Inspection on 17/08/09 for Fairfield Residential Home

This inspection was carried out on 17th August 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfield Residential Home 18/08/08

Fairfield Residential Home 01/09/06

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 25/11/2009.

Key inspection report Care homes for older people Name: Address: Fairfield Residential Home Fairfield 115 Banbury Road Oxford Oxfordshire OX2 6LA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kate Harrison     Date: 1 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Fairfield Residential Home Fairfield 115 Banbury Road Oxford Oxfordshire OX2 6LA 01865558413 01865513699 aliparry@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Management Committee of Fairfield care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Fairfield Residential Home is situated on the edge of Oxford city centre, and can be easily reached by bus, taxi, or on foot. It is also within walking distance of Summertown, a shopping area. Fairfield is currently registered for 30 older people. The house is a large town house with large grounds and gardens. The house has been extended over time to provide 30 single bedrooms, all with a sink and vanity unit, and 19 rooms have en-suite facilities. There is a small passenger lift to the first floor. Care Homes for Older People Page 4 of 31 Over 65 30 0 1 8 0 8 2 0 0 8 Brief description of the care home People living at the home have the use of two small kitchens. The fees currently range from GBP 420.00 to GBP 546.00 Care Homes for Older People Page 5 of 31 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: zero star poor 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: This inspection of the home was an unannounced Key Inspection, and was carried out by one inspector between 10.15 and 18.30 during the day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home through the homes self assessment document, the Annual Quality Assurance Assessment (the AQAA) and any other information we received about the home since the last inspection. We looked at records and documents relating to the care of the people living there. We saw recruitment records and information about staff training, looked at how peoples medication was managed and we saw the communal areas of the home. We asked the views of the people who live in the home, through questionnaires we had sent out. Altogether we received 13 completed surveys from people living in the home, and their views are reflected in this report. We spoke to several people living in the home during our visit, to the manager, the deputy manager and some staff members, and discussed the running of the home with them. This inspection was a thorough look at how well the home is meeting the standards set Care Homes for Older People Page 6 of 31 by the government and in this report we make judgements about the outcomes for the people living in the home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 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 9 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not provide intermediate care. Pre-admission assessments are carried out but people do not always receive enough information about the home before they move in. Evidence: The home has changed the recording system since our last visit and now records the pre-admission assessments using a preprinted format. We saw pre-admission assessments for three people and these contained basic information about the needs of individuals requesting admission to the home. We noted that a letter is sent to individuals following assessment stating that the home could meet their needs, and the first month is seen as a trial period. People receive an information pack on admission and we saw that the complaint procedure supplied as part of the homes statement of purpose does not include the timescale of 28 days for the home to respond to complaints, although the separate copy states that the home will respond within 14 days. The discrepancy needs to be addressed so that people receive all the Care Homes for Older People Page 10 of 31 Evidence: correct information they need about the home. We noted that the home did not display a copy of our last inspection report in the home, but displayed a copy of our last annual service review of 2008, and a copy of the current inspection report needs to be available for people. People who spoke to us were not clear about some aspects of how the home is run, and the manager agreed to supply an up to date copy of the statement of purpose and service user guide to people living in the home. Part of the managers contract is that she lives in the home, but people told us that it was not always clear what this meant for them and there is no written information for people about how this could affect them before they move into the home. The home needs to clarify in its written information about the home how this affects people before they move in. Care Homes for Older People Page 11 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not always properly met, and the home is not meeting its statement of purpose as dignity and choice is compromised. Evidence: We saw three care plans showing that risks are assessed and basic care plans developed to meet health and personal care needs. The home uses a proprietary documentation system and this does not include the recommended evidenced based assessment tool for assessing people who may be underweight. We discussed this with the manager and she said she would start to use the recommended tool, so that people at risk of being underweight are better identified and their health needs better met. The care plans we saw need to be more personalised as they do not usually document peoples preference in how their care is delivered, including how they want to manage their medication. People told us during our inspection and by responding to our survey that they could not have a bath or shower every day if they wanted to. One person said that this was very much against personal preference, as his/her usual practice was to have a bath every day. We discussed this with the manager who told us that it was at times not possible for people to have a bath, as people who needed Care Homes for Older People Page 12 of 31 Evidence: assistance with personal care needed to have a staff member to help and a bathroom free, and as they were sometimes not available this meant that some people did not have a bath every day. We found that this shows a lack of understanding and concern for individual rights and is not in keeping with the homes statement of purpose. The statement of purpose states that the philosophy of the home is to meet the physical, intellectual, emotional, spiritual and social needs of the individual in such a way as to maintain their dignity and independence, while promoting choice and autonomy. The homes self assessment document, the AQAA, says that it does not discriminate against people because of age, but as people with a physical disability cannot have a bath every day it means they are not having the same service as people who do not have a disability, and this needs to be addressed, to make sure the home is not discriminating against some people. The home is failing to understand the negative social and emotional effects that the lack of control over their personal care is having on people, and they need to take action to address it. The majority of people who responded to our survey told us that the home usually or always makes sure that they get the medical care they need. One individual stated that there are times when we would like to see our doctor but he sends instructions by the management. The manager states that the individuals GP would make the decision if they would need to visit. The manager states that no GP has ever refused to visit when the home has requested a home visit in an emergency. People are encouraged to remain with their general practitioner if possible after admission, and some prefer to manage their own medication. We looked at how the home manages medication. Information in the AQAA , the homes self assessment document, shows that a risk assessment is carried out to make sure the individual can manage their medication safely and secure facilities are provided for safe storage. We asked about the risk assessments and understood that they were not recorded and centred around the persons capacity to manage. Written risk assessments need to be in place, in accordance with the Royal Pharmaceutical Societys The Handling of Medicines in Social Care, the recommended guidance for care homes. At our last inspection visit we found that the controlled drugs cupboard was not appropriate and that there were errors in the recording of medication. We made a requirement that the home provide training about medication for staff and install an appropriate controlled drugs cupboard. At this inspection we found that medication that should be stored in the controlled drugs cupboard was stored in the general medications cupboard. The manager and deputy manager had discussed the storage of the medication with the pharmacist and had been informed that it did not need to be stored in the controlled drugs cupboard. However we noted that the manager had not consulted the Royal Pharmaceutical Societys guidance for care homes, and this clearly states that the medicine must be stored in the controlled drugs cupboard. This was confirmed on the day of inspection by a pharmacist, and the medication was moved to the controlled Care Homes for Older People Page 13 of 31 Evidence: drugs cupboard. We found that the temperatures in the fridge used for the storage of medication were not recorded, and although no medication was in use that needed to be stored at a temperature below 8 degrees, the temperature in the fridge should be monitored daily to make sure that any medication needing to be stored in the fridge would be stored appropriately. A fridge thermometer was found and arrangements made to start the daily recordings. The homes manager needs to take responsibility for the management of medication, and make sure it is managed in peoples best interests according to the Care Homes Regulations and this includes updating the homes policy and procedures for the management of medication. The AQAA shows that the home does not have a policy in place for managing any physical intervention and restraint, and the home needs to develop a policy, so that staff have the appropriate information and training if an event arises. Care Homes for Older People Page 14 of 31 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. The provision of few activities and concerns about the quality of the food mean that some people in the home are not supported to follow personal interests and do not feel that they have a healthy diet. Evidence: An equal number of people living in the home who replied to our survey said that there were always, usually and sometimes activities available they could take part in. Some people are able to go outside the home independently and several have trips out regularly with family members. The home does not organise any trips out, so if individuals need support to go out they are unable to. The homes garden provides good outdoor space and we saw some individuals enjoying the good weather on the day of our visit. The homes self assessment document shows that seasonal activities are organised such as the Christmas and summer parties, and states The manager works hard to ensure that the residents have a varied program of activities and encourages visitors to participate where possible. The activities are often seasonally related and are arranged according to the residents choices and taste. Some of the responses to our survey commented that more activities would be welcome. When we looked at the August Calendar showing the activities schedule we saw that there are usually two activities provided every week, an exercise class and an art class, among Care Homes for Older People Page 15 of 31 Evidence: several religious meetings and visits from the hairdresser. Sometimes an individual comes to play the accordian, and several people told us that they did not like this entertainment. Our last inspection report of August 2008 commented that people then said that if meditation and bible study did not appeal there were few other activities provided, but the home has not acted on this and the provision of activities has not improved. We discussed this with the manager and she said she had organised an activity following a complaint about the lack of activities, but some people complained that as it was in the main lounge it prevented them from using the room. We saw from the feedback following this years quality assurance survey that people commented on the lack of activities provided. The feedback included an invite to people to let the manager know if they had any ideas about what activities they would like, but we understood that no further action has been taken to address the issue and people in the home who are not able to go out independently for social activity are not having their needs met. The homes statement of purpose states that residents are encouraged to participate in various activities but there is very little variety provided by the home and this needs to be addressed. One individual said its up to the individual, but if your family cant help then it is a very different story. A group of individuals in the home organise activities around their common religious practice such as the twice weekly bible study sessions and regular Evensong. Christian ministers of religion visit regularly and support people who want to attend church services. Visitors are welcome in the home and can make arrangements to have lunch or stay overnight in the home. People gave a variety of views about the meals provided at the home, and the majority said they usually or sometimes liked the meals. Some said the food was good but comments from people living in the home included: soup tepid and flavourless, food could be better food not suitable for our age group, too much potatoes and puddings and cakes and cream and not enough fruit and vegetables. One individual commented that better organisation of meals and distribution of food would improve the home. People also told us during our inspection that the food was not suitable for their age group, and needed to have more fruit and vegetables provided. The manager said that there is regular consultation about the meals provided and that action is taken whenever possible to improve peoples experience, but people have concerns about the meals provided and more action needs to be taken to meet their needs. Care Homes for Older People Page 16 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people know how to make a complaint some people in the home have no confidence that their concerns or complaints will be properly addressed. Evidence: We saw the homes complaints procedure displayed on a notice board in the lounge, containing information that all complaints are responded to within 14 days and people can contact the Chairman of the Managing Committee if their complaints are not addressed. The procedure does not contain our phone number as required by legislation, and so the document is incomplete and does not give enough information to people if they want to contact us. The manager said that the procedure would be updated to include our phone number in all copies of the homes complaints procedure. The home keeps a record of complaints but it is difficult from the records to see that the timescales are kept, and the record keeping needs to be improved to clearly show when complaints were responded to, what the response was, and if the complainant was satisfied with the homes response. We understood that complaints made to the Management Committee may not always be recorded, but all complaints about the home need to be documented, including those made verbally to the home or to the Management Committee, to make sure that the home responds appropriately. All but one person who responded to our survey said they knew how to make a complaint, and one person said but the Committee is not open to change. We received recent information about comments made to a representative of the local authority about the lack of activities provided in the home. Care Homes for Older People Page 17 of 31 Evidence: We saw that the homes safeguarding procedure does not contain all the details staff members need to consult the local Safeguarding Team, and the manager said that it is being updated so that staff members know who to contact if they need advice about protecting people in their care. We saw the updated procedure following the inspection and it needs to show that the local Safeguarding Team take the lead in investigating allegations, not the home as stated in the procedure. We asked members of staff if they had attended safeguarding training and they said it had been provided and they knew what to do if they suspected abuse in the home or were accused of harming people in their care. Care Homes for Older People Page 18 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home cannot be sure their environment is safe, as the home has no effective quality assurance procedures for the identification and management of risks to do with the environment, and people feel they are excluded from parts of their home. Evidence: The home is well situated near shops and facilities and has a good sized well maintained garden, with paths and seating. The home employs a person who is responsible for the general maintenance and upkeep of the home, so that issues arising can be addressed on a daily basis, and she/he has completed a health and safety course. The homes AQAA states that the staff all receive health and safety training as well as infection control and advice on the use of chemical and cleaning products, but we found that the training is not used effectively to protect people living in the home from hazards. We saw all the communal areas of the home, and noted that an upstairs bathroom and toilet had no restrictors on the windows causing a hazard for people, including visitors to the home, as a person could fall from the windows. This does not reflect what the AQAA says, as it states: safety and security is taken very seriously; all windows above 1.5 metres from the ground are fitted with restricted opening devices. We also noted that a bottle of bleach and a bottle of toilet cleaner was stored on the floor of a downstairs toilet, and that chemicals were stored in the laundry room with Care Homes for Older People Page 19 of 31 Evidence: easy access for individuals, causing hazards for individuals living in the home and visitors. Hand drying facilities were missing from one bathroom and the laundry room, so that people were not able to dry their hands properly, and this aids the spread of infection. The manager arranged for paper towel dispensers to be fitted and the chemicals to be stored safely and this was done during the day. She also arranged for window restrictors to be fitted to the identified windows and confirmed she would carry out a risk assessment about access to the area until the window restrictors were fitted. Following the inspection we received information that the risk assessment was in place while awaiting the fitting of restrictors, so that people were not put at risk of falling out of the window. We noted that some areas of the home including the bathrooms were not kept clean and discussed these individually with the manager. She said she would arrange a deep clean for the areas identified. The majority of people told us through surveys that the home was always fresh and clean, but some said it was sometimes fresh and clean, and comments included could be cleaner and the cleaning should be much better. On the day of inspection comments to us included cleanliness of bathrooms needs to be improved. People also told us that they do not have access to some communal rooms at certain times of the year. The manager explained that the home has an arrangement with a local school to use a lounge room over examination time and for that time people living in the home are excluded. She said this happened a minimum of 12 times over the recent school exam period with the exclusion lasting about 3 hours at a time. She said that people had given approval for the arrangement, but we understood that the arrangement was not recorded and it was not certain that all the people in the home had given their agreement. It is not mentioned in the homes information pack so people are not aware of the arrangement before making their choice of home. At the time of the inspection visit the manager informed us that the small passenger lift to the first floor was not being used. This is following an Oxfordshire County Council Health and Safety inspectors visit in February 2009 when concerns were raised about its safety. Following recommendations made by the homes insurers the home is looking to replace the small passenger lift to the first floor. Care Homes for Older People Page 20 of 31 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. Some people cannot be sure that their needs will be met, as they cannot depend on enough staff being available to help them or that the staff team will be able to work in their best interests due to the type of training and supervision provided. Evidence: The staff team at the home is stable and people living there appreciate the continuity this gives them. The majority of people told us through our survey that there are always or usually staff available to help them when needed, and comments from our survey about the staff group include very friendly, very helpful, very kind and caring and staff very patient. During the inspection individuals told us that the girls are very good and staff good. From information provided in the AQAA about staffing levels, and staffing rotas seen, there are not enough staff available at times to meet the needs of the people living there, as people had told us, and the home must address this so that people receive personalised care. The homes rota does not show what shifts the deputy or manager work, but they do not work evenings or weekends. The manager, deputy manager or a former manager of the home is on call when they are not on duty. People also told us that at weekends they would like a senior manager to be available, and we saw from the July residents meeting that they requested a named deputy be in place to support the deputy manager while the manager was on holiday. This reflects their anxiety about management cover and the home needs to discuss with people living in the home how their concerns about the Care Homes for Older People Page 21 of 31 Evidence: homes weekend management can be addressed. Five of the 14 care staff team hold the National Vocational Qualification (NVQ) Level 2 in Care and the AQAA shows that two more are taking the training and two more are due to enroll. This means that the home has made little progress in improving the numbers of staff with an NVQ Level 2 from last year when there were four staff members with the qualification. The homes AQAA states that the induction programme for new staff members is to the Common Induction Standards, and that all care staff received the necessary regular training, including about moving and handling people, fire training and infection control. The manager told us that recently the home has started using training courses from a new training provider. The training is through distance learning and the manager said that this type of training is suitable for the staff group. Some staff members have completed training on Basic 1st Aid, Health and Safety, Mental Capacity Act, Care and Administration of Medicines and Safeguarding Adults with the new training provider. We discussed with the manager the fact that staff and management in the home had not noted the issues about safe storage of medication, safe storage of chemicals hazardous to health and the lack of restrictors on the upstairs windows, and the management of the home needs to consider how to address this shortfall. At our last inspection visit we noted that people started to work at the home before all the necessary information was available for them. We looked at the recruitment files of two staff members recruited since our last inspection to check that only people who are safe to work at the home are recruited. We saw that the home requests all the necessary information and that all the information was available for both individuals, except one reference. The manager said she was sure this had been received and she confirmed that it had been found following the inspection. Care Homes for Older People Page 22 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not run in the best interests of the people living there. Evidence: The registered manager and deputy manager both have management training to the expected standard of the Registered Managers Award, and have several years experience of running the home, but this report shows evidence that the home is not run effectively for the benefit of the people living there. We were concerned that people other than staff members or people living in the home had easy access to the office where records and medications were stored, and could have use of the homes computer. The managers said that there was no danger of a breach of confidentiality, but the home needs to have policies and procedures in place so that people living in the home can have confidence that only staff members and authorised people have access to the homes office where their records and private information is kept. All sections of the AQAA were completed but the information gives an inaccurate picture of the current situation within the home, such as The Manager is confident Care Homes for Older People Page 23 of 31 Evidence: that the recording and review of policies, procedures and systems is appropriate to allow her to plan and implement a high standard of safety, care and comfort for the residents, staff and visitors to Fairfield. We could not find enough evidence to support this claim. The home does not manage money for people living in the home as all of the individuals manage their own financial affairs or have relatives or representatives who do so for them. Regular quality assurance surveys are sent to people living in the home and we saw that people commented on the lack of activities provided and food issues in the feedback from the last surveys in June 2009. The manager responded asking people for ideas but the activities provided did not improve and there are remaining issues with food. This shows a lack of responsibility from the management for improvement in the home, and it needs to be addressed proactively. The lack of cleanliness in the bathrooms and in the laundry shows a shortfall in the quality of the monitoring process, as does the fact that chemicals are stored where they pose a risk to people living in the home. The homes health and safety policy statement is displayed in the home, and the manager is the responsible person for health and safety. We understood that following a health and safety inspection at the home in February 09 a recommendation was made that the home use the booklet Health and Safety in Care Homes for advice, but we found that information in the booklet about window restrictors and chemicals was not put to use in the home. We found that window restrictors were not fitted to two upstairs windows accessible to people living in the home and their visitors, and that chemicals were stored in a way that presented hazards to people living in the home and to visitors, and this means that the homes health and safety procedures and the auditing and supervision procedures are not effective. People commented in our survey that there is no direction between home manager and staff, and not always clear about the chain of command for the direction and supervision of staff and commented about managing the home: think it is very difficult for an amateur committee to cope with places such as Fairfields. We noted that the monthly reports conducted by the Management Committee are not to the standard detailed in Regulation 26 of the Care Home Regulations 2001, as there is no record of interviews with people living in the home during the visit to obtain their opinions of the standard of care provided by the home. People told us that two individuals meet regularly with members of the Managing Committee but that they never get feedback, and they are not sure if records are kept to follow up issues effectively. The home is failing to meet the needs of the people living in the home as their needs are not met in personal care or the provision of enough activities and their concerns or complaints are not always properly addressed. Care Homes for Older People Page 24 of 31 Evidence: At our last inspection visit we judged that the homes management was anxious and able to improve quickly but we found at this inspection that the home has not improved and is not meeting its statement of purpose. Care Homes for Older People Page 25 of 31 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 26 of 31 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 18 Ensure that at all times 30/09/2009 suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. So that the home can provide a personalised service to all the people living there, including meeting their need for activity and daily bathing or showering. 2 9 13 Make suitable arrangements 30/09/2009 for the recording, handling, safekeeping and safe administration of medicines received into the care home. So that risks are identified and managed for people who want to manage their own medication. Care Homes for Older People Page 27 of 31 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 3 10 12 Promote and make proper provision for the health and welfare of service users. To make sure that people can have a daily bath if they want. 30/09/2009 4 12 16 Consult people living in the home about their social interests and make arrangements to enable them to engage in local social and community activities. So that the home meets its statement of purpose about meeting peoples physical, social, emotional and intellectual needs. 30/09/2009 5 16 22 Record, investigate and address any verbal or written complaints made according to the complaints procedure. So that people can regain their confidence that the home acts in their best interests. 30/09/2009 6 19 13 Carry out an assessment of the home to ensure that all parts of the home to which service users have access are so far as is reasonably practicable free from hazards to their safety. 30/09/2009 Care Homes for Older People Page 28 of 31 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 To identify and eliminate any hazards to service users or visitors. 7 19 5A Consult with all people living 30/09/2009 in the home about temporary and permanent changes to their environment before making any changes, and keep a record of the consultation. To make sure that the home is not breaking the contracts made with individuals about the provision of services in the home, and to make sure that all people living in the home have their views heard and responded to. 8 33 26 During the monthly 30/09/2009 unannounced visits to the home the Management Committee must interview enough staff members and people living in the home and their representatives as appears necessary in order to form an opinion of the standard of care provided by the home, and inspect the premises to make sure that the people living there are safe. So that the management of the home understands what Care Homes for Older People Page 29 of 31 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 needs to be done to improve the daily experience of people living in the home and to make sure the premises are safe for the people living in the home. 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 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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. 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