Inspection on 10/01/08 for Fairfields Country Rest Home

This inspection was carried out on 10th January 2008.

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

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

Fairfields Country Rest Home 19/12/06

Fairfields Country Rest Home 07/02/06

Fairfields Country Rest Home 15/09/05

Fairfields Country Rest Home 22/02/05

Fairfields Country Rest Home 22/09/04

Similar services:

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

The Garden House

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

CARE HOMES FOR OLDER PEOPLE Fairfields Country Rest Home Launcells Bude Cornwall EX23 9NH Lead Inspector Susan Taylor Unannounced Inspection 10th January 2008 10:00 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 Fairfields Country Rest Home DS0000009172.V352291.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. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfields Country Rest Home Address Launcells Bude Cornwall EX23 9NH 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) 01288 381241 01288 381199 Mr Terence Pantling Mrs Linda Pantling Helen Goodgroves Care Home 30 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (30) of places Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (Code OP) 2. Dementia - (Code DE) The maximum number of service users to be accommodated is 30 to include a maximum of 6 persons with a primary care need of dementia. 19th December 2006 Date of last inspection Brief Description of the Service: Fairfield is a single-storey building providing level accommodation for older people with en suite bedrooms that are mainly for single occupation. The majority of the bedrooms look over the gardens or countryside. There is a large dining room with views over the surrounding countryside. At the centre of the home is an attractive garden room. The home has been altered to include the addition of a new spacious lounge and improved bathing/shower facilities, hairdressing salon and four new en-suite bedrooms. This accommodation has been completed to a high standard. The grounds surrounding the home are spacious and parking is available at the home. As at January 2008, the fees ranged between £350 and £455 per week for personal care. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This was the first key inspection of Fairfields Country Rest Home (hereafter referred to as Fairfields) under the ‘Inspecting for better lives’ arrangements. People described Fairfields as being a “lovely home” and gave it “top marks” when asked how they would rate it. We were at the home with people for 8½ hours. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. Surveys were sent to 10 people that live at Fairfields, 10 staff: 100 of the people living at the home and 90 of staff responded to the survey. The comments of the people who responded are included in the report. As at January 2008, the fees ranged between £350 and £455 per week for personal care. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk What the service does well: People living at Fairfields Country Rest Home (hereafter Fairfields) say that they are made to feel “very welcome” from their very first day living at the home. Important information is obtained about residents prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet people’s needs. Care plans are well structured around what each person wants from the team. The team of staff have good links with professionals, which helps to improve residents’ health. People who live at the home say that the staff are very attentive and “know what they are doing” because they are well trained. Their relatives are very satisfied with the care and also say that their relations are happy living there. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 6 People living at the home told us they are treated as individuals. Professionals say that the people they support are well cared for. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. The also feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the acting manager and provider. Families and friends say that they are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. At the same time, the home plays an active part in the community. There is a good choice of appetising and well-balanced meals at Fairfields. People say that the choice is good and meals are “tasty” and are “always of good quality and plentiful. Fairfields is a spacious and comfortable place to live. At the same time, people who use wheelchairs or walking aids find it easy and safe to get around the home. People living there say that they are encouraged to see it as their own home and that it is always clean and well maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. What has improved since the last inspection? The manager had amended the statement of purpose to show that the home can cater for 30 older people, some of whom may have dementia. All of the people living in the home had a copy. Facilities and activities had been improved for people. Raised beds had been created with the help of the ‘Princes Trust’ so that if people wanted to do some gardening they could do. Additionally, plants in the garden included fragrant colourful flowers that people living there had chosen. An occupational therapist had been working with people in the ‘Arts for Health project’, which is a government funded initiative. People told us that they really enjoyed doing this and we saw their artwork throughout the home. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 8 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 Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is excellent. People are supported to be fully involved in the assessment process. Information is gathered from a range of sources including other relevant professionals, and with the individuals agreement, carer’s interests are taken into account thus ensuring that people’s needs are met. The home does not offer intermediate care; therefore no judgement has been made about this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home and relatives verified in a survey that the home provides sufficient information for them to make decisions about whether to live at the home or not. We saw that everyone had a copy of the ‘service Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 10 users guide’ in their room. Similarly, everyone that responded in the survey had received a contract. We spoke to a number of people that live at the home who told us that Fairfields meets their needs. Visitors told us that the home “is fantastic, we looked at other homes but nothing compares and the reputation is very good locally.” The manager told us that people are assessed by herself or the deputy manager who go to visit the person in their current setting to make an assessment. The pre admission form seen included information about their current abilities, medication, next of kin and equipment required. We examined three care files. A thorough assessment of needs had been completed with people and their relatives when they moved into the home. Assessments completed covered establishing any risks for an individual about their tissue viability, falls, and nutritional status. Additionally, information about the individual had also been obtained from social services if the care package had been commissioned by them. The acting manager and provider verified that intermediate care is currently not provided at Fairfield Country Rest Home. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is excellent. People that live at Fairfields Country Rest home receive effective personal and healthcare support that is person centred and is based upon the rights of dignity, equality, fairness, autonomy and respect. Care is delivered to people in a sensitive way that promotes their dignity and privacy. The team works in partnership with other professionals to ensure that the healthcare needs of people are met. Procedures ensure that medication is managed in a way that protects people living at the home and ensures that they are given the right medication at the right time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined three care files and saw that the needs of people living in the home are translated into detailed care plans that staff and the individuals Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 12 themselves have access to. People’s weight was being monitored and risk assessments had been completed and regularly reviewed. We tracked care for the individuals that had a range of health and social care needs including diabetes, dementia and immobility. Advice had been sought from healthcare professionals such as the diabetic nurse and tissue viability nurse specialists. Where needed, specialist equipment had been obtained such as a pressure relieving mattress and cushion. The person who was had mobility needs told us that they were well cared for and needed a lot of attention because they needed to change their position regularly. We saw that the person was lying on a pressure relieving mattress that was fully operational. Daily records demonstrated that the person was seen regularly by the district nursing team. Similarly, the person had also been visited regularly by their GP to monitor their healthcare needs. We tracked the care of a person with dementia, who was being treated for an infection as detailed in their care plan. Daily records demonstrated that the GP had visited this person regularly. Antibiotics and pain relief that had been prescribed by the GP was given as prescribed. Continence advice had also been sought from a specialist practitioner. Staff told us that they were working to the guidance given. Training records verified that all of the care staff had attended courses on dementia awareness and continence care. The nutritional needs of a person with diabetes were tracked. A care plan had been written outlining how the person would be monitored, the type of diet they needed and medication they were prescribed. At lunchtime the individual concerned told us that they always had a meal that was suitable for them, reduced sugar and low fat. They told us that their weight was regular monitored and we saw a record that had been kept in the individuals file. Daily records documented when the person had attended the eye clinic at the local hospital for regular screening, and correspondence about this was also examined. All of the people we spoke to and received surveys from were completely satisfied with the health and personal care they receive. Particular examples are given such as prompt attention to dental care and contacting GP in the event of ill health of the service user. Similarly, at the inspection people told us that staff “always knocked” before entering their rooms and treated them as individuals. We observed that people who were unable to make informed choices due to dementia were dressed individually. Two visitors told us that the home took a lot of time and care in making sure that their mother was “well turned out, exactly how she would have wanted to if she could have done it for herself”. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and the inspector tracked medication administered to three people. Records Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 13 accurately reflected medication having been administered as prescribed by the GP. All medication was kept in a secure place. We observed medication being given to people after the lunchtime meal. This was done safely and records were completed appropriately after each person had taken their medication. Other care staff that were spoke to during the inspection told us that medicines are only adminstered by people that are trained to do this. We examined a random selection of 3 staff files, 2 of which had certificates demonstrating that the people responsible for giving out medication had received training. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is excellent. Routines and activities are flexible and individualised for people. Resources have been imaginatively introduced ensuring that people living in the home continue to have a community presence. Staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. People are consulted or listened to regarding the choice of daily activities. The food in the home is of good quality, well presented and meets the dietary and cultural needs of people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided information to verify that 82 of people living at Fairfields Country Rest Home are of christian faith. The remainder do not follow a religion. People we spoke to told us that some people like to go to Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 15 church on a Sunday and are enabled to do this. Staff told us that either they take them to church or relatives or congregation members do so. Surveys from people living in the home and relatives indicate that the home has a good level of activities and outings. An advertisment was seen for two outings and various activities during the month of January. We observed an individual ask to be taken out for some fresh air in their wheelchair. This was organised immediately for the person, who was taken out in their wheelchair and into the garden. According to information sent to the Commission 6 people have dementia. We wanted to establish how those peoples needs were met with regard to meaningful activity. We examined a care file for someone with dementia and saw that the home had information about the individuals interests and had tried to accommodate them where ever they could. Additionally, relatives of the individual told us that the manager and staff had spent time finding out about their mother’s past life, interests and hobbies. We read the newsletter for Autumn/Winter 2007 and saw that there had been lots of new developments in the home. The garden had been improved so that it is a safe place for people to walk or sit. Raised beds had been created with the help of the ‘Princes Trust’ so that if people wanted to do some gardening they could do. Additionally, plants in the garden included fragrant colourful flowers that people living there had chosen. We were shown a newspaper article about how the home had secured the services of the ‘Princes Trust Scheme’ to landscape the gardens resulting from consultation with the people living in the home and their relatives. An occupational therapist had been working with people in the ‘Arts for Health project’, which is a government funded initiative. Three of the management team had attended training so that they could facilitate group art sessions. Completed artwork was displayed and people told us that they really enjoyed doing this. People living in the home, relatives and staff indicated in surveys that the food and menus at the home is good. Lunch was served during the inspection, which was well balanced and appetising. We saw at least three different choices being served. The cook had creatively incorporated plenty of fruit and vegetables into all courses and sought informal feedback from people throughout the meal. People we spoke to made comments like “lunch is lovely” and “they know what you like . We also observed how staff supported people that needed help with eating their meals. Carers focussed all their attention on the individuals concerned chatting with them, gently explaining what was on the plate and at a pace that suited the person. We saw that equipment such as plate guards were used enabling people to continue feeding themselves without assistance. We examined three care files, which demonstrated that weight is checked on a monthly basis to ensure that people stay within a healthy weight. These records showed that people had either Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 16 steady gained or decreased weight towards more healthier levels dependent upon their needs. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is excellent. Fairfields arrangements for the protection of vulnerable adults, including dealing with complaints ensures that people are protected and able to voice their concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Complaint procedure is prominently displayed in the hallway and is contained in the service users guide, which we saw in every bedroom. In a survey, people living in the home, staff and relatives are satisfied that the home listens to them and deals with any concerns in a timely way. The manager verified that no complaints had been received since sending information to the Commission. We looked at the record of complaints that had been previously dealt with and established that prompt action had been taken and that there was good communication with the people concerned. Staff that returned surveys verified that the majority of staff are aware of adult protection procedures. We saw a copy of the ‘Alerters guide’, which was out of date. The home also had a whistleblowing policy, which all of the staff we spoke to understood. Kind and caring interactions were observed Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 18 throughout the day between staff and people living in the home. Staff engaged positively with people who had dementia and demonstrated a high level of skill in engaging those individuals. Four staff whose files we looked at had attended recognised training about safeguarding people. 95 percent of care staff held the national vocational qualification in care, of which a component module is about abuse and adult protection. Information sent to the Commission hightlighted that no referrals had been made to POVA (Protection of Vulnerable Adults List). One referral had been made to the local authority to safeguard the interests of a person living in the home. Four staff we spoke to told us that there was a ‘zero tolerance’ of abuse in the home. All of them understood the concept of whistleblowing and who they should report to if they needed to. We looked at the manager’s training portfolio and saw certificates for an adult protection course and one about the mental capacity act. The manager told us that she was gradually introducing the guidance on mental capacity into all aspects of care practices in the home to ensure that staff properly understand how this affects the people living at Fairfields. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of people living there and is homely, clean, safe and comfortable, well maintained and reflects individual tastes. The management has an infection control policy and they work closely with their own staff and external specialists, such as NHS infection control staff, to ensure that infections are minimised for the people that live there. In terms of quality assurance, the home did not monitor its own practices using a recognised tool. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 20 We toured the premises and saw that radiator guards were in place throughout the building. Fire exits were clear and accessible. All the bedrooms were inspected and found to be clean, individualised and comfortably furnished. People living in the home told us that there is always a housekeeper on duty. All of the wcs and bathrooms had locks on the doors. Communal areas were comfortable and homely. Maintenance certificates were seen for assisted baths, electrical installation, and central heating and fire alarm systems. Surveys from people living in the home and relatives verified that the home is kept fresh and clean. The commission received notification from the home that there had been an outbreak of diarrhoea and sickness. The manager verified an audit using the department of health guidance had been carried out and we saw a record of this. Excellent practice had been followed during the outbreak and the home was commended by the local health centre for the action they took which contained it. By the time we inspected people were fully recovered and there were no further cases. On entering the home we saw a poster displayed reminding visitors not to enter if they had any sort of infection to prevent the people living in the home from contracting an infection. Additionally, alcohol gel was in the entrance hall and all visitors asked to use it before entering the home. All of the staff we spoke to had received training about the prevention of infection and management of infection control. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff were seen to deliver care to people. The laundry was clean and well organised. We observed good infection control measures being followed when staff were dealing with soiled linen. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is excellent. The training and development culture at the home means that people are confident that the staff have the right skills, experience and knowledge to care for them. This home has far exceeded national standards with 95 of staff holding a qualification, which is excellent. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. We found that Fairfields had excellent recruitment procedures that protect people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that there was a “low turnover of staff”. We saw old duty rosters that demonstrated that the home was well staffed to meet the needs of people that live there. During the period of the inspection each member of staff was looking after five people. Half of the people living in the home needed minimal support, and a quarter needed substantial care support. We observed that staff did not appear stressed or rushed in their work. 100 of people responding in a survey felt that staff were ‘always’ or ‘usually’ Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 22 available when they needed them. We examined duty rosters for four weeks up to the week of the inspection. On the day of the inspection there was three carers and the manager on duty during the day till 8pm and two waking staff at night. Additionally, there was a cleaner, kitchen assistant and cook on duty. Staff we spoke to told us that they were busier in the mornings but did not feel rushed. Maintenance staff had also been employed. We examined the files of three of the newest staff. Two satisfactory written references had been obtained for all of the staff prior to employment. Pova checks had been undertaken and criminal records bureau certificates had been obtained also before employment commenced. The home had a written procedure about recruitment and retention of staff and it was clear that these had been followed to protect the people living in the home. Staff told us that they enjoyed their work and felt well supported. Information that the manager had sent us verified that a wide range of training had been provided over the last 12 months. Records demonstrated that 95 of the care staff had achieved the NVQ level 2 award in care or above, which is excellent and well exceeds the standard required. We saw individual training files, which contained further evidence of specialist training having been provided e.g dementia awareness. Induction records seen demonstrated that training meets the appropriate standards set out by the ‘Skills for Care’. We spoke to staff about their experience and training opportunities in the home and people verified that this was regularly offered to them. The training and development plan for the home contained information for the period 2007-8 and reflected the needs of people currently living in the home so would ensure that staff have the knowledge and understanding to meet these needs. Two vistors told us that the staff “are competent and caring, particularly with people with dementia”. People living in the home told us that all of the staff were “trained properly” and the care they received was “excellent” and “second to none”. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is excellent. The manager and provider are qualified and very experienced and put people that live there at the centre of everything they do there. Quality assurance systems are well established and the views of people living and visiting the home are respected and acted upon in a proactive way. Fairfields financial procedures safeguard people’s interests. People living in the home, staff and visitors are aware of safety arrangements and have confidence in the safe working practices of staff. Excellent initiatives have been put in place that further safeguard people unfamiliar with the layout of the home in terms of fire procedures. This judgement has been made using available evidence including a visit to this service. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Manager is experienced and she has been in charge of the establishment for several years. She holds the Registered Managers Award and NVQ Level 4 in Care Management. We saw the certificate for this displayed. In discussion with the manager, she told us that she used the internet extensively, in particular the Commission’s professional website, to keep up to date thus ensuring that the care delivered is best practice. She showed us her training portfolio, which contained a certificate for a recent course she had attended about the Mental Capacity Act. Throughout the inspection we found her to be competent at her role and she demonstrated this by having an excellent overview of all the areas of the home that collectively help the home to meet its aims and objectives. We observed that there are clear lines of accountability within the home. The Registered Manager has a team of people who assist her in meeting the needs of the people who live in the home and also the business. The registered provider is also very much hands on and visits the people that live there every day. We spoke to four staff and observed practice throughout the day and saw that there is an open door policy that also allows people living there, visitors and staff to speak with the Registered Manager should they wish to do so. Two visitors who’s relative had just been admitted said that the Registered Manager had told them all about the home, and the complaints procedure, before they had read the statement of purpose, and that they valued this contact with her so early in the admission. The Commission asked for, and promptly received, the AQAA (Annual Quality Assurance Assessment) document. The information provided was detailed and enabled us to know what to focus on during the inspection. Additionally, it was clear that the manager and provider fully embrace quality assurance and put the people living in the home at the centre of everything they do. At the sametime, they are open about what they could do better and were able to demonstrate continous improvement in various areas throughout the course of the inspection. We read minutes of meetings held with staff and discussed these with the people we met. Staff told us that meetings were held regularly and that there is an open atmosphere in which they feel confident to make suggestions about improving their practice and the quality of life for the people they care for. We received 10 surveys from people living at Fairfields and 9 from staff. All of the comments were positive and in particular people felt that they were always listened to. Similarly, people living in the home told us that they were always asked how things are on a day to day basis and more formally in questionaires. All of the people we spoke to had been asked to participate in a quality assurance survey during 2007. We met 2 visitors who told us that the home was “fantastic” and had a “very good reputation locally”. They also went on to say that they felt that they had “fallen on their feet” and were “exceptionally pleased with the care” their mother received there. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 25 We read the minutes of a meeting that had been held with people living in the home and their relatives, which covered a discussion about events, outings and activities people were interested in. Additionlly, people attending were asked for feedback about the home. The manager had a clear understanding about quality assurance and told us that this was an area that was constantly under review. For people that are unable to look after their own money, Fairfields holds a small float of money for people whose relatives are unable to do this for them. The money is kept in a ‘residents’ account with a local bank. People we spoke to verified this and told us that either they managed their own money or relatives did this for them. Two visitors told us that they were very satisfied with the way that the home manages money for their mother. They said that they “receive a bill every month” and we were shown these. Additionally, they told us that the home held a float of money for their mother and every time they topped it up they were “given a receipt for it”. We saw records that the home kept and checked balances – which were correct – for 3 people living in the home. All three staff files contained a written record of supervision with the individual concerned. The manager told us that supervision was frequent. This was also borne out when we spoke to 4 staff that told us they felt well supported by the manager and provider. Comprehensive Health & Safety policies and procedures were seen. The organisation uses an external advisor, and we examined the annual audit report that had been completed. As a visitor on arrival we were given a laminated card showing where fire exits were. Relatives told us that they were “always given information like this” when they visited the home. This is an example of excellent practice that keeps visitors to the home, as well as the people that live and work there safe. The staff we spoke to verified that they had had recent moving and handling training. We saw certificates showing that hoists in use were regularly serviced every six months. People told the inspector that they felt safe at Fairfields. Electrical appliances had been checked to ensure conformity and safety. The electrical wiring system certificate of compliance was seen and it was last checked in 2006. Staff on duty had First Aid qualifications. First Aid boxes were accessible to staff. A fire risk assessment and strategy in the event of fire was seen. All of the staff that the inspector spoke to had received training in the last twelve months. We examined the fire log and established that the fire alarm system, emergency lighting and extinguishers had been regularly checked and properly maintained by an outside company. Induction records for new staff were seen and demonstrated that they are supported, trained and supervised until they are considered competent in all areas of care. Accident records were examined, were well kept and demonstrated that prompt and appropriate action had been taken. Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 26 Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 27 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 4 x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 4 4 x x x x x x 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 4 Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 28 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. Refer to Standard Good Practice Recommendations Fairfields Country Rest Home DS0000009172.V352291.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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