Inspection on 09/02/09 for Fairfield Residential Care Home

This inspection was carried out on 9th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfield Residential Care Home 21/02/08

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

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fairfield Residential Care Home 27 Old Warwick Road Olton Solihull West Midlands B92 7JQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Fairfield Residential Care Home 27 Old Warwick Road Olton Solihull West Midlands B92 7JQ 01217062909 F/P01217062909 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Dilip Mayariya,Santok Mayariya Name of registered manager (if applicable) Mrs Patricia Dunkley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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. 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. 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. 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. Care Homes for Older People Page 4 of 38 care home 18 Over 65 18 0 Date of last inspection Brief description of the care home Fairfield is a large extended detached house providing care for up to 18 older residents. 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 is a ramp to the front of the home to allow for easy access into the building. 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 offroad parking outside the home. Fees are detailed in the Service User Guide for the home at at the time of this inspection were £360 to £375 per week. Additional charges are made for personal items such as newspapers, dentist, hairdresser, chiropody, clothing and toiletries. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our 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. The last key inspection took place on 21 February 2008. This inspection took place between 7.30am and 7.45pm. Three people who were staying at the home were case tracked. The case tracking Care Homes for Older People Page 6 of 38 process involves establishing an individuals 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 peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Information contained within this has been included within this report where appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. Residents were observed in the lounge and dining room to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. What the care home does well: What has improved since the last inspection? What they could do better: The Service User Guide needs to be reviewed to ensure it contains all of the required information to help prospective residents in making a decision about whether to stay. Care plans in regards to skin care and mobility need to be more specific and detailed to ensure staff support residents appropriately when meeting their needs. Systems for the management of medication need to be reviewed to ensure all medications prescribed are given consistently. Care Homes for Older People Page 8 of 38 Social activities need to be improved to ensure residents are sufficiently stimulated to maintain their health and wellbeing. Menus need to be reviewed to ensure they are sufficiently varied. Residents should be involved in choosing meals for the menus to ensure they have choices that they like. Menus should be on display showing all meals, snacks and drinks available so that residents know what is available to them. Records relating to complaints and management of allegations of abuse need to be reviewed to ensure they contain sufficient information on people to contact and processes that must be followed. The cleaning arrangements for the kitchen need to be improved to ensure all cupboards are kept clean and the freezers defrosted. This is to enable food and equipment to be stored in a clean and safe environment. The laundry needs to be kept clean and organised. Staff need to have access to a dedicated handwash sink, hand drying facilities, gloves and aprons in the laundry to ensure infection control within the home is managed effectively. Staffing arrangements for the home need to be reviewed to ensure they are effective. This applies to domestic and laundry services as well as staff interaction and social stimulation with of the residents. The providers should ensure the manager is supported in her role by ensuring she has access to all up-to-date information relating to the compliance of care standards and regulations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to some information about the home to help them make a decision on whether to stay. An assessment of needs is undertaken prior to residents staying at the home to ensure their needs can be met. Evidence: There is a Service User Guide available in the home which tells prospective residents about the care and services provided. It was evident that some of the information has been updated since the last inspection. The Guide includes a Contract of Residence which sets out the terms and conditions for each resident in regards to their stay as well as the fees charged. There was no summary of our inspection report included within this document as required. This should be given so that prospective residents have access to all information about the home to enable them to make an informed choice to stay. Care Homes for Older People Page 11 of 38 Evidence: During the inspection a query was raised about how hospital escorts are managed. The Service User Guide did not make this clear so that residents and relatives know how this will be managed. The manager was made aware of this. Three people who use the service were case tracked and their files viewed. It was evident that only one person out of the three had an assessment of their needs undertaken prior to their admission. The record in place was for a person recently admitted to the home and also contained a dependency assessment completed by the manager. The manager explained that the other two residents had been in the home for some time and assessments therefore should have been done before she was in post but these had not been located. The manager gave assurances that preassessments are undertaken prior to any new person staying at the home. Care Homes for Older People Page 12 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place to help support the care needs of residents but these are not always clear to ensure care needs are met consistently. Systems are in place to ensure medication is managed effectively but they are not always followed to demonstrate care prescribed is given. Evidence: Since the last inspection the manager has undertaken a lot of work to review all of the care plans in the home to ensure the care needs of residents are identified, risk assessments are in place and staff know what is expected of them in terms of delivering care. Care plans had improved in that they were more detailed and better structured for staff to follow. There were some records that were being kept separately such as professional visits, weights and daily records and this did make the process of reviewing a residents care more time consuming. Care Homes for Older People Page 13 of 38 Evidence: Each of the three residents who were case tracked had a care plan stating their needs and the staff actions required to meet these needs. Files also contained Daily Living sheets detailing a list of each residents needs in a summary format so that those staff less familiar with the residents could easily identify the care to be given. It was evident that staff were aware of residents needs such as diabetes and dementia and knew those residents who required specialist support such as the district nurse. Although work has been done to improve the care records it was evident that the process of ongoing review of residents care was not always effective. This is in regard to both identifying changes and implementing short term care plans for specific needs identified such as wounds or pressure areas. The manager advised that one of the residents had a pressure sore. The file for this person was viewed. There was a care plan in place stating that the resident was at risk of pressure sores and to encourage the resident not to sit for long periods at a time and for staff to check for pressure sores daily whilst undertaking personal care. The continence care plan advises staff to apply cream daily. Staff are instructed to contact district nurse if they have any concerns. It was not clear from the care plans that this resident actually had a pressure sore. This was only established by reading the Pressure Sore Risk Assessment. The manager had completed this assessment showing the resident was at high risk of developing a pressure sore and one had developed in January 09. A moving and handling assessment stated that in May 08 the resident has pressure sores to both heels, it was not clear from this record if these still existed. A falls risk assessment dated in July 08 stated that a pressure sore to the heel has healed. It was not clear why this information has been recorded in the falls risk assessment. The professional visits book showed that the district nurse had given instructions for Cavilon cream to be applied to the residents skin. The nurse also had applied a dressing to the right leg and toe to protect a wound. There was no care plan in the file to show these wounds existed or how staff were to manage them. In February the district nurse had attended to apply dressings to the toes and left heel indicating that this resident continues to have pressure areas or wounds that require attention. Care plan reviews had been completed each month in regard to prevention of pressure sores. These repeatedly stated no change when clearly there were changes in the residents health. The medication records for this resident showed they had been prescribed an antibiotic in regard to the infected wounds which had been given. They also had a food Care Homes for Older People Page 14 of 38 Evidence: supplement prescribed to be given twice a day. The Medication Administration Record (MAR) was not signed to confirm this was being given to help maintain the residents health and to help prevent further skin damage. The fortisips (food supplement) were however available in the home and it was evident the Cavilon cream was being applied. A second resident was reported to have a poor appetite and sometimes refuse food. The resident had suffered a stroke and had limited use of one hand and could not communicate well. A care plan for eating and drinking had been devised stating that staff should encourage the resident to eat and drink well. There were no instructions for staff to regularly weigh the resident or any indication that food supplements should be used. There was also no instruction to monitor the residents food intake. It was established from the medication record that this resident had been prescribed Thick n Easy powder to thicken any fluids and make them easier for the resident to swallow. A carer stated that this had been prescribed because the resident can choke when they take liquids. This was not made clear in the care plan which could result in this powder not being used consistently. It was further noted that the satchets of the powder that had been ordered could not be located to confirm this medication had actually been received and was being used. A meal supplement had also been prescribed, the medication record was not signed to confirm this was being given. Weight charts confirmed this residents weight was being maintained despite the care plan not being specific in how this residents poor appetite should be managed. It was not clear from the mobility care plan how this persons mobility was being managed other than the resident needed the assistance of one or two carers when walking. It was not clear why this was One or Two as opposed to a specific number. The care record should make it clear specifically how many staff are required for the task to maintain the safety of the resident as well as the staff. A falls risk assessment stated that the resident had a history of falls and needed the assistance of one or two carers for walking, standing, toileting, transfers in and out of bed. No equipment to support the resident was listed such as slide sheets, handling belts and it was not clear what the resident could actually do for themselves. This is particularly important as the resident had suffered a stroke and may have limitations in what they can achieve. Care Homes for Older People Page 15 of 38 Evidence: A third residents care plan file was viewed. This showed that the resident was independent in most areas and only needed prompting. A comment card received by us stated that the the management of personal care for a resident in the home was not being managed well resulting in unpleasant odours. This is said to have been noticed on several occasions. This issue will need to be followed up by the manager to ensure the personal care of all residents is being managed appropriately. Medication management was reviewed but it was the first day of the new medications being given so the review was primarily based on records and management of those medications given on the day of inspection. On the whole medications audited were found to be managed appropriately. Those areas where management could be improved related to where medications had been prescribed One or Two X times a day. Staff were not recording on the MAR whether one or two tablets had been given or, two or three spoonfuls had been given. Fortisip food supplements and Thick N Easy powder had not been signed for to show they had been given and Fucidin ointment had a line through it on one record. The member of staff undertaking the medications audit with the inspector could not say why this line had been drawn through the cream on the chart and did not know what it meant. A controlled drugs register was in place and appropriate storage facilities were also available. Warfarin management was checked and was found to be managed appropriately. Training records viewed showed that nine members of staff had completed medication training to help ensure they can administer medications safely. The District Nurse was observed to arrive to administer insulin to a resident. A suitable private place was located to respect the persons privacy and dignity. The nurse said that staff within the home had been shown how to monitor blood sugar levels and they were Managing this much better now. The policy in regards to privacy and dignity for the home was viewed. This states to create a stimulating environment and provide appropriate support services. It also states creating a lifestyle which is flexible and which can adapt and develop as service users change. It was not evident that this aspect of the policy was being met. There was minimal Care Homes for Older People Page 16 of 38 Evidence: social interaction and no social activities were observed on the day of inspection. Care Homes for Older People Page 17 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to some social activities to help meet their social care needs or interests and some residents are satisfied with the food provided. It is not clear systems are in place to ensure residents choices can be fully considered and met. Evidence: There is no Social Activity Co-ordinator within this home but there are some social activities provided by carers and external providers. A social activity diary is being kept and activities that have taken place are recorded. These included hairdresser, balloon game, manicure, bingo, board games, church services every two months. It was not evident that a social activity takes place each day or that there is much variation in activities provided. The manager said that a choir comes into the home and they have mobility exercises every week on a Tuesday. The Annual Quality Assurance Assessment (AQAA) completed by the manager shows that some outside visits have taken place including visits to the Botanical Gardens, Black Country Museum and Dove Theatre. Care Homes for Older People Page 18 of 38 Evidence: The conservatory was noted to contain board games including Jumbo Four in a Row, Game of Life, Dont Panic, puzzles, Trivial Pursuit, I Spy, Skittles and Bingo. There were also some large print books that one of the residents in the home said they would choose from if they did not have any of their own to read. The atmosphere in the home was quiet with little interaction amongst the residents. Staff were observed to speak to residents only when they needed them to do something such as take their medication or when they were giving them a drink. There were four residents in the one lounge during the morning two of them were asleep and two awake. In the other lounge there were a similar number with some residents coming in and out. One resident was talking to themselves and one was drifting in and out of sleep during the day. One person had got ready to go out and was waiting for their relatives to arrive. One resident commented on how warm the home was and said they did not know how the residents could just sit and not do anything. Another resident displaying symptoms of dementia said yes everyone is fed up and sitting down is only thing to do. They used to do lots of things they dont do nothing now there is nothing to do now. Another resident said its terrible things have gone down and was suggesting staff were not as attentive as they usually are. We were advised that the providers who usually spend time in the home with the residents were on a long holiday. Later during the day the television was put on and the member of staff did flick through the channels with the remote controls to find something the residents may like to watch. Comment cards were received by us from six residents but three of these residents had the help of a member of staff within the home so their responses will not be an independent view. Of the three that responded without help, two were assisted by a member of their family. One stated that there are always activities arranged by the home they can take part in and state we have chose to stay in our room and only go downstairs occasionally. Another states there are usually activities they can take part in and another states never. Of the three that had assistance from staff, two have stated there are always activities they can take part in and one has stated usually. Care plans continue to detail personal choices in regards to how residents would like their care and services to be provided. This includes preferences of times they get up Care Homes for Older People Page 19 of 38 Evidence: and go to bed, what time they want breakfast, whether they prefer a bath or shower and how often. One also showed food preferences for breakfast. Menus for the home were not seen to be on display so that the residents could see what meals, drinks and snacks were available to them. Menus held in the kitchen had two choices of main meals each day but some of the choices on some days were very similar. For example choices on Wednesday, week 2, are cod with parsley sauce or fish cakes, this is two fish dishes. Friday of same week, scampi or fish fingers. Saturday, beef stew or beefburgers. Other choices included sausage casserole, pasta bake, chicken curry, pork chops, faggots, lamb chops, Cornish pastie, mince and onion pie. On the day of inspection the meal served was sausage casserole, the second choice as stated on the cooks menu should have been pasta bake but this was not provided. The handyman was doing the cooking and said that the residents didnt like pasta bake and so beefburgers had been cooked instead. Meals were observed, the sausage casserole option consisted of two scoops of mashed potato, sausage in gravy and mixed vegetables. Two residents were observed to have beefburgers which the handyman said he had cooked so they were soft for the residents to eat. These did not look very appetising. Residents were seen to eat the meals and some enjoyed them. One person was observed to scrape their plate clean with their knife. There were some residents that did not enjoy them. It was established they did not like sausage very much or beefburgers. They would have preferred a sandwich but were not aware this was an option they could have. One person declined to comment on the food and another was unable to effectively communicate their thoughts. One resident said during the inspection dinner was beautiful yesterday. It was not evident that the meals on the menu were being followed. A copy of the choice list for the day was requested but this had not been completed. The inspector was informed this would be done after residents had eaten. Residents spoken to prior to lunchtime could not say what they were going to have. This information suggests that the residents are not being offered a sufficient choice. The food available in the home was viewed. One freezer was full of food, another was heavily frosted with one of the drawers jammed shut due to the build up of frost. There were limited stocks of fresh produce. The food cupboard is kept locked and was stocked mostly with value tinned food and dried produce. Staff were asked if there was Care Homes for Older People Page 20 of 38 Evidence: any home cooking and they stated that the cook does make cakes. A visitor said they had seen the residents have scones. Sandwich choices for the evening meal were not indicated on the menus. On days when there is soup and sandwiches it is either soup or sandwiches and there appears no option to have both. On the day of inspection it was sandwiches or spaghetti on toast. The spaghetti was noted to be very watery. The second options on the teatime menu sometimes consist of salads or a toasted sandwich. This suggests residents have limited choices available to them and sometimes no hot choice. Milky drinks for supper are not indicated. The inspector was made aware that a resident likes Horlicks. Menus did not indicate this is provided and it was therefore not clear this choice is made available. Menus state that fresh fruit should be offered between meals. The fruit bowl in the dining room had three apples in it that looked shrivelled suggesting they must have been there for some time. The manager advised that the handyman was temporary working in the kitchen and she was hoping to employ a second cook. Training records seen showed that the handyman and all care staff had completed training in food hygiene. Comment cards received by us from six residents show that four residents always like the meals in the home and two people sometimes like the meals. One comment states I do not like most of the meals and they also state they do not like sausage, beefburgers and liver as it is hard to chew. The resident has also commented that they are not usually aware of what they are having for dinner. Care Homes for Older People Page 21 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know how to make a complaint but procedures are not clear in regards to the management of complaints and protection ensure staff know their responsibilities in safeguarding residents. Evidence: We have not received any complaints for this service since the last inspection and the home also have not received any complaints. The Complaints Procedure in home was viewed. This contained details of the manager and the homes contact telephone number but did not contain details of the provider, Social Services or our current address and current telephone number as required. The complaints procedure in the Service User Guide was different to the one on display but also did not contain sufficient information in regard to contacts and telephone numbers. It was however more specific about how complaints are managed and our correct address was detailed. The procedures that the home follow in the event of alleged abuse were viewed. The procedure was not sufficiently detailed in regards to contacts and telephone numbers should abuse need to be reported. A member of staff was asked about what they would do in the event of observing abuse and they stated they would wait for the Care Homes for Older People Page 22 of 38 Evidence: manager to come in to report it if she was not on duty. Incidents of this nature need to be reported promptly and staff need to be aware of the reporting processes in the absence of the manager so that appropriate action can be taken. This response demonstrates that not all staff are fully aware of their responsibilities. Care Homes for Older People Page 23 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is warm, homely and comfortable but some cleaning practices could be improved to ensure both residents live in a pleasant environment consistently. Evidence: The environment is homely and pleasant and residents have access to two communal lounges which can be split by glass doors. Since the last inspection new carpets have been purchased for both lounges. Chairs are now placed across the glass doors so that the lounges are used separately as opposed to having one large open lounge. There is a conservatory off the one of the lounges which overlooks the garden and which contains cane type furniture. The conservatory is accessible to residents but only one person chose to sit in here as it was cooler than the lounges. 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 woodpanelled floor and the majority of residents use this at mealtimes. Residents have a choice of using the communal shower or bath. The bathroom was however being used to store a zimmer frame, wheelchair and commode which makes Care Homes for Older People Page 24 of 38 Evidence: it less homely for the residents. The home has two floors and residents can access the upper floor via a shaft lift. Some of the corridors on the first floor have steps leading to bedrooms that would not be suitable for people with mobility difficulties. Some bedrooms viewed were pleasantly decorated and tidy and contained equipment to support the resident such as a toilet raiser and handrail. In one room viewed the residents dirty clothes were on the floor and the incontinence sheet on the bed was stained. The manager gave assurances this had been washed and the delays in removing the residents dirty clothes had been due to the resident being in bed for periods during the day. This was observed to be the case by the inspector although the manager did acknowledge that the clothes should have been removed. The towels available were frayed on the edges and looked well used and in need of replacement. In another room the carpet was in need of hoovering and the net curtains in the ensuite looked dirty. The manager has identified in the Annual Quality Assurance Assessment (AQAA) forwarded to us that there are areas within the home that need to be decorated. It states that they plan to continue with their decoration and maintenance programme. There were no unpleasant odours identified. The kitchen area was viewed and some areas were not being maintained in a clean condition. One of the freezer drawers was jammed shut and was broken suggesting the freezer was overdue to be defrosted. Some of the cupboards in the kitchen were in need of cleaning and a meal had been left in the microwave. A member of staff said that it needed to be thrown away and did this immediately. The laundry is in the basement of the home. The laundry continues to be an area that could be improved in regards to organisation and cleanliness. There is sufficient equipment in the laundry for cleaning and drying clothes but no dedicated member of staff to manage laundry. Care staff are allocated to do this each day. White open-weave baskets were being used for dirty laundry which are not easy to clean to maintain good infection control practices. Gloves are kept in the main part of the home as opposed to the laundry where they should be accessible to staff. The manager said that whoever is in charge of the laundry that day brings gloves down Care Homes for Older People Page 25 of 38 Evidence: into the laundry with them. The handwash sink was dirty and had some dirty cloths in it. There were no paper towels available for staff to dry their hands should they have access to the sink. Staff should have access to a dedicated handwash sink in the laundry to wash their hands. The inspector was advised that there was nobody in the home cleaning on the day of inspection. One carer had been allocated to be in charge of getting dirty clothes into the washing machine out of the three carers on duty. A resident spoken to said that one of their main concerns was the management of their laundry. This person said they are very strict. They explained that staff had come to empty their wardrobe to wash their clothes but stated they dont always come back and that worried them. The resident seemed very anxious about this. A comment card received by us stated the washing is not of a high standard, I have found soiled pants in X drawer. Care Homes for Older People Page 26 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements for the home are not clear to demonstrate there are sufficient staff to support both the care needs and provision of ancillary services to residents consistently. Evidence: The manager confirmed that she aims to have three carers on duty during the morning, two carers on duty between 2 to 8pm plus an additional carer between 4pm and 8pm and two waking night carers. Duty rotas showed that these staffing arrangements are being met. The manager works in a supernumerary capacity. Duty rotas showed that the manager is working a long day from 8am to 8pm from Monday to Friday. On the day of inspection there were 15 residents in the home. The manager said that there is a domestic person who does the cleaning on four days per week. Duty rotas seen over a four week period showed that for two weeks a domestic person worked from 9 to 1pm but for two weeks there was no member of staff identified to complete these duties. It is not clear from the rotas who does the cleaning in the home when the domestic person is not on duty. No extra carers are Care Homes for Older People Page 27 of 38 Evidence: identified on the duty rota when the domestic is off. The manager confirmed there is no laundry person employed and that care staff do this. She stated that each day a person is identified to do this. Duty rotas do not indicate which staff are undertaking this duty or what hours are allocated to confirm these are sufficient to support the needs of the home. There is a dedicated cook who works five days per week. The handyman is indicated on the duty rota to do the cooking on the other days. The manager said that she was hoping to employ another person to do the cooking on the two days when the cook is off duty. As carers are covering laundry and cleaning duties this will reduce the amount of time they can spend providing care to the residents. Residents and relatives spoken to gave mixed responses in regards to questions asked about staff. One person said requests are sometimes carried out by staff. One person said the staff just seemed to treat it as a job and suggested that staff were not as attentive as they used to be. During the inspection a member of staff was observed to help a resident out of her chair to support them to the bathroom but then the carer looked out the window and walked behind the resident with no attempt to interact with them. Other carers were observed to go about their duties with little interaction with the residents. The handyman who had been allocated to work in the kitchen on the day of inspection was noted to have a cheery personality which residents did react well to. Comment cards received from residents show that two out of six feel that staff are always available when they need them and four feel they usually are. Five residents have stated that staff listen and act upon what they say and one person has stated they do not. They have commented it can vary depending on who is on duty but queries or requests more often than not dont seem to get passed on. Training for staff is provided and records confirmed that all care staff have completed moving and handling training and most have completed food hygiene, first aid and fire training. The manager has indicated due dates for other staff to attend which demonstrates a commitment to staff completing statutory training. It was not evident that care staff have completed training in dementia despite there being residents in the home with this condition. If staff have not had this training then it cannot be demonstrated that staff have the skills and knowledge to care for these residents effectively. Action will need to be taken to address this. Care Homes for Older People Page 28 of 38 Evidence: It was noted that a resident showing symptoms of dementia in the care home was not socially stimulated throughout the day with the exception of when they received a visitor. The training schedule seen shows that six care staff have completed a National Vocational Qualification (NVQ) II in Care out of the 14 permanent care staff employed. This training helps staff to provide more effective care to the residents. A review of staff records was undertaken to confirm recruitment practices carried out. Appropriate checks had been carried out including two written references for each member of staff. One of the Criminal Record Bureau (CRB) checks had not been received although this had been applied for in August 08. A check to see if this person was on the Protection of Vulnerable Adult (POVA) Register had been received. The manager agreed to follow up the missing CRB check. One member of staff had presented an ID card stating that this was their passport. This will need to be checked with the appropriate agency to ensure this is correct. Staff had undertaken some induction training but it was not evident that staff competencies had been evaluated as part of the training undertaken. Records need to demonstrate that new staff have completed training in relation to the Skills for Care Common Induction Standards which is usually undertaken over a period of weeks to allow staff to build up their competence to care for residents safely and effectively. Care Homes for Older People Page 29 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is continuing to develop ways to improve the home to ensure this is run effectively and in the best interests of the residents. Systems for monitoring quality of care and services for residents are not always independent to ensure the views of residents are accurately reported and can be acted upon as required. Evidence: Since the last inspection a new manager has been appointed to the home. At the time of this inspection the application process for the manager to become registered with us was still being completed. The manager has a National Vocational Qualification IV in Care and a Diploma in Management and has worked in the caring profession for a number of years. She advised that she has recently undertaken all of the statutory training such as moving and handling, fire, food hygiene as well as training in prevention of abuse and diabetes. Care Homes for Older People Page 30 of 38 Evidence: It was evident that the Annual Quality Assurance Assessment (AQAA) completed by the manager was not fully comprehensive in demonstrating compliance with care the standards. For example there were no dates when policies and procedures had been reviewed to demonstrate they were up-to-date and there was no information detailed in regards to some of the standards to demonstrate how they were being met. The manager was advised to discuss this matter with the provider to ensure she has all the information required to ensure the home complies with the care standards and regulations. The accident book for the home was viewed but completed sheets had been removed and stored into resident individual folders. This made it difficult to evaluate that appropriate actions had been taken following accidents in the home. The manager had completed an accident audit but this was only in relation to falls and there was no outcomes recorded so this was also difficult to evaluate. It was evident that some residents had sustained multiple falls which had not been reported to us. The manager explained that she had been told by us that she did not need to report falls. Where accidents can impact on the safety and wellbeing of the residents, these must be reported to us this includes multiple falls of any one resident. This is so we can be sure the home is taking appropriate action to address these to safeguard the resident. A review of residents money was undertaken. Records and money available were found to be accurate. Receipts were available for most transactions made. It was found that two receipts were missing for one resident (these have subsequently been found by the manager). For another resident there were no receipts, the manager said that this was because they kept theirown. Storage facilities for residents money were observed to be very small with insufficient space to store records and monies effectively. Quality monitoring of the service is carried out although it was evident that staff have in some cases assisted residents in completing questionnaires which is not an independent process. It was evident during the inspection process that residents gave mixed views about the home. Some of these views are indicated earlier in this report. One persons comment card states the manager and staff are always there to provide help and provide information. Another states X states she is always happy here. Another states their concern that their relative does not always seem to be washed and soiled clothing has been found in the room. Care Homes for Older People Page 31 of 38 Evidence: Residents meetings are held two monthly. The notes were viewed for a meeting that had taken place in September. These showed that residents had been asked if they were happy, if they were satisfied with social activities and if they know how to complain. Positive responses had been received and any actions required had been documented. Relatives had been sent questionnaires to ask their opinion of the service. Questions asked included, How do you rate the quality of care, How do you rate the friendliness of staff, How do you rate the cleanliness of the home and What are your overall impressions of the home. Again mostly positive responses had been received with good or excellent ticks being completed against questions asked. One relative gave excellent ratings to all questions and stated all residents always clean and tidy open visiting, lovely meals. They also state that they have never had to make a complaint. A professional visitor has indicated improved lately, staff appear more friendly. Another professional visitor has stated that staff are caring and considerate, very friendly and helpful. They have also stated that the service is excellent and they would recommend it to others. Staff meetings are held and the notes of a meeting held in January 2009 were viewed. Issues discussed included laundry, gloves, completion of duties, signatures on medication records and keeping the kitchen clean. There were also reminders to staff about checking specific residents regularly. This demonstrates that the manager is identifying where improvements need to be made and is taking action to report this to staff to help this happen. Health and safety checks had been undertaken within the required timescales for gas and hot water. The five year electrical check could not be located. The electrical portable appliance checks had been provided to the home on a CD which meant this could not be accessed by staff to confirm what had been tested and when. The manager did however state these had been completed on 19 June 08. The AQAA provided by the manager stated that checks had recently been completed on fire equipment, lighting and the alarm. Care Homes for Older People Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The needs of residents with 31/03/2009 mobility must be met safely. Care plans for mobility need to be clear in regards to what residents can do independently and how staff are to support them and with what equipment. This is to ensure staff support residents safely and appropriately. 2 7 12 Reviews of care needs must identify changes in health and the support required. This is to ensure the support provided meets the needs of the resident. 31/03/2009 3 7 12 Care plans need to be developed for short term needs such as pressure sores and wounds to ensure staff know how to manage these. 31/03/2009 Care Homes for Older People Page 34 of 38 This is to ensure residents receive the care they require and a consistent approach is adopted by staff. 4 9 13 Medication prescribed must be given consistently. This is ensure the health of the resident is maintained. 5 27 18 Staffing arrangements for the home need to be reviewed to ensure they are sufficient. They also need to be clearly demonstrated on duty rotas. This is to ensure staff are being deployed effectively in all areas to meet both the care and service needs of the residents consistently. 15/04/2009 13/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should contain a copy of the summary inspection report for the home to ensure prospective residents have all the information they need to make a decision to stay. This matter has not been addressed from the previous inspection. The personal care for all residents needs to be managed effectively. Actions should be taken to ensure all staff are following the homes procedures in regards to personal care to ensure all residents are kept clean consistently to maintain their health and wellbeing. Any changes to medications should be signed and dated with evidence these changes have been agreed by the GP. This is to ensure there are clear records in place to prevent any errors in administering medication to the residents. 2 7 3 9 Care Homes for Older People Page 35 of 38 4 12 The provision of social activities and social stimulation should be reviewed. This to ensure the social care needs of all residents are met consistently to maintain their health and wellbeing. It is recommended that residents are involved in developing the menus to ensure they have items on the menu that they have chosen and will enjoy. Any resident involvement should be demonstrated within records as appropriate. Residents need to receive a varied and nutritious diet and records of meals provided need to demonstrate this. Copies of full menus should be made available to residents so that they are aware of choices available regards to meals, snacks and drinks on a daily basis. The complaints procedure for the home needs to be reviewed to ensure this includes all of the required information in assisting a resident or their representative in making a complaint. The procedure for the management of an allegation of abuse needs to be reviewed to ensure this contains all of the information required to make a referral. Staff will also need to be clear on their responsibilities for managing any allegation received or observed. The laundry system needs to be managed effectively to ensure all laundry is cleaned appropriately and returned to residents promptly for them to use. All areas of the home need to be maintained in a clean condition consistently. The laundry area needs to be kept clean and organised. Staff need to have access to a dedicated handwash sink as well as hand drying facilities, gloves and aprons in the laundry to ensure infection control within the home is managed effectively. This is outstanding from the previous inspection. National Vocational Qualification training should continue to ensure at least 50 of the care staff hold this qualification to effectively care for the residents in the home. Recruitment records need to be followed up as appropriate to ensure it can be demonstrated that staff are deemed suitable and safe to care for the residents. Staff must be suitably trained to meet the care needs of the residents in the home this includes those with dementia. Staff induction should be suitably comprehensive to Page 36 of 38 5 14 6 7 15 15 8 16 9 18 10 26 11 12 26 26 13 28 14 29 15 30 16 30 Care Homes for Older People demonstrate staff competencies in regards to meeting the Skills for Care Common Induction Standards. This is so that staff can care for residents safely. 17 31 It is recommended that the providers ensure the manager can access the CSCI professional website to enable her to keep updated in matters relating to the care standards and regulations and assist in her Management role of the home. It is recommended that storage facilities for any monies kept at the home are reviewed to ensure these are both sufficient and suitable. It is advised that the manager develops a system which enables the effective auditing of accidents so that any patterns in relation to these can be easily identified and acted upon. Confirmation is required that all health and safety checks have been completed as required including the 5 year electrical wiring check. 18 35 19 37 20 38 Care Homes for Older People Page 37 of 38 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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