Inspection on 21/02/08 for Fairfield Residential Care Home

This inspection was carried out on 21st February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fairfield Residential Care Home 09/02/09

Fairfield Residential Care Home 30/08/07

Fairfield Residential Care Home 18/12/06

Fairfield Residential Care Home 28/07/06

Fairfield Residential Care Home 15/11/05

Fairfield Residential Care Home 09/06/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Fairfield Residential Care Home 27 Old Warwick Road Olton Solihull West Midlands B92 7JQ Lead Inspector Sandra Wade Unannounced Inspection 21st February 2008 08:15 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 Residential Care Home DS0000063831.V360063.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 Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfield Residential Care Home Address 27 Old Warwick Road Olton Solihull West Midlands B92 7JQ 0121 706 2909 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) Santok Mayariya Mr Dilip Mayariya ** Post Vacant *** Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The current registered double room is to remain as a permanent single room for as long as the existing service user chooses to remain in that room. During this period the effective capacity of the Home will be seventeen service users. Service users in the six upstairs bedrooms located in the original part of the house may continue to live there as long as their needs can be met. Until such time as the difficulty of split-level floors is solved to the satisfaction of CSCI all future service users residing in this area must be ambulant. In the event of the Registered Manager leaving, a fulltime care practice consultant must be retained until such time as a replacement manager is actually registered. This arrangement to exist for a period of two years and applies to any reoccurrence of a registered manager leaving within that period. The current minimum staffing levels must be maintained until such time as agreement is reached with CSCI on the basis of service user needs, environmental factors and staff competency that these may be changed. 30th August 2007 2. 3. 4. Date of last inspection Brief Description of the Service: Fairfield is a large extended detached house providing care for up to 18 older service users. The home is located in the Olton area of Solihull and is readily accessible to amenities such as shops, places of worship and public transport. The home comprises of 16 single bedrooms, thirteen of which have en-suite facilities and there is one double bedroom. Accommodation is provided on two floors and on the upper floor there are rooms, which can only be accessed via a few stairs, which means they would only be suitable for people who are fully mobile. There are two lounges separated by glass doors, which when opened creates one large lounge area, there is a television based in both areas. A dining room and conservatory are also provided. There is a shaft lift to the upper floor. There are attractive gardens to the rear of the property, which are accessed via a ramp from the conservatory enabling access for service users in wheelchairs or with a disability. Handrails are also provided. Limited parking facilities are available at the front of the building and there is also on-road parking outside the home. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 5 Fees are usually detailed in the Service User Guide for the home but at the time of this inspection this was being updated to reflect current fees. Additional charges are made for personal items such as newspapers, dentist, hairdresser, chiropody, clothing and toiletries. Fairfield Residential Care Home DS0000063831.V360063.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 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes’ capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place from 8.15am to 5.50pm and was carried out by two regulation inspectors. Due to the number of issues identified at the last full key inspection in August 07, this home has been subject to further random inspections to check compliance to requirements. Some of these visits were specifically to monitor progress in improving medication management. Random visits were undertaken on 17 October 07, 6 November 07, 15 November 07, and 10 December 07. A further visit was scheduled for January 2008 to assess care planning and staffing but on arrival to the home it was found insufficient progress had been made for a meaningful assessment of these areas to be undertaken. Two people who were staying at the home were ‘case tracked’. This involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide, staff duty rotas, social activity records, kitchen records, accident records, financial records, health and safety records and medication records. A tour of the home was undertaken and the inspector spent time speaking with residents, visitors and staff within the home. What the service does well: The providers are spending a lot of time in the home to ensure the home runs effectively in the absence of a manager. Staff and the providers are friendly and approachable and residents are complimentary of the support they receive from them. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 7 There are good systems in place for managing any money that residents have in the home. What has improved since the last inspection? What they could do better: A manager needs to be appointed to the home to ensure the home is run effectively and in the best interests of the residents. There are still some records, which require attention to ensure the home can demonstrate they do what they say they do. This includes updating the Service User Guide, complaints procedure and ensuring training records are up-to-date for staff. There are some elements of care planning that still require attention to ensure all care needs of residents are clearly identified and can be met by staff. This includes care plans for specialist care needs such as dementia and skin Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 8 problems and the development of risk assessments in these areas as appropriate. This will enable a consistent approach by staff in meeting the needs of the resident. Health and Safety checks need to be carried out regularly and appropriately in all areas as required. This includes recording accurately fridge/freezer temperatures to ensure food is stored safely, regular monitoring of hot water temperatures so there is no scald risk to residents and ensuring the hoist is serviced regularly as required so it is safe to use for residents. There needs to be sufficient supplies of paper towels, aprons and gloves in the laundry as well as hand towels in residents rooms so that infection control and management of hygiene is effective. The laundry needs to be suitable for purpose, sufficient storage and surfaces to manage the laundry need to be available. 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 Residential Care Home DS0000063831.V360063.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 Residential Care Home DS0000063831.V360063.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): Standards 1 and 3 were assessed. Quality in this outcome area is adequate. Prospective residents receive some information about the home to allow them to make a decision about whether to stay at the home. Assessment records are in the process of being updated to ensure any new residents are suitably assessed prior to their admission to ensure their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Service User Guide available in the home but on viewing this it was evident it is in need of reviewing. There was no summary inspection report included with this document and the information on fees and the new arrangements for dealing with complaints has not been updated. This means prospective service users would not have access to up-to-date information to enable them to make an informed choice to stay at the home. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 11 There have been no recent admissions to the home to check the home is undertaking appropriate pre-assessment procedures when admitting residents. This will need to be followed up at the next inspection. The management consultant who is working with the provider in the home advised that new assessment records are in the process of being developed. It was explained that this would be more thorough to help staff identify if the care needs of the resident can be met. Fairfield Residential Care Home DS0000063831.V360063.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is adequate. Care plans are in place to help support the care needs of residents but records do not always show that care needs are being met consistently. Systems are in place to ensure medication is managed effectively to the healthcare needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection both providers were working in the home and were very supportive and caring towards the residents. Carers were observed to sit amongst the residents and talk to them for periods during the day which resident’s enjoyed. Since the last full inspection the care plans have been reviewed and now contain more personalised information about each resident. Specific care needs are now easier to identify and there are staff actions listed to meet care needs. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 13 Care plans were found to not always give the finer details needed to ensure all staff adopts the same approach to care. For example a social worker assessment document stated that a resident was only able to use one hand due to arthritis and needed to have their drinks provided in a certain beaker. The care plan for food and drink did not give these specific details although it was observed the resident did use a special beaker. One resident was known by the inspector to wear incontinence pads and was prone to soreness. The resident said they were feeling particularly uncomfortable on the day of inspection. In this resident’s file there was a social worker assessment which confirmed this problem and stated the resident was to use a pressure cushion to sit on to prevent developing soreness. The information about using the pressure cushion had not been detailed in any of the care plans to ensure staff knew this although the resident was observed to be sitting on a pressure cushion. There was also no risk assessment in place in regards to the risk of developing sore areas on the skin to ensure staff were fully aware of risks and what actions they needed to carry out to avoid them. The Medication Administration Record showed that there were creams being applied to this resident in two areas. It was not evident from care plans that there was any problem with these areas of skin and staff had not been instructed in care plans why this was necessary. The home is now managing the monitoring of weights of residents well. Where it is identified that residents are prone to poor nutrition or weight loss they are monitoring their weight weekly. It was evident that one resident’s weight was variable each week and where staff had noted a drop in weight they had taken actions to address this and the following week the weight had increased again. A risk assessment had been developed for a resident with swallowing problems and food and fluid charts were being completed to monitor the resident’s nutritional intake. There were clear guidelines to staff on how often they should provide fluids. Care plans had been developed in regard to residents mobilising and support required. One care plan did not show that a hoist was being used to support the resident when it was evident from daily records this was being used. Care plans need to clearly show any equipment being used so that staff can provide support safely. Manual handling assessments had been completed showing how many staff should assist each resident with each mobilising task, which is good practice. Records are being kept of when residents are bathed or showered to ensure this is being done. For one resident it was not evident this was being carried out regularly. Records showed one bath in December and one bath and shower in January 2008. The provider felt that the records had not been kept Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 14 up-to-date in this instance and stated that all residents receive are assisted to wash each day. A care plan had been developed for a resident with dementia but this did not show specifically how the resident’s dementia care needs should be met. These needs are usually linked to sensory needs such as touch, feel, and smell. Daily records showed that the resident was “not settling and getting aggressive during the night” and that they needed to have familiar things around them”. It was not clear from the care plan what familiar things this meant. It was established that the resident had been moved to another room in the home and this had resulted in an unsettling effect on them. The care records did not state this. It was also evident that there were specific items that the resident liked to keep with them. It was observed that staff did not always make sure these were within the residents reach when the resident was sitting in lounge. The resident looked frail and had been sitting in the lounge for much of the day. It was noted they were not sitting on a pressure cushion and had no extra pillows to make them more comfortable. It was observed that later in the day the provider observed this and provided extra cushions for the resident. The provider agreed to follow up if a pressure cushion was needed. Care plan records showed that the doctor is being called upon when medical needs are identified and residents also access support from district nurses, chiropodists and opticians. One resident with diabetes was having their blood sugar levels monitored each day. Care plans in relation to diabetes were not sufficiently detailed to show how staff should monitor this between district nurse visits. This should include symptoms associated with high/low blood sugars so that staff know there maybe a problem that needs to be reported or managed. It is also good practice for staff to know the “usual” range of blood sugar levels for each resident so which can help to make them aware of any potential problems. Daily records are now being completed for each resident to give a picture of the resident health and support provided by staff over a 24hr period. Although these are more detailed, they require further review to ensure they show that the care needs identified are being met consistently. The provider agreed to review this. A review of medication was undertaken. Since the last inspection the home have received three random inspection visits specifically to monitor progress with addressing medication requirements made. It was evident from this inspection that there has been a significant improvement in this area and medication is now being managed well. The only area requiring attention was in relation to handwritten entries on the Medication Administration Records (MAR). It was found that instructions on a box of eye drops stated “one drop in BOTH eyes once daily at night” but a Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 15 handwritten entry had been made on the MAR which stated, “left eye” which conflicts with the prescribing instructions. It was not clear who had made this change and if this was something that had been agreed with the GP. There were no concerns identified regarding the privacy and dignity of residents during this inspection. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14 and 15 were assessed Quality in this outcome area is good. Service users have access to social activities to help meet their social care needs/interests and are satisfied with the food provided. It is not clear systems are in place to ensure resident’s choices can be fully considered and met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a programme of social activities, which lists each day the activities planned. This includes sing a long with Josh, hairdresser, cards, board games, manicures, bingo, quiz afternoon, skittles and ball games. Carers in the home provide many of the daily activities but there are also outside organisations that come into the home. On the day of inspection the residents enjoyed an exercise and singing session in the afternoon with an outsider provider. One resident spoken to explained how they enjoyed the bingo and the game “higher and lower” using playing cards. They were also able to confirm other activities that take place in the home as listed on the activity schedule. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 17 It was observed that staff do spend time sitting amongst residents to have a chat when the opportunity arises and the provider was observed to spend oneto-one time with one of the less able residents. Care plans detail personal choices in regards to how care and services are provided. This includes choice of staff gender when providing personal care to ensure residents are asked if they mind receiving care from both male and female carers. Care files also contain a ‘daily routine preference sheet” which shows how the resident wishes to be supported throughout the day. For example: 7am assisted to get up and dressed, breakfast at 8am, activities at 9am, toilet at 10am, lunch at 12, rest at 1pm, activities 2pm, tea and snack 3pm, rest at 4pm, relaxation at 5pm, supper at 6pm. In one file it was not clear what time the resident wished to go to bed. Daily records completed by staff showed that they were not happy if they could not be taken to bed when requested. On speaking to the resident they explained that they did not always have their bath at the times when they wanted one. They explained that they usually were awake for much of the night including early morning and therefore liked to get up early. They said that on one day each week they had to wait for the day staff to come in before they could have a bath and they didn’t like having to wait because they wanted to be up and dressed. The resident acknowledged that night staff were busy with other residents early mornings. Since the last inspection action has been taken to implement the menus devised. Menus show there are two choices of main meals offered each day. On the day of inspection residents opted for the chicken dinner and it was observed that all seemed to enjoy this. The meal looked appetising and residents spoken to were satisfied with the meals provided. Menus state that fresh fruit is to be offered between meals and 5 portions should be eaten daily. The menus also state that sandwiches are to be served with salad and pickles if requested. Staff said there was always enough food for snacks and sandwiches should they need to make these between meals. The inspector was informed that sometimes the food was late in arriving to prepare for meals as the provider shopped each day. Also sometimes it was difficult to get the meat tender for residents due to this needing to be cooked over a long period of time. Menus show that there are hot items provided for breakfast each day but through discussions with residents and staff it was not clear these are always provided. On the day of inspection residents were observed to have cereal and toast. The provider said that cooked breakfasts are provided if residents choose to have them. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 18 Kitchen staff is now keeping records of meals provided to residents so that it is clear whether residents are receiving a nutritious diet. Records include any specific items prepared for those diabetic residents, which is good practice. Records viewed for breakfast showed that residents are having toast and cereal for breakfast. A resident was observed to be assisted to eat by the provider who was patient and took time to ensure the resident could eat their meal at their own pace. It was observed that this took a considerable amount of time due to the swallowing difficulties of the resident. Due to the time involved, it is likely the meal would have gone cold. This matter needs to be considered when preparing and serving the meal. It was evident that a resident who had limited movement in their hands had been provided with special cutlery to eat. Their care plan stated that staff were to cut up the residents food and this had been done. It was also observed that the staff used a specific beaker to allow the resident to drink independently. The kitchen was viewed and contained supplies of fresh food and food cupboards were well stocked with dried and tinned produce. Some opened packets of food had not been appropriately sealed to ensure they were pest proof. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. Service users know how to make a complaint but records in regards to complaints and protection of residents are not up-to-date to ensure these areas can be managed effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints or allegations of abuse received by us since the last inspection. The provider advised there have also been no complaints received by the home. A complaints procedure is in place but this has not been updated to reflect changes in how complaints should now to be managed. For example it does not make any reference to referring complaints (where appropriate) to Social Services. Our recent change of address has also not been updated. Residents are asked to complete a “Charter of Rights” form, which asks various questions about their lifestyle in the home. One of the questions asks if they understand how to make a complaint. One file seen had been completed to say the resident did know how to make a complaint but this form was not dated to show this was the case currently. Those residents spoken to were aware to approach the providers should they have any concerns. The training schedule viewed does not show that any of staff have done prevention of abuse training but staff spoken to said that they had completed Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 20 this training. At the last inspection staff spoken to also said they had completed this training and gave examples of abuse and knew what their responsibilities were in terms of reporting this. The provider will need to ensure that training records are kept up-to-date to reflect all training staff have completed. This is so that it is clear that staff have done the necessary training to work with residents safely and appropriately. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 21 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): Standards 19,21 and 26 were assessed. Quality in this outcome area is good. Residents live in a generally wellmaintained environment with new bath/shower facilities and no unpleasant odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is subject to ongoing improvements by the providers. The environment is homely and bedrooms viewed were clean and there were no unpleasant odours identified. There are two communal lounges, which are split by glass doors, which are usually open to form a large lounge area. There is a conservatory off the lounge which overlooks the garden and which contains cane type furniture. Due to the low level of this furniture, this could be difficult for some residents to use. The conservatory was not in use on the day of inspection due to the Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 22 colder weather. There is an attractive garden, which has a patio area with seating as well as a grassed area so that residents can sit out in the warmer weather. The garden can be accessed from the conservatory and there is a ramp to assist those with mobility difficulties or in wheelchairs. There is a dedicated dining room, which has been fitted with a wood-panelling floor and the majority of residents uses this at mealtimes. There is a pleasant shower room with chair which is bright and clean with the exception that the grouting on the wash-hand basin is black and in need of replacement. This was also identified at the last inspection. There was no soap available for staff or residents to wash their hands in this shower room and the provider agreed to address this. Since the last inspection the home have obtained a new bath and this is situated on the upper floor. Bedrooms viewed were pleasantly decorated and tidy although some had no towels. These should ideally be replaced when the old ones are taken away for washing so that residents have access to these at all times. The home has a sluice room and there were soap and paper towels available for staff to wash their hands. The laundry, which is situated in the basement of the home, was viewed and since the last inspection this has been refurbished and contains two new washing machines and two driers. The laundry area was generally untidy with washing powder and water stains on the floor and surfaces. There were residents clothes stored on the top of the machines and there was no clearly identified space for staff to work such as an area to fold items that have been dried. There were no paper towels in the dispenser and no gloves or aprons available in the laundry for staff to maintain good hygiene. The provider said that staff usually obtain these before they go into the laundry. On entering the stairway to the basement it was noted that there was a laundry trolley stored in the entrance, which prevents free passage of staff in the event of an emergency. The storage of this trolley should be checked with the fire officer and records kept of any agreement for it to be stored here. Fairfield Residential Care Home DS0000063831.V360063.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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good. There are sufficient staff to meet the needs of residents although it is not clear all staff are up-to-date with training to care for residents safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager has left and the providers have been working in the home. The provider stated that they still aim to have three carers on duty during the day and two at night. At the time of this inspection there were eleven residents in the home and staffing was therefore sufficient to meet the needs of the residents. Since the last inspection the provider has reviewed the duty rotas to show which care staff are undertaking other duties such as laundry and kitchen duties. Duty rotas show that there are days when the provider undertakes laundry, caring and cleaning duties, which is not ideal. The provider was observed to spend periods of time with one resident in particular who needs one-to-one support for some of their care needs to be met which demonstrates a commitment to ensure care needs are addressed. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 24 Staff spoken to said that they have noticed changes in staffing in that they now are working more together and there is more “give and take” amongst staff. Residents spoken to felt they were being cared for satisfactorily with the exception that one felt they still had to wait sometimes to be assisted as they needed two staff to assist them and sometimes there were not always two staff free to help as quickly as they would like. This will need to be addressed by the provider. There is a training schedule in place but it was identified that this has not been kept up-to-date. This made it difficult to confirm that all staff had completed the necessary training, which includes food hygiene, moving and handling, fire and first aid within the appropriate timescales. The training schedule does show that some staff have completed training during 2007 in these areas and the provider stated they felt this training was up-to-date. The provider said there were 19 care staff working for the home and training records showed that over half of these staff have completed a National Vocational Qualification (NVQ) II in care which should help staff to provide more effective care to the residents. As over half of the staff have completed this training the home is exceeding the care standard for 50 of staff to achieve this which is to be commended. Since the last inspection there have been no new staff employed to check that recruitment practices are being managed appropriately. The care standard relating to recruitment was however met at the last inspection. The provider is aware that any new staff must have two written references, a clear employment history and criminal records check in place prior to their employment. Fairfield Residential Care Home DS0000063831.V360063.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): Standards 31,33, 35,36 and 38 were assessed. Quality in this outcome area is adequate. There is currently no manager for the home to ensure the home is run effectively and in the best interests of the service users. Some attention is required to maintain the health and safety of the home to protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager has left and the providers have been working in various roles to support the home. A management consultant has been employed and is working with staff to set up systems to help the home run effectively. The management consultant was able to show all work done so far in recording the type of actions staff need to follow to meet care standards. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 26 Although staff have reported they are working more together, they still felt that there is an element of having to “work things out for themselves” due to there not being a manager in post. They also felt they have less say on what hours they work on the duty rotas and said they felt the management of the laundry could be improved. The provider confirmed they are actively looking to recruit a manager as soon as possible so that there are clear lines of accountability to enable the home to be managed effectively. Since the last inspection there have been quality satisfaction surveys sent out to families. On viewing these surveys it was evident that questions within this apply to both relatives and residents, which would mean relatives would need to complete this with the resident. Questions are asked on cleanliness, laundry, food, care, staff and general impressions. The provider advised that responses to this survey were still in the process of being received. Outcomes will need to be collated into a report and this report made available to residents and other interested parties. The financial records relating to service user personal monies held in the home were viewed. Money held by the home was found to be correct in relation to the records in place demonstrating money is being managed appropriately. Records gave full details of expenditure and balance transfers and there were receipts in place for each transaction undertaken. In regards to staff supervision, the provider reported that all staff have had at least one formal supervision session and this was carried out in November 2007. Records seen for two staff confirmed this. The provider is aware that all staff need to have six formal supervision sessions per year. Health and safety checks are being carried out but it was found there are some actions required in relation to completing some of these. Hot water checks are not being undertaken regularly to ensure the hot water is safe and will not scald residents although those taps checked were not too hot. Fridge and freezers temperature records showed they were running above the recommended guideline temperatures to ensure food is stored safely. The provider agreed to address this. The hoist was overdue for a service; records showed this was last checked in June 07. Records seen showed that the lift and gas checks had been carried out as appropriate. A Legionelleas water check had been carried out in November 2007 to confirm water in the home is safe. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 27 There is a Fire Risk Assessment in place but the names of residents listed within this document were not accurate and it was advised this is updated. Since the last inspection some of the doors to bedrooms have been fitted with door guards so that if residents wish to have their doors open they can do so safely. The door guards release and automatically close the door in the event of a fire. Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 28 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 X N/A X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X 3 X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 (1) Requirement Care plans need to show all care needs of service users (including those with complex needs such as dementia) to ensure these can be met. Staff must ensure risk assessments are devised or reevaluated when the health of a resident deteriorates and places them at risk of poor health. This in particular applies to skin deterioration as well as changes in mobility. Fridges and freezers in the home must operate at temperatures within the recommended guidelines to ensure food is stored safely and is safe for residents to eat. Opened packets of food must be appropriately sealed to ensure they are pest proof and the contents do not deteriorate. Timescale of 10/12/07 not met. . Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 30 Timescale for action 31/03/08 2. OP8 13(4) 31/03/08 3. OP38 13(4)(c) 31/03/08 4. OP38 13(4) Health and safety checks must be completed within appropriate timescales to ensure the home is safe for residents. This includes servicing the hoist and regular checks of hot water temperatures to ensure they are not too hot they would scald a resident. 31/03/08 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. Refer to Standard OP1 Good Practice Recommendations The Service User Guide should be reviewed to ensure this contains the summary inspection report for the home to help prospective service users make an informed choice on whether to stay at the home. Where residents have made choices in relation to their care or services, records need to show these are being considered and met consistently. The complaints procedure needs to be updated to reflect current guidance in how these should be managed plus our current address. The grouting on the wash-hand basin in the shower room needs to be replaced, as this is black and unhygienic. There should be sufficient supplies of paper towels, aprons and gloves in the laundry for staff to maintain good infection control practices. Hand towels should also be available in resident’s rooms so they have access to these as all times. 6. OP26 The laundry should be maintained in a clean and tidy condition and there should be sufficient surfaces and storage areas for staff to work effectively. DS0000063831.V360063.R01.S.doc Version 5.2 Page 31 2. OP14 3. OP16 4. 5. OP21 OP26 Fairfield Residential Care Home 7. OP30 Training records need to be kept up-to-date so that it is clear staff are suitably trained to care for residents safely and appropriately. A suitable manager needs to be appointed that is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Results from quality surveys need to be collated and detailed in a report which is made available to service users and their representatives. Actions to address comments made must be clearly demonstrated to show the home is committed to improving the ongoing quality of care and services provided. Ongoing action is needed to ensure all staff have regular supervision sessions – at least six per year to ensure training and development needs are identified and met. 8. OP31 9. OP33 10. OP36 Fairfield Residential Care Home DS0000063831.V360063.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Residential Care Home DS0000063831.V360063.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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