Inspection on 18/08/08 for Fairfield Residential Home

This inspection was carried out on 18th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfield Residential Home 17/08/09

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 05/12/2008.

Inspecting for better lives 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:   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: Kate Harrison     Date: 1 8 0 8 2 0 0 8 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. the things that people have said are important to them: They reflect 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 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 25 Information about the care home Name of care home: Address: Fairfield Residential Home 115 Banbury Road Fairfield Oxford Oxfordshire OX2 6LA 01865558413 01865513699 aliparry@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Alison Parry 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: 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 19 of which have en-suite facilities. There is a small passenger lift to the first floor, and people living at the home have the use of two small kitchens. 0 Over 65 30 Care Homes for Older People Page 4 of 25 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: This inspection of the service was an unannounced Key Inspection. We arrived at the service at 11.30 hours and the inspection lasted for 6 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service through the Annual Quality Assurance Assessment (the AQAA referred to in the report) and any information that we received about the home since the last inspection. We saw most areas of the home and looked at records and documents relating to the care of the people living there. We asked the views of the people who live in the home, and the staff team through questionnaires we sent out. During the inspection we spent time with people who live in the home, to hear their views of life in the home, and to meet with relatives who Care Homes for Older People Page 5 of 25 were visiting, and their views are included in this report. We discussed the running of the home with the manager, and saw some staff files and how the medication was managed at the home. We looked at how the service was meeting the standards set by the government and in this report make judgements about the outcomes for people living at the home. From the evidence seen and comments received, we consider that this home would be able to provide a service to meet the individual needs of people from diverse backgrounds, taking into account the homes admission policy. The weekly fees range from 420 pounds to 560 pounds. The last inspection of this service was completed on 01/09/2006. 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 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 7 of 25 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 8 of 25 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 homes method of carrying out pre-admission assessments is inconsistent and needs to be improved to make sure that all the needs of the individual are recognised and met. Evidence: The registered manager said that she or her deputy usually visit people who want to move into the home, and carries out a pre-admission assessment. We saw the preadmission information gathered by the home about two individuals before they came to live in the home. For one individual the pre-admission assessment had been carried out by reviewing the information provided by the discharging hospital and by the social worker. The other individual had visited the home with her daughter before admission, and the manager said that information was gathered by discussing the individuals needs with the transferring care home and the individuals daughter. We saw no record of a pre-admission assessment but the manager said that the Residents Care Plan was Care Homes for Older People Page 9 of 25 Evidence: used to record the pre-admission information. Recently the home has changed documentation, and now uses a branded system to record information and risk assessments. We noted that the pre-admission assessments are now recorded on a risk assessment form. The manager needs to be certain that this system of assessment is suitable for recording all the needs of the individual before admission to the home, so that the home can be certain that all the needs of the individual can be met at the home. Care Homes for Older People Page 10 of 25 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. Although the healthcare needs of people are met, the management of medication must be improved to make sure people living in the home are not put at risk. Evidence: The home is in the process of introducing a new system of documenting care, and the manager is assessing how best to use the system to suit the home. We saw two care plans to check the quality of care provided. Some risk assessments had been completed to minimise the risks to the individuals, and staff members had completed daily records about events affecting the individual during the day. All the people living at the home are registered with a general practitioner (GP), and most who come from the area are able to keep their GP. The home is able to get access to other healthcare professionals, such as the district nurse and the palliative care service. Several individuals told us that the care is good, and one said that the staff members are wonderful. We looked at the medication system to check the homes procedures. All the medication is appropriately recorded as received into the home, and the records of Care Homes for Older People Page 11 of 25 Evidence: administration are good. We checked the controlled drugs and found that the cupboard used to keep controlled drugs at the home does not comply with the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendments) Regulations 2007. The home must make sure that this is addressed. We found that the home was not using a bound register with numbered pages to record the controlled drugs received, administered and returned to the pharmacy, and this needs to be addressed. We saw that the record of one individuals controlled drugs were not correct, and the manager investigated and found where the error had occurred, and corrected the mistake. To make sure that the management of controlled drugs improves to meet the regulations, a senior person at the home must attend training about the management of controlled drugs. Care Homes for Older People Page 12 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are encouraged to remain independent for as long as possible, and have opportunities to make their views known about life in the home. Evidence: We talked to individuals living in the home to hear their views about the quality of daily life. Views were generally positive, and people valued the regular availability of the manager to hear their views. Some people are able to conduct their daily lives without much support, including going out with friends or to shop locally. Several individuals liked the weekly painting class, and appreciated the grounds of the home. Others said that if meditation and bible study did not appeal there were few other activities provided. There are good links with local Christian churches to suit the spiritual needs of people living in the home. One individual said she valued the fact that she was able to bring her own mattress, and was able to spend the day as she wanted to. Visitors are encouraged and the information provided by the manager shows that people living in the home can invite guests for meals or for short stays in the guest Care Homes for Older People Page 13 of 25 Evidence: room. The dining room has recently been redecorated with the views of people living in the home taken into account. Several people told us that the food at the home is good. The AQAA shows that the menu is reviewed regularly and changed seasonally. Although the menu does not always show that an alternative dish is available, the manager said that people are told what the alternative is on a daily basis. Most people were aware that they could choose an alternative, and people can record comments about food in the daily food diary. Care Homes for Older People Page 14 of 25 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 good 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 say they can complain if they wish to, and they are protected by the homes safeguarding procedures. Evidence: The complaints procedure is displayed in the hall and people living in the home said they knew whom to complain to if any issue arose. People told us that the manager is aproachable, and is available most days for a chat if necessary. A representative from the management and trustee team visits the home regularly to hear the views of the people living there, and people can also make their complaints known then. Complaints are recorded and the procedure includes a 28 day response timescale. We have received no information about complaints about the home since our last inspection visit. The AQAA information supplied by the manager shows that the home has a safeguarding policy and procedure. The manager knew whom to contact locally to report safeguarding issues, and explained that half of the staff team had completed the update safeguarding vulnerable people training, and that arrangements were in place for the remaining staff to have the training soon. Care Homes for Older People Page 15 of 25 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 good 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 appreciate the well kept surroundings and good arrangements are in place to manage the upkeep and cleanliness of the environment. Evidence: The home is situated in a residential area in large gardens tended by a full time gardener, and has a development plan to manage improvements to the environment. We saw all communal areas of the home used by the people living there. The carpet in the sitting room needs attention as it has become overstretched and could be a trip hazard. The manager is aware of the problem and is arranging to minimise the hazards. One bathroom needs attention, as the paint was peeling off the bath side panel. Several improvements have been carried out since our last inspection visit, including updating the kitchen, refurbishing the dining room and refurbishment of the sash windows. People living in the home said they liked their rooms, especially the views of the garden. There is a full time maintenance person responsible for the general upkeep of the home. The AQAA information shows that service contracts are in place to maintain safety and the manager said that a recent satisfactory environmental health inspection had been Care Homes for Older People Page 16 of 25 Evidence: carried out at the home. An inspection visit by the Fire Service showed that some issues needed attention to make sure that the homes Fire Risk Assessment is appropriately managed, and the manager said that all the outstanding issues have been addressed. The homes laundry system is being improved to make sure that people living at the home have their individual laundry safely returned. All the staff team have received recent infection control training. Care Homes for Older People Page 17 of 25 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. The care needs of people living in the home are usually met, but shortfalls in the homes recruitment procedure may put vulnerable people at risk. Evidence: The manager said that there are rarely staffing shortages at the home, and the staff turnover is low. The homes staff rota shows who is working at the home over the 24 hours, and the manager explained that as well as the care staff there were two cooks and two cleaning staff, supported by the registered manager, the deputy manager and a part time administrator. On the day of the inspection, for the 26 people living at the home there were five care staff, supported by the registered manager, and kitchen and cleaning staff, and these numbers were meeting the needs of the people living there. The home encourages care staff to enroll on the National Vocational Qualifications(NVQ) training programme, but has found that there are delays due to the lack of assessors from the training college. At present there are four care staff with NVQ Level 2 in Care, two in the process of completing the course, and two ready to start the programme. This means that the home is not yet meeting the National Minimum Standard of 50 NVQ trained staff members. We looked at three staff files to check the homes recruitment procedures. The three new staff members had completed the homes application forms and for each person the home had requested and received two written references. There was clearance from the Criminal Records Care Homes for Older People Page 18 of 25 Evidence: Bureau (CRB) for two people before they started work. One individual started work at the home on 14/04/08, received POVA clearance (showing this individual was not on a list banning them from working with vulnerable people) on 08/05/08 and a clear certificate from the CRB on 27/05/08. This means that the individual had been working with vulnerable people without evidence that he/she was safe to do so from 14/04/08 to 08/05/08. The registered manager said that the individual was working part time only and was working under supervision during that time, and was recommended to her by a trusted individual. She recognised the error, said that this was the only time it had happened and said she would not put the individuals in her care at risk again. A requirement is made about recruitment practice in this report. Several of the staff have been at the home for many years and have experience of the needs of the individuals living in the home. New staff members undertake the homes induction programme, which meets the Common Induction Standards, and the manager tries to make sure that individuals complete the induction process within six weeks. The manager is interested in staff training, and has introduced in-house training to make it easier for staff members to access the training. At present all staff members have up to date training on key subjects such as moving and handling, fire awareness, first aid and infection control. Update training is currently being provided on safeguarding vulnerable adults. People living in the home praised the quality of the staff team, and comments include: they know what they are doing and wonderful. Care Homes for Older People Page 19 of 25 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. Although the shortfalls in the management of medication and recruitment practice put the best interests of people living in the home at some risk, the homes management is conscious of the shortfalls and is anxious and able to improve quickly. Evidence: The registered manager has been working at the home for several years and has her NVQ Level 4 in Management. She keeps up to date with current care issues, and is due to start a degree course in care management. She conducts monthly audits in several areas to monitor the quality of care and this is noted in the AQAA. People living in the home commented about the accessibility of the manager, and we noted this during our visit. The home conducts quality reviews of the service by surveys to people living in the home every three months, and results are published in the homes regular newsletter. The home does not manage petty cash for people living in the home, and this is Care Homes for Older People Page 20 of 25 Evidence: managed by relatives, advocates or other professionals. The home has a fire risk assessment in place and regular fire safety training takes place for all staff members. New evacuation measures have been developed to improve safety for people living in the home in the event of fire. The issues arising in this report, about conducting robust pre-employment checks and improving the management of medication, reflect on the ability of the management, and these issues were discussed with the registered manager. Care Homes for Older People Page 21 of 25 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 22 of 25 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 9 12 That the home provides up to date staff training about the management of controlled drugs, and provides a controlled drugs cupboard to meet regulations. So that people living in the home are safeguarded from harm, and that controlled drugs are kept according to the regulations. 28/10/2008 2 29 19 Have a robust recruitment procedure, to make sure that no staff member works with people living in the home unless a Criminal Record Bureau certificate is applied for, and a satisfactory POVA First check is received, and the staff member is supervised and monitored in line with the regulations. 28/10/2008 Care Homes for Older People Page 23 of 25 To stop poor practice and to safeguard 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 24 of 25 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 © (2008) 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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