Inspection on 01/09/06 for Fairfield Residential Home

This inspection was carried out on 1st September 2006.

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

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

Other inspections for this house

Fairfield Residential Home 17/08/09

Fairfield Residential Home 18/08/08

Fairfield Residential Home 30/08/05

Fairfield Residential Home 02/06/05

Fairfield Residential Home 09/12/04

Fairfield Residential Home 27/07/04

Fairfield Residential Home 05/03/04

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

CARE HOMES FOR OLDER PEOPLE Fairfield Residential Home Fairfield 115 Banbury Road Oxford Oxfordshire OX2 6LA Lead Inspector Delia Styles Unannounced Inspection 1 September 2006 11.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairfield Residential Home DS0000013084.V307165.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 Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfield Residential Home Address Fairfield 115 Banbury Road Oxford Oxfordshire OX2 6LA 01865 558413 01865 513699 fairfieldoxford@onetel.net.uk 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) The Management Committee of Fairfield Alison Parry Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 30 August 2005 Brief Description of the Service: Fairfield Residential Home is situated on the edge of Oxford city centre, and can be easily reached by bus, taxi, or for the more energetic, on foot. It is also within walking distance of Summertown, a shopping area. Fairfield is currently registered for 30 elderly residents. The house is a large town house with exceptionally large well-maintained grounds and gardens. The house has been extended over time to provide 30 single bedrooms 19 of which have en-suite facilities. The internal decor is of a high standard and the home provides spacious accommodation. There is a small passenger lift to the first floor, and the residents have the use of two small kitchens. The current range of fees is from £1601.00 to £2085.00 per calendar month. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 11am and was in the service for 5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. A total of 5 comment cards was received from residents; 6 from GPs who see their patients in the home; and 7 from relatives/visitors. The inspector had a tour of the building, spoke to many of the residents, the manager and several staff and looked at samples of paperwork relating to staff recruitment and training, residents’ care, health and safety. The inspector looked at how well the service was meeting the standards set by the government, and has in this report made judgements about the standard of the service. Residents and staff are thanked for their assistance and welcome. What the service does well: The home is comfortable, homely, attractive and well maintained with domestic style furniture and décor. Residents are treated as individuals and their likes and dislikes catered for in a calm and well-managed environment. Residents and their families and friends made many very complimentary comments about the care provided by the staff such as: ‘We are very impressed with the care and collaborative working relationships which we have with Fairfield. They are always prepared to ‘go the extra mile’ and their local knowledge also helps. They are highly regarded by local professionals’ ‘This is a really excellent residential home, with good management, wonderful staff and excellent facilities’ ‘Fairfield is an extremely happy and well-run residential home. The staff are always welcoming and there is a very low turnover rate. The home is always clean, as are the residents’ rooms. All in all an excellent home.’ Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 7 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 Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable, as intermediate care is not provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are fully assessed prior to admission so the individual and the home can be confident that the placement is appropriate. EVIDENCE: A pack of the information that is given to prospective residents was seen at the inspection. It contained the information needed for the person to make an informed choice. The three resident records looked at in detail showed assessment of the resident’s needs prior to admission. The manager confirmed that all residents were assessed thoroughly before admission to make sure they will meet the specific criteria for residency. Residents are encouraged to visit the home and to stay for a few days before deciding on admission. A trial period of between a month and three months is offered so that prospective residents and the homes staff can decide whether the home will meet their needs. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The delivery of care is good and meets residents needs in a personalised and effective way. Improvements should be made to the recording of care to reflect the practical standards.The health needs of residents are well met with evidence of good multi disciplinary working taking place. EVIDENCE: The inspector looked at a sample of 4 residents’ care records in detail. These consist of a brief summary of each persons care needs with any changes or updates asterisked. Care records are reviewed monthly. Whilst most residents are very independent in this home and do not have many changes in their care needs, there should be a regular evaluation of care so that the manager and resident can check whether the care provided still meets the resident’s needs or whether alterations should be agreed and implemented. One resident who had sustained a significant injury following a fall, did not have an update to their care plan although their care needs had temporarily significantly changed. Though care staff evidently know the residents well, any Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 10 changes to residents’ care needs should be accurately documented so that all staff are aware of any aftercare and follow-up treatment, or additional precautions or risks that affect the resident. There was no accident report for a resident who had fallen during the preceding evening. This resident is at increased risk of falls because of visual impairment. Accurate accident/incident records will assist staff in identifying any particular pattern of accidents, and care records should reflect the ways in which care staff and this resident could minimise the risks of further injuries. Printed medication administration records (MAR) were seen and these showed evidence of the procedure for the safe administration of medication. The medicine cupboards were seen at inspection. Most medication is in individual cassette boxes received directly from a local pharmacy each month and stored in this cupboard. Several MAR sheets had handwritten entries made by the home’s staff, where doctors had made alterations to residents’ prescriptions or added new medications. Where possible, the GP should be asked to sign the MAR chart. If care staff amend the MAR they should have a system to check the source and accuracy of the changes, and cross-reference the alterations to the resident’s daily care notes. Staff should write the name of the doctor or prescriber who gave the new instructions, date the entry and sign it clearly. A second member of staff should check and countersign the MAR, if possible, to reduce the risk of staff making errors that could result in a resident receiving the wrong medication. The MAR charts have code letters to indicate the reason for a resident not receiving prescribed medication. There was no definition for the code letter ‘O’ used on some entries: the manager explained that this indicated that the medication had not been delivered. Staff should use the code letter system accurately to record the reason for any omission of a prescribed medication. Residents are free to choose whether or not to keep and take medicines themselves, and this is an important element of resident choice. All residents have a lockable drawer in their room for storing medication safely. However, the home does not have a formal risk assessment in place to assess any risk to the resident or others in the care home if they look after their own medicines. Staff should undertake a risk assessment to identify whether residents can safely keep and take their own medicines, and ensure that the way in which their medicines are packed and labelled help promote continued selfadministration: for example, ordinary container caps instead of child-resistant closures or large print labels if their eye sight is poor. The manager confirmed all staff who administer medication have received training from the pharmacist and that this is regularly updated. A list of carers who administer medication and a specimen of their usual signature and initials was seen. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 11 Residents’ feel that staff respect their privacy and independence, and this was evident through their responses in comment cards and in the way in which staff and residents interact with each other. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a range of opportuniites to participate in stimulating and motivating activities. There is scope for improvement around meals and menu choices. The manager is aware of this area of weakness and there is a good capacity for the service to improve. EVIDENCE: Several residents said how happy they were with the living arrangements. They appreciate the extensive well-kept gardens and grounds, and the access to Oxford City and Summertown suburb. There is a good bus service in and out of Oxford with bus stops close to Fairfield House. On the morning of the inspection several residents enjoyed taking part in the regular art class. Other weekly or fortnightly activities include ‘physio’ exercises and quiz afternoon. Theatrical shows, fashion and shoe sales are held quarterly. A mobile library service visits every fortnight. Residents can attend local churches and there is a fortnightly Holy Communion service, and a Bible study group in the home. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 13 Relatives’ comment cards showed their appreciation of staff members’ ‘local knowledge’ and the welcoming and helpful approach of staff when they visit. A residents’ diary book in the front hall is used by residents to sign in and out. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs Residents varied in their opinions of the meals and menu choices. There is no choice of the lunchtime main course. The inspector talked to several residents in the dining room at lunchtime. On the day of the inspection lunch was Kedgeree served with garden peas. Some residents were unaware of the availability of an alternative vegetarian dish. One resident complained that hot food was served on cold plates and another that portions were too large, resulting in too much waste. The inspector checked the temperature of the plates and confirmed they were cold. Residents said that menus for the week are usually displayed in the hallway outside the dining room, but this was not the case today. The manager explained that the deputy manager usually makes sure the menus are put up, but that she was on holiday. Residents can always choose an alternative – the vegetarian option, or a plain boiled fish dish, for example. The chef was currently working with limited kitchen equipment – an old gas hob oven had been decommissioned. The inspector was informed that a plate-warming cabinet was available, and that this would be used in future to make sure that hot food was served correctly. The chef only serves the meat/fish portion of the main course, and the residents self-serve their vegetables from serving dishes on each table. Care staff advise the chef about resident’s preferred portion size at mealtimes. The inspector noted that residents have raised the topic of food and mealtimes as one area that could be improved in the home. A comments book is provided in the dining room for residents to enter their comments or suggestions about meals. The kitchen is to be refurbished and re-equipped, and work is due to start in mid-September. It is hoped that this will resolve the shortfall in kitchen equipment and capacity. The manager and chef continue to involve residents when planning the menus. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system and residents feel that their views are listened to and acted upon. EVIDENCE: The home has a written complaints procedure that is included in the information pack given to all residents. The inspector looked at the record of complaints and concerns maintained by the home; this also included a date and comment about how any issues have been resolved. The Commission has received information concerning one complaint made against the service since the last inspection, and judges that the provider has met the regulations in relation to complaints. Residents confirmed that they are able to voice any concerns and are confident that any concerns are listened to and acted upon. Members of the management committee visit the home fortnightly. There is also a monthly residents meeting attended by 2 committee members. The manager or her deputy is always available to speak to residents or their families. This was evidently the case during time spent in the manager’s office, when residents and relatives called in to speak to the manager. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 15 All staff receive training in adult safeguarding issues and this training is regularly updated. All staff receive a copy of the Oxfordshire Multi Agency Codes of Practice for the Prevention of Abuse and the General Social Care Council (GSCC) Codes of Conduct Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment both inside and outside this home is good providing residents with an attractive and homely place to live. EVIDENCE: A tour of the building showed that the home was clean and well maintained. Several rooms were seen and they reflected their owners’ personality with their own possessions and furniture. All residents praised the high standard of cleanliness throughout the home and the way in which the extensive grounds and gardens are kept. The inspector undertook a random test of the hot water temperature in two shower and bathrooms and found it to be within the ‘safe’ recommended range of close to 43ºC. The manager confirmed that the hot water temperatures are regularly checked and adjusted if necessary. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The vetting and recruitment practices are good so that residents are protected from unsuitable people being employed. The arrangements for the induction and training of staff is good. The number and experience of staff mean that residents receive consistency of care that meets their individual needs. EVIDENCE: Residents’ written and spoken comments and comment cards received from relatives, visitors and GPs confirmed that the numbers and skill mix of staff meet the residents’ needs. Comments made included: ‘we are very impressed with the care and collaborative working relationships which we have with Fairfield’; ‘staff are always welcoming and there is a very low turn-over rate’; ‘the staff are extremely dedicated and professional’. On the day of the inspection, a visiting professional expressed her appreciation of the standard of care and knowledge shown by staff in relation to her client(s). The staff confirmed most of them had worked at the home for many years and knew Fairfield and the residents really well. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 18 Residents in this home are largely independent and so the range of care experience that can be gained by care staff who are undertaking more advanced care qualifications through the National Vocational Qualification (NVQ) scheme may require some additional work and experience in other care settings. The manager is aware of this, and tries to ensure that staff remain motivated and ‘stretched’ in their learning programmes and do not become complacent about their roles. Three care staff have have gained NVQ Level 2 qualifications, two will have completed by the end of 2006 and three staff are currently working towards this qualification and should complete during 2007. The manager confirmed that the recommended proportion of 50 care who have NVQ Level 2 or above should be achieved by the end of 2006. The inspector saw evidence of a comprehensive induction and training in staff records. The inspector checked the process in place for the recruitment of new staff by looking at the staff files of two recently appointed staff members, and two others. The files showed that the recruitment procedures are generally satisfactory. One staff member’s Criminal Record Bureau (CRB) check had been applied for, but had not yet been received. The manager said that she had contacted CRB on several occasions to ask the reason for the delay and did so again on the afternoon of the inspection. Two staff files did not have recent photos: the manager explained these were awaiting development. The manager said she would address these shortfalls promptly. The application form for new employees requests 2 references but does not stipulate that one should be from the person’s most recent employer, and the other from someone who has professional experience of the applicant’s work. It is good employment practice to request references from professionals rather than friends or relatives and from the person’s most recent employer in order to check any gaps in previous employment. The inspector also recommends that staff should sign that they have received and read the home’s policies and procedure documents. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements are good, and residents feel involved and able to influence the way in which the home is run. The quality assurance systems are effective and there is a planned programme of improvements to the facilities. EVIDENCE: Mrs Parry has been the registered manager for this home for two years and has achieved the Registered Manager (Adults) NVQ Level 4 and Care management. She has extensive experience in caring for older people. Comment cards confirmed residents’ and relatives’ positive views about how the home is managed. Comments included: ‘this is a really excellent residential home with good management, wonderful staff and excellent facilities’; ‘the management at Fairfield have provided a huge amount of Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 20 support, not just to my [relative], but also her family’; and ‘Fairfield is an extremely happy, well-run residential home’. Residents confirmed they are very involved with any decisions made about the home. They have 3 monthly questionnaires to help maintain the quality of the service. The residents confirmed they could always speak to the management or someone from the Trust’s committee. The manager confirmed that the policies and procedures are regularly reviewed in accordance with good practice. Records of formal supervision with care staff showed that some staff have not had supervision since May or June this year or earlier. The manager acknowledged that the programme of staff supervision has lapsed recently, but that this will be addressed when key senior staff have returned from annual and sick leave. The manager confirmed the residents are in control of their own financial affairs. In cases when the resident becomes unable to do this, a family member or a solicitor has power of attorney. The home has a safe, but residents like to keep possessions safe in the lockable cupboard in their own room. The home employs a part-time administrative assistant and a treasurer. The homes’ procedures for health and safety and maintenance of the home are good, with evidence of regular fire risk assessment and fire safety training, First Aid, manual handling and food hygiene training in place for staff. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations * Care plans should be updated to reflect changes in resident’s care needs and be sufficiently detailed for staff to provide the necessary care interventions. * Evaluation of care should be improved and documented in consultation with residents. * Accident records should be completed as soon as possible after any accident/incident and should be monitored to check whether there is any particular pattern indicating that risk assessments and care plans for ‘at risk’ residents should be amended. * The home should undertake self-medication assessments with those residents who wish to maintain their independence with managing their own prescribed medication. Staff should regularly review the resident’s abilities, and the packaging and storage of medication, to ensure that the storage, administration and effectiveness of the prescribed medicines are safe and as intended by DS0000013084.V307165.R01.S.doc Version 5.2 Page 23 2. OP9 Fairfield Residential Home 3. OP15 4. OP29 5. OP36 the prescriber. * If hand written alterations are made to residents’ MAR charts as a result of a doctor changing resident’s prescription, the member of staff making the entry should date, sign and indicate the source of authorisation on the resident’s MAR chart. Ideally the GP or authorised prescriber should date and sign the amendment in person. * Residents should have a choice of menu at lunchtime. Consideration should be given to producing daily menu sheets on each table and/or for residents who wish to take their meals in their rooms, so that the menu choices are readily available. * Hot food should be served on hot plates and portion sizes managed by the residents themselves as far as possible. * Prospective employees should be requested to give their last employer and a professional source as their two referees. * Individual staff files should include a recent photograph of the employee. The programme of formal supervision of staff should be fully implemented with the recommended frequency of at least 6 times in 12 months. Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fairfield Residential Home DS0000013084.V307165.R01.S.doc Version 5.2 Page 25 - 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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