in the recognition and prevention of abuse, but the training matrix did not demonstrate that all staff have received this training. There is a requirement to ensure all staff are trained in adult protection, and it is recommended that they have regular updates (e.g. yearly). Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 19 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): 19-26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The company need to consider how to address the many issues which make this an unsatisfactory environment for caring for service users. EVIDENCE: Fairfield is an old Manor House, which is not very easy for meeting nursing needs. Some corridors are quite narrow, and difficult for managing wheelchairs and hoists. There is currently one passenger lift in operation, which accesses all four floors (basement to second floor). There is apparently another passenger lift which is still in situ, but which has been boarded up. It would be very beneficial if this was opened back up, and the necessary repairs were carried out, as it would provide quicker access to all floors for service users; and also for nursing staff, care staff, kitchen staff, domestic staff and Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 20 maintenance – who all have trolleys or equipment to move about the home. The one lift in place is in constant use, and staff and service users have to wait for availability. The kitchen has fly screens at the windows, which were seen to be badly stained, in spite of a regular cleaning programme. Walls are painted and difficult to clean, and consideration should be given to tiling these, for more effective cleaning. The exterior of the building would look more inviting if paintwork was renewed, and if more attention was paid to garden areas. The home provides insufficient maintenance hours to cover maintenance duties which include day to day repairs, routine maintenance checks, considerable refurbishment of the premises inside and outside, and gardening. Communal areas were in a reasonable state of repair. There is a large “through lounge” which provides 2 separate areas, and a further small lounge. This had been partially redecorated. There is a separate dining room. The décor in corridors appears very worn, with chipped paint on the walls, and damaged and chipped skirting boards. Many bedrooms are in poor condition, with poor quality walls and skirting boards. Some bedrooms viewed had badly damaged walls, with holes in the plasterboard. En-suite facilities viewed were mostly far too small for service users to use if they are wheelchair bound. Ensuites viewed were also in poor condition – with cracked and peeling paintwork, damaged plaster, uncovered pipes etc. One bedroom is not currently in use, as it is too small; it is being used as a storage area. Many of the bedroom and corridor carpets are in poor condition and need replacing. The manager and maintenance man were already fully aware of the extent of the need to upgrade bedrooms and communal areas, and had attempted to start addressing this situation, by redecorating bedrooms as they become vacant, and offering redecorated rooms to long term service users if they wish to move into them. Bedrooms which had been decorated looked much improved, but mostly still need new carpets, soft furnishings and furniture to upgrade them properly. A few items of new furniture were in evidence. There are old divan beds in some rooms which are unsuitable for nursing clients. These should be replaced with nursing beds, which can be raised or lowered – so as to assist service users and staff with moving and handling issues. Bathroom facilities are also a concern. There are two disabled toilet facilities on the ground floor, and one of these has a small shower unit. This is unsuitable for service users who need assistance, as it is a normal shower space, and not designed for service users with mobility problems. There is a “Parker” bath on the top floor, and one assisted bath on the first floor, which needed some work to improve it (there is no side to the bath, and no integral hoist). There have Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 21 been suggestions for this to be altered to provide a “wet room” – i.e. a proper shower room. The 4th bath facility is in a small room on the first floor. It does not have an integral hoist, is too small for a wheelchair and a mobile hoist, and has carpet on the floor which is in poor condition. This bath could only be used by ambulant people who could get in and out of a bath unattended, so this bathroom cannot be considered useable. This therefore leaves 3 bathing/showering facilities for up to 36 service users, which cannot be considered sufficient. (Although current numbers of service users do not exceed 35, as one bedroom is too small for use, and is being used as a storage room). The Inspector observed that the corridors and some service users’ bedrooms have uncovered hot pipes which could constitute a risk to service users. If a service user fell against these, they are hot enough to burn someone who has frail skin. These pipes are a health and safety issue, and must be dealt with as a priority. This is also relevant to standard 38. Radiators have been covered for safety, and hot water temperatures are checked weekly to ensure the thermostats keep the hot water within the required temperatures. The laundry is situated on the ground floor, and has two areas. One of these is for washing and drying, and the other is for ironing and storage of clean clothes. The laundry contains two commercial sized washing machines and two tumble dryers. The washing machines have a sluicing facility. A red alginate bag system is used for the management of soiled clothing. The laundry was very tidy and well organised. There are separate hand washing facilities. Waste bins at the rear of the premises had lids which did not shut properly, allowing seagulls access to domestic waste. The home was generally clean, and domestic staff work hard to keep it reasonable. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 22 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): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff work well together as a committed team, and are sufficiently trained and competent to do their jobs. However, insufficient numbers leaves service users at risk. EVIDENCE: On the day of the inspection visit, there were 31 service users actually residing in the home, and one other who was in hospital. The home was staffed with 1 Registered Nurse on duty, working 7am to 7pm, 5 care staff in the morning, and 3 care staff in the afternoon. One of the care staff had been borrowed from another Southern Cross home nearby, as the home had insufficient care staff. The Inspector viewed the staffing rota for the previous week, and for the next 2 weeks. This clearly indicated that shortages of care staff were occurring every day. The Inspector gave an immediate requirement at the end of the day, with a phone call made to the Operations Manager, and a letter sent to the home’s Responsible Individual the next day. The Inspector was informed on the following day that the senior management had responded by arranging for agency staff in the short term, and additional recruitment in the long term. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 23 The numbers of care staff were deemed as inadequate for the following reasons: The home is a large building, with bedrooms and communal facilities for service users on three floors. There is only one lift. If 2 service users need assistance from 2 staff at the same time, this leaves only 1 carer for the rest of the building in the mornings; and in the afternoons the nurse has to help care staff, and the rest of the building is not covered. Most service users have been assessed as having high or medium dependency needs. This means that many require assistance with personal care and at meal times. There were two other aspects to this requirement: these were to ensure there are sufficient nursing staff on duty; and to keep staffing numbers under review to ensure that there are sufficient numbers of staff to meet the assessed needs of service users. There is usually one registered nurse on duty throughout the twenty four hour day. The Inspector observed that the medication round was taking a long time to complete, and was informed that some medication rounds take over two hours. This means that service users are not getting their prescribed medication at the correct times. This is partly due to the amount of medication needed and the layout of the building, and partly due to care staff having to ask the nurse for advice while administering medication, as there is no other nurse available. This may indicate the need for more nursing staff to be on duty at various times of the day, and this matter must be reviewed and addressed. Pharmacy guidelines indicate that medication should be given within one hour of the specified time. There is an additional requirement to review the numbers of cleaning staff. There are only 2 domestic staff employed from Monday to Fridays, and 1 at weekends, to clean a four floor building, with 36 bedrooms, communal areas and bathrooms. While they manage to keep these areas generally clean, this does not provide time for additional duties such as cleaning behind beds, skirting boards, lampshades and inside windows. Care staff are motivated to study for NVQs, and nearly 50 had achieved level 2 or 3. The number on the day of the inspection was 7 out of 16 care staff, or 43.75 . The manager was in the process of recruiting more care staff. The Inspector viewed 3 staff files, and these were mostly well put together, and the majority of information had been obtained. However, two of these did not have a current photograph; and two had only one reference. All staff have a POVA First check prior to commencing work, and the CRB application sent off. Staff Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 24 work under supervision until a satisfactory CRB is received. But staff should not be allowed to commence work if two satisfactory references have not been received, as well as the POVA First check. The Inspector pointed out the amendments to the Care Homes Regulations (Amended 2003), which contain up to date requirements for recruitment (Schedule 2). The training matrix showed that staff have an induction period, which includes mandatory training. Four staff are moving and handling trainers, and there was evidence that their training is updated to enable them to train others. Domestic staff are trained in manual handling. Three staff had not had their moving and handling training updated since 2004 or 2005. There is a recommendation that all staff have yearly updated moving and handling training. Other training was evident for infection control, fire awareness, health and safety, first aid, dementia awareness, deaf/blind awareness, and COSHH. Internal trainers from the company mostly carry out staff training. Trained staff have the opportunity to update and develop their competencies and skills. These included courses for supra-pubic catheterisation, care planning, flu vaccination (and anaphylactic shock), and dysphagia (swallowing difficulties) management. The manager carries out competency checks for all nurses in regards to medication administration as part of regular audits. Nurses have differing responsibilities, such as oversight of medication, continence, or infection control. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33, 35-38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is showing ability and competence in running the home. She needs to be supported by the senior management of the company for her management to be effective. EVIDENCE: The home appointed a manager last year, who has a background in psychiatric nursing and care of older people. She has not yet been registered with CSCI, and was in the process of tendering her application. She has identified the areas in the home which are a weakness, and has the confidence and support of the staff team. Staff work together under her direction, and she has vision Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 26 for ways to develop the home, and improve it for service users and staff. She has developed good auditing procedures in a number of areas. Quality assurance procedures are in place, with monitoring visits every month by the Operations manager for this region, and 3 monthly visits from senior management. Identified concerns need to be followed through by the company. Survey forms are made available to service users and relatives (usually yearly), and the audited results are displayed on the home’s notice board. Residents and relatives meetings are held monthly, and the minutes of these meetings are available to view. Service users can have small amounts of “pocket money” stored in a home account for safety. Individual records are maintained of all credits and purchases. Service users are informed prior to commencement that the account does not pay interest, and does not accrue bank charges. Staff supervision was in the process of being implemented, and the manager was currently training senior staff in how to carry out effective supervision for allocated staff. The supervision format enables staff to discuss concerns such as issues raised as part of their working day, and training issues. Policies and procedures are written and reviewed by the company. The inspector did not view these at this visit. The manager must ensure that they meet the procedures suitable for this individual home. Other documentation viewed was generally up to date, except where already specified. The inspector viewed the fire maintenance records, and noted that fire alarms and servicing of fire extinguishers and emergency lighting was up to date. Fire training could be evidenced for most staff. One fire drill was recorded so far for 2007, and 12 staff had attended this. Some fire doors still required some attention. Weekly checks are maintained for the fire system. Lift servicing was carried out in October 2006. Gas and electrical certificates were up to date. Accidents are recorded and notified to CSCI as appropriate. The manager carries out a daily environmental check to see that everything is in order. Several carpets were rucked, and could become a health and safety issue. The one in the clinical room has already been identified in standard 9. The other health and safety issue of concern regards hot pipes, and this has been addressed in standard 25. Fairfield Manor DS0000065787.V315054.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 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 2 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 1 2 3 2 1 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 3 2 Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 (2) Requirement To ensure that medication is given at the prescribed times. (Pharmacy guidelines indicate these should be within 1 hour of the written time). This was written as an immediate requirement in the letter to the Responsible Person, in respect of numbers of nursing staff. Action should be taken within 28 days. 2 3 OP9 OP9 13 (2) 13 (2) To ensure that there is sufficient space for the correct storage of controlled drugs. The clinical room carpet should be replaced with washable flooring, in line with infection control guidelines for places where medicines are stored. To ensure that all staff are trained in the recognition and prevention of abuse. To provide CSCI with an action plan by the specified date, with: details of a redecoration programme for bedrooms (where applicable), enDS0000065787.V315054.R01.S.doc Timescale for action 20/03/07 20/03/07 01/04/07 4 5 OP18 OP19 13 (6) 23 (2) (b) 20/05/07 20/04/07 Fairfield Manor Version 5.2 Page 29 6 OP21 23 (2) (j) 7 8 OP22 OP24 23 (2) (n) 16 (2) (c) 9 OP25 13 (4) (a,c) 10 OP27 18 (1) (a) suite facilities, and corridors, with proposed dates of completion. Details of a redecoration programme for the exterior of the building (i.e. paintwork), with dates. A review of the kitchen, and how the company propose to ensure that the walls and fly screens can be kept properly clean. To provide CSCI with an action plan by the specified date, showing how the company will ensure there are sufficient numbers of toilets and bathing facilities, and how these will be refurbished where applicable (with the exception of the ground floor toilet already being refurbished). With proposed dates for the work to be done. To ensure that suitable nursing beds are provided for all service users with nursing needs. To provide CSCI with an action plan by the specified date: demonstrating how bedroom furniture, carpets and soft furnishings will be replaced as needed. For the replacement of worn carpets in other areas, e.g. corridors. With proposed dates for completion. To carry out risk assessments for all areas where there are uncovered hot pipes, and take action in line with the risk assessments - so as to eliminate possible risks to service users. Immediate requirement. To ensure that there are sufficient numbers of 20/04/07 20/05/07 20/04/07 01/04/07 22/02/07 Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 30 suitably trained care staff in the home at all times, and able to meet the assessed needs of service users.(This was given as an immediate requirement, and was responded to by the Operations Manager in two days). Registered nurses are to be on duty at all times in sufficient numbers to ensure that they are able to meet the assessed needs of the number and dependency of service users currently accommodated. This must also meet the statement of purpose and the aims and objectives of the service. (This was given as an immediate requirement, which has not yet received a response). Numbers of registered nurses and care staff are to be kept under review to ensure that the company are providing registered nurses and care staff in sufficient numbers to meet service users’ assessed needs; and to meet the aims and objectives and the statement of purpose. (This was given as an immediate requirement, which has not yet received a response). Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP1 OP8 OP15 OP19 OP22 OP29 Good Practice Recommendations To ensure that the correct details for CSCI are included in all relevant documentation e.g. statement of purpose, service users’ guide, complaints procedure. To ensure that care plans are included for each service users’ assessed needs e.g. wound care. For the company to enable the main chef to have additional intermediate training in catering. To review the number of maintenance and gardening hours, so as to ensure that ongoing maintenance and gardening can be carried out effectively. To review the possibility of repairing the second passenger lift. To ensure that all recruitment files contain the required information. Fairfield Manor DS0000065787.V315054.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local 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.V315054.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. 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!