Inspection on 03/12/05 for Fairfield Nursing Home

This inspection was carried out on 3rd December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Nursing Home 07/02/06

Fairfield Nursing Home 14/03/05

Fairfield Nursing Home 05/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Fairfield Nursing Home 10 Quarry Road East Heswall Wirral CH61 6XD Lead Inspector Les Smith Unannounced Inspection 3rd December 2005 10:00 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 Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 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 Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fairfield Nursing Home Address 10 Quarry Road East Heswall Wirral CH61 6XD 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) 0151 342 8886 0151 342 8886 admin@fairfield.wanadoo.co.uk Fairfield Healthcare Limited Mrs Elaine Gerrard Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2005 Brief Description of the Service: Fairfield Nursing Home is a large detached house situated in the residential area of Heswall. The home is registered with the Commission for Social care Inspection to provide nursing care for up to thirty residents under the category of old age. Standing in its’ own grounds there is car parking to the front and large gardens to the rear. All rooms are for single occupancy and a number have en-suite facilities. Communal areas comprise two lounges and a designated dining room. There is also a large conservatory, which is used for entertainment. There is a lift access to the second floor and all areas are accessible to residents. The home is situated close to public transport, local amenities and is easy accessible to visitors. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a single day in the presence of Siobhan Smith RGN. Time was spent in discussion with the Registered Nurse in charge and examining records and associated documentation. A tour of the home was carried out. The inspector spoke to several residents and visitors to the home. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 6 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 Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 There is good information available to allow prospective residents to make a fully informed choice about where they want to live and be confident that their individual needs will be assessed and met. EVIDENCE: The statement of purpose and service user guide meets the required standard and is available to prospective residents. Service user guides are also available in each room as a source of reference for individual residents. Detailed pre-admission assessments were seen on files examined. Also included in the files were social work / nursing assessments and the written summary provided by the manager detailing the care required that is used as part of the care planning process. Prospective residents’ and their representatives are encouraged to visit the home at any time and as often as they wish before making a decision to accept a place at the home. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The initial care planning system in place is adequate which provides staff with the information they need to satisfactorily meet residents’ needs. However care plans are not regularly reviewed to respond to changing needs. The basic systems for recording, administration and disposal of medications are satisfactory but are not always complied with, potentially putting residents at risk. EVIDENCE: Initial care plans are based upon the activities of daily living and include continence, falls, depression, manual handling, Waterlow pressure sore risk, side rails assessment and detailed environmental risk assessments. There is no nutritional risk assessment and this will be a recommendation of this report. Detailed diary sheets evidence the care delivered over the whole 24-hour period that provides a picture of how residents’ needs are responded to and met. Whilst the homes policy states that care plans are reviewed monthly a large number of care plans examined show no evidence that regular reviews have Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 9 been carried out. Some care plans have not been reviewed for six months or longer. One file examined had no care plans in situ and the inspector was informed that it must have fallen out. Care plans that had been reviewed, frequently showed an inadequate evaluation of care ‘No change to plan’ with no justification for the statement. Basic observations of pulse, blood pressure and weight are maintained and were found to be up to date. One resident was noted to have lost weight each month (approx. 3lbs per month) for the previous four months but whilst the resident was noted to have a poor appetite there was no evidence of dietician referral or specific intervention. Health care needs are met by GPs of the residents’ choice and there was evidence of visiting opticians and podiatry services. There was clear evidence that staff refer residents for the input of members of the multi-disciplinary team such as the Tissue Viability specialist nurse. Verbal handovers are undertaken at the start of every shift to facilitate continuity of information and ensure that all care staff have up to date information. The inspector examined a random selection of Medication Administration Records (MAR sheets). Photographic identification was available for each resident. There were several instances of gaps in the recording of administration of drugs. There were also instances of hand transcribed prescriptions without the required two signatures. Controlled drugs were checked against the controlled drug register and found to be correct. Drugs of potential abuse were checked regularly on the MAR sheet by staff at the time of administration. The medication room and drug fridge temperature are recorded daily and were noted to be within the optimum parameters. The drug fridge contained adrenaline injection, which expired in October 2005. Eye drops in current use were not annotated with the date of opening. The inspector was informed that the eye drops were changed each month when the new prescriptions were received but it remains best practice to date the container when opened. There is a policy and contract in place for the disposal of unwanted medication and all relevant documentation was in place. All service users are accommodated in single bedrooms. Personal care is given to service users in their bedroom or in the bathroom as appropriate. Service users spoken to during the inspection confirmed that staff respected their privacy and dignity at all times. Service users may meet with their visitors in their bedroom or in one of the communal areas as they wish. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 10 Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 As far as possible residents have choice and flexibility in how they spend their day in the home, and pursue leisure activities according to their choice and preferences allowing independence and individuality for each resident. Meals at Fairfield are good, offering choice and variety whilst catering for residents dietary needs or cultural preferences EVIDENCE: There is a comprehensive activities programme in place and residents are kept informed via a ‘Dates for your Diary’ sheet, which is distributed, to all residents. Religious services are held in the home on a regular basis by visiting priests and ministers. The provision of an activities co-ordinator would enable more one to one activities to be provided for the relatively high number of high dependency residents. Visitors are welcome at the home at any time and residents may receive their guests in either in the communal areas or privately in their own room. Residents are encouraged to maximise their independence as far as possible. Details of independent advocacy services are displayed on a notice board in a Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 12 prominent area of the home and residents are clearly supported by staff in making choices in respect of their own preferences. Bedrooms seen by the inspector evidenced a high level of personalisation with pictures; furniture etc. and some residents have their own telephones fitted. The inspector was shown a five-week cycle of menus that evidenced that a varied and nutritious diet is provided. A choice of meals is offered each day and residents and asked for their preference the day before. The inspector observed the mid-day meal being served and assistance being given to residents in a dignified and sensitive manner. Meals taken to resident’s rooms were on a tray laid with all appropriate accoutrements and the meal properly covered. When required liquidised meals are served with individual element portions to enable colour and texture to stimulate and be appreciated. The kitchen was very clean and tidy and food stores found to be well stocked including fresh fruit and vegetables. All kitchen staff has valid food handling and hygiene certificates. Evidence was seen that temperatures of hot food were being taken and recorded but the temperatures of the fridge and freezers were not being recorded every day. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Residents and their families can be confident that any complaints or concerns will be listened to and appropriate action taken. The home has a complaint and adult protection policy and procedure in place that helps ensure the safety and welfare of residents. EVIDENCE: Fairfield has an appropriate complaints procedure. All complaints / concerns are recorded in a register together with details of any action taken. The complaints procedure is included in the service users guide available in all rooms. It will be a requirement of this report that the phone number of the CSCI be included in the procedure. The inspector was informed that all residents’ are registered on the electoral roll and have the opportunity to vote. All staff have access to the policy on adult protection which is in place and includes whistle blowing and the local Wirral inter-agency protocol on adult abuse. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The standard of the environment at Fairfield is good providing a safe homely place to live. EVIDENCE: The overall structure and external presentation of the home is good and the premises are suitable for its intended purpose and function. There is a handyman employed and maintenance issues are dealt with promptly. Environmental risk assessments are in place for residents to help ensure that the home is a safe place to live. Most staff members have completed or are currently doing a course in infection control and it was evidenced that staff are fully aware of the appropriate policy regarding MRSA. Tastefully decorated throughout Fairfield has a homely appearance and ambience which was described by one visitor spoken to as ‘just like home’. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 15 There are areas were the decoration is looking tired and worn and consideration should be given to a programme of redecoration addressing the more worn looking areas first. The dining room carpet is badly stained and requires replacement. The inspector was informed that the high dependency of residents had led to a significant increase in spillages of food and drinks and that the carpet was cleaned on a regular basis. Residents have ample bathing, toilet and washing facilities. It was evident however that the communal bathrooms and toilets are still being used to store items such as wheelchairs, hoists and bed linen. A communal toilet was found to have exposed duvets and pillows stored in it. It will be a requirement of this report that the issue of storage facilities be addressed as a priority. The grounds to front and rear are evidently well maintained. On the day of inspection the home was clean, tidy and apart from one room free from odours. The inspector was told that the room on the first floor that was malodorous is due to the behaviour of the resident and that everything possible had been done to reduce the malodour. Because the malodour is permeating the corridor it may be worth considering the provision of an alternative floor covering for this room. It was clearly evident that appropriate equipment and facilities are available and used to meet the needs of service users. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 There are sufficient numbers of trained and care staff employed to meet the needs of the residents for most of the time and staff are aware of their roles and responsibilities. EVIDENCE: The high usage of agency staff evidenced at the last inspection has been reduced and the inspector was informed that the numbers of staff on duty had been increased to meet the current higher dependency levels. If agency personnel are required to meet shortfalls every effort is made to engage the services of people who are familiar with the home. Staff spoken to all expressed concern in relation to the time period 1800 to 2000 when the staff level is 1 trained and 3 carers and consideration should be given to reviewing this level for what is a particularly busy period. A staffing level of 1 trained and four carers during this period would provide time for the trained member of staff to speak to relatives and visitors and ensure that care plans were kept up to date. It was evident from records examined that staff members have training in a variety of topics in addition to mandatory training and staff members spoke highly of the support and knowledge given by the trained staff. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38 Residents benefit from a well qualified, experienced manager who is competent to ensure that the health, safety and welfare of residents is promoted and safeguarded. EVIDENCE: The registered manager has a wealth of experience in nursing and management of Fairfield and is well qualified to fulfil her role. The manager has been responsible for many changes that have enhanced the quality of life for the residents at the home. Staff spoken to all expressed the view that the manager was very approachable and would listen to any concerns/suggestions they had. Staff meetings are held on a regular basis and minutes for these were seen published in the staff room. It is evident that staff do not feel constrained and are able to air their views freely. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 18 The home has gained the ‘Investors in People’ award. The registered manager undertakes eight hours clinical practice each week to monitor care delivery and maintain her own clinical skills. It is clearly evident from the discussions held with staff, visitors, residents and documents examined that the focus of the home management is firmly set in the best interests of the residents and that those interests are safeguarded by the policies and procedures in place. Staff supervision is in place and evidenced by relevant records. Appropriate valid safety certificates were seen as follows: Fire alarm and Emergency lighting service contracts and test records; Fire extinguishers service certificate Fire risk assessment; Gas safety certificate; Relevant service contracts and inspection certificates for lift and hoists; Periodic 5-year electrical certificate; The Public Liability insurance certificate was displayed in the nurses office and it is recommended that it be displayed in a prominent position within the home were it can be seen by everybody. Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 19 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X 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 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 20 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 2 Standard OP7 OP9 Regulation 15(2)(b) (c) 13(2) Requirement The registered person must ensure that care plans are reviewed regularly The registered person must ensure that handwritten prescriptions are properly signed by two staff The registered person must ensure that all medications administered are correctly signed for and if not given the reason for non-administration clearly stated. The registered person must ensure that all medications held in stock are in date The registered person must ensure that telephone number of the CSCI is included in the complaints procedure. The registered person must ensure that suitable provision is made for storage for the purposes for the home. The registered must ensure that the dining room carpet is replaced. Timescale for action 14/01/06 14/01/06 3 OP9 13(2) 14/01/06 4 5 OP9 OP16 13(2) 22(7)(a) 14/01/06 14/01/06 6 OP19 23(2)(l) 31/01/06 7 OP19 23(2)(d) 31/03/06 Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 21 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 Refer to Standard OP7 OP9 OP12 Good Practice Recommendations It is recommended that a risk assessment for nutrition be included in individual care plans It is strongly recommended that medications with a limited life such as eye drops (28 days after opening) be annotated with the date opened. It is recommended that the activities programme be developed to include more one to one activity for those residents that cannot participate in group activities. The services of an activities co-ordinator would facilitate this. It is strongly recommended that steps be taken to address the malodour in the first floor room It is recommended that steps be taken to ensure that fridge and freezer temperatures are taken and recorded daily It is recommended that the staffing level for the time period 1800 to 2000 be reviewed. 4 5 6 OP26 OP38 OP27 Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fairfield Nursing Home DS0000020936.V270628.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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