CARE HOMES FOR OLDER PEOPLE
Fairfields Country Rest Home Launcells Bude Cornwall EX23 9NH Lead Inspector
Mike Stokes Key Unannounced Inspection 19th December 2006 10:30 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.V318578.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.V318578.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 26 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (26) of places Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To include 1 named service user with a mental disorder, excluding learning disability or dementia (MD(E) Total number of service users not to exceed a maximum of 26 Date of last inspection 7th February 2006 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 two 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. Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Fairfields is registered to provide personal care and accommodation for older persons and the range of fees is from £360.00 to £480.00. This was an unannounced inspection to look at standards of care provided in the home. I arrived at 10.30 am and the inspection continued until 3.30pm. During this time the registered provider, registered manager, service users, staff and visiting relatives assisted me in reviewing records, case tracking of 3 service users, a tour of the home and discussing developments at the home. A telephone discussion also occurred with a relative to confirm the pre admission arrangements and procedures at the home. What the service does well: What has improved since the last inspection?
Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 6 The registered providers continue to refurbish the existing facility and are currently building an extension to provide improved reception, office and laundry space, 4 additional bedrooms and a new bathroom with assisted bathing equipment. The registered providers have made appropriate applications to the relevant agencies and this commission to increase registered numbers. The registered manager continues to develop the systems and procedures at the home. A stable staff group are retained and the staff training records, profiles and multi disciplinary working arrangements have been developed. 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.V318578.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is good. The registered person has provided a statement of purpose and service users guide that details the facilities and services available within the home. The registered person will assess all prospective service users prior to admission to ensure that the home can meet their care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records were inspected for a service user that had recently been admitted to the home. These records include information received from other agencies to assist in an appropriate admission to the home. Prospective service users are invited to see the home and are involved in the completion of the dependency assessment documents. The registered manager will visit prospective service users in their own home or in hospital prior to admission to complete an assessment process and a meeting has occurred with relatives. A statement of purpose is available within the home and a service users guide is issued to each service user to explain the services and facilities available within the home as part of the contract and that hairdressing, transport,
Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 9 chiropody and newspapers can be provided at the home and are at the service users expense. All service users receive the terms and conditions, contracts and local authority contract details that are held on the individual service users records. The range of fees is from £360.00 to £480.00. The relative of the service user that had recently been admitted was able to confirm that the guide had been received and that the pre admission process was helpful in assisting his mother to move to Fairfields. Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is good. The health needs of service users are met with evidence of multi disciplinary work occurring to provide for service users welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records regarding the plans of care for 3 service users were inspected and discussed with the registered manager. The plans appropriately referred to the various needs of service users, the care required and regular reviews to monitor their changing needs regarding medication, diabetes, mobility, personal care and nutrition. There are care plans for all service users that are developed from assessments. A communication log is used to record messages between management and staff to ensure appropriate care is given. This is done with reference to dependency ratings and risk assessments that are reviewed regularly and monitored each month by staff and the service user. Service users expressed approval of the care and attention received from staff. The registered manager is aware of the Integrated Falls Coordinator and liaison occurs with the community nursing service to provide for the welfare of service users. A range of pressure relieving equipment and adaptations are provided
Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 11 for service users. Service users are registered with local GP’s in Stratton Medical Centre and Holsworthy Health Centre. The registered manager was seen to meet a visiting community nurse to discuss the changing care needs of a service user and amend the records appropriately. The records inspected showed that a range of health care professionals, speech therapist, physiotherapist, and opticians are consulted to provide for the physical and mental health needs of service users. The administration of medication procedures; records and staff training are appropriate. The providing pharmacy has completed a care home visit to review the medication procedures and a checklist report dated 14/11/06 was provided for inspection. The registered manager stated that 2 service users wish to retain control of their prescribed medication and they are enabled to self medicate. Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Service users exercise their choice to enjoy the privacy of their own rooms or join other service users in communal areas for company or meals. Service users are predominantly dependent on relatives to access community facilities and the registered provider will organise visiting entertainers and group activities at the home. The meals provided in the home are good with special diets catered for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated in a quiet rural area with extensive views across the surrounding countryside and sea view. The service users understand that this is a quiet rural area with no public transport services and that the nearest shops are a few miles away. The registered manager discussed the travel arrangements to support service users through Age Concern, relatives, friends and occasional outings to places of local interest funded by the registered providers. Service users can meet in comfortable communal areas provided at the home or enjoy the privacy of their own single rooms. Service users bring items of furniture and possessions such as televisions, radios and CD players to personalise their bedrooms and for their individual use. Service users expressed approval that regular visits are received from their relatives or friends. I met the visiting relatives of 2 service users and the
Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 13 service users in the privacy of their rooms to discuss the services provided at the home. The registered manager organises occasional entertainment at the home, the seasonal activities occurring included bell ringers, carol singers, musicians and a Christmas party for service users and relatives. The minutes of the service users meetings detailed their approval of the services provided and how effective consultation is occurring at the home. The registered manager has ensured there is a second hairdresser visiting the home to provide a choice for service users. There is a choice of 2 main meals at lunchtime and the main midday meal was served to service users from a trolley in the dining room to provide an individually plated service. The cook has worked at the home for many years and service users consistently approve of the catering services provided. Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. The registered provider uses the policy and procedures at the home to assist in the protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure containing the Commissions contact number and address was displayed in the home and is detailed in the service users guide. A visiting relative stated that she had seen the complaints process and would not hesitate in discussing concerns with the registered persons. The registered providers live on the premises and in conjunction with the registered manager are working at the home on a daily basis. This ensures they are available to monitor standards and support service users and staff as required. The homes adult protection policy and procedure includes references to supporting staff in reporting concerns (whistle Blowing) and reporting allegations or incidents immediately to the Adult Social Care Services (No Secrets) and this Commission in compliance with regulation 37. The registered persons have recently completed staff disciplinary and adult protection procedures to maintain the welfare of service users. Service users are supported in maintaining their personal finances and affairs through relatives and Power of Attorney processes. Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 15 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): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is excellent. The registered persons have developed the home to provide facilities to a high specification with a comfortable and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is set in large grounds that are well maintained and offer views across the countryside and sea views. The spacious, shared communal areas are bright and seating is set to encourage small social gatherings. There are sufficient toilet and bathroom facilities; all bedrooms have en-suite toilets and 10 rooms also have en-suite showers. A programme of refurbishment and maintenance is recorded with 8 bedrooms decorated recently. The home is on one level and grab rails are in place to assist service users along corridors to their bedrooms. An accessible call bell system is provided in each room. The home provides modern industrial washing and drying equipment to maintain an efficient laundry service.
Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 16 Care staff are also expected to complete some domestic duties, appropriate hand washing facilities and disposable gloves and aprons are readily available, a domestic is employed and the home presented as clean, pleasant and hygienic. The registered providers are currently building an extension to provide improved reception, office and laundry space, 4 additional bedrooms and a new bathroom with assisted bathing equipment. The registered providers have made appropriate applications to the relevant agencies and this commission to increase registered numbers. Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. The registered provider is ensuring that staff have appropriate training opportunities and service users expressed approval of the care received. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a minimum of 2 carers at all times with 6 carers at peak times of activity, including management and ancillary staff. 2 waking night carers are provided for service users that require attention at night. On arrival at the home there were 3 carers, a domestic, cook and kitchen assistant in addition to the registered manager and registered provider. The service users expressed approval of the services and attention received from care staff at the home. The recruitment procedures and records were reviewed for staff and the registered manager was able to provide written references and records regarding this process. The registered persons have a commitment to providing a trained workforce and individual staff files contain training schedules and opportunities. Appropriate training is occurring for 15 carers at NVQ level 2, 3 and 4, food hygiene, moving and handling, first aid, infection control and health and safety. The registered manager discussed how training is being provided through an house training package with an external verification process. The reference www.skillsforcare.net is provided, this replaces TOPPS and offers advice regarding induction and training staff in social care facilities.
Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 18 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, 32, 33, 35, 37 and 38. Quality in this outcome area is good. The registered person is providing clear and effective leadership and management to maintain a safe and comfortable home for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has appropriate experience in care settings and has completed the Registered Managers Award and NVQ level 4 in care qualifications. Appropriate communication systems are maintained and the minutes of the recent staff and service user meetings were available. This was demonstrated by observing the staff handover procedures when detailed information was exchanged regarding service users welfare. Quality assurance surveys and a newsletter publication have been developed and should be maintained by the registered manager. The registered manager conducts safety checks, maintenance and repairs to the home. Staff training and risk assessments are provided in fire precautions and first aid. The registered
Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 19 manager is advised to continue the review of this standard to ensure the health, safety and welfare of service users are promoted and protected. Records regarding service users finances have monthly management checks. A review of the records required in schedules 3 and 4 of regulation 17 showed that the registered manager is completing appropriate records to provide for the welfare of service users. Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Fairfields Country Rest Home DS0000009172.V318578.R01.S.doc Version 5.2 Page 21 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.V318578.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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
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