CARE HOMES FOR OLDER PEOPLE
Fairhaven 19 Park Avenue Watford Hertfordshire WD18 7HR Lead Inspector
Sheila Knopp Unannounced Inspection 10th February 2006 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 Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 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. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Fairhaven Address 19 Park Avenue Watford Hertfordshire WD18 7HR 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) 01923 220811 01923 490585 Mrs C.C. Fletcher Mr C.G. Fletcher Mrs C.C. Fletcher Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (20) Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1. The large bedroom situated on the ground floor may be used to accommodate two service users providing they have consented to share and that the room will revert to single occupation should one of the couple permanently leave for any reason. 4th July 2005 Date of last inspection Brief Description of the Service: Fairhaven is a large double fronted house with a purpose built extension to the side and to the rear of the home. A building programme to extend the home is in progress. On completion there will be 18 single rooms and 1 large room that can accomodate a couple who consent to share. Bedrooms are situated on both the ground floor and the first floor, which is serviced by a small two-person lift. The home is situated in a tree-lined road on the outskirts of Watford Town centre with all its community service, shopping centres, local and national bus and train services. The home has a homely and welcoming atmosphere. There is a large garden to the rear of the home, in which there is a patio area for free standing furniture. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second of two planned unannounced inspections for the year April 2005 – March 2006. Details of key standards not covered by this report can be found in the inspection report dated 4.7.05. This inspection focussed on the experience of residents coming to live in the home for the first time and to review the involvement of residents in choosing how they wish to spend their time. The inspector spent time with the residents individually in their rooms and also in the lounge as they took part in a lively and good-humoured exercise programme during the afternoon. The views of 2 residents and 4 relatives who sent comment cards to the Commission during January have been included in this report. The Commission has not received any complaints about this service between inspections. The home is currently in the middle of substantial building works, which will incorporate number 17 Park Avenue and increase the occupancy from 15 service users to 19. This will provide an additional four bedrooms with ensuite facilities, a lounge/dining room, a larger kitchen and utility room, a main office area and two assisted bathrooms. The original home will also have a new treatment room. What the service does well:
The residents spoken with confirmed they got on very well with each other and the staff. They felt that there was enough to do and that Fairhaven feels like home. This view was also reflected in the comment cards completed by residents and relatives. The residents were positive about the support they receive and added that they were:- ‘very happy’ and the home was ‘very good’. The relatives all said they were satisfied with the care being provided and added the following comments:- ‘the whole staff team are very friendly caring people. They take very good care of all their residents’. ‘ The care she receives is of an excellent standard’. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 6 The manager and staff have created a bright positive atmosphere in which to provide residents with support based on their individual needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 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 Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 - standard 6 does not apply to this service New residents are assessed by the manager before coming into the home to ensure that their needs can be met. EVIDENCE: Information collected by the manager before the admission of a resident was reviewed confirming that a full assessment of needs was carried out to ensure that the Fairhaven was suitable for that person. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not fully inspected. However requirements under standards 7 & 9 made following the last inspection were followed up. Further requirements have been made under standard 9 to ensure that medicines are stored at the correct temperature and administration records signed for all prescribed items. It has been recommended that authorisation for individual staff to carry out a technique, which remains the responsibility of the community nurses is updated to reflect changes in staff and ensure the correct procedures continue to be followed. EVIDENCE: A management plan for a resident identified as being at risk from choking has been put in place. Staff have not consistently met a requirement from the last inspection to record the administration of a prescribed food supplement. This is prescribed and therefore a record of administration must be maintained to verify that it has been given.
Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 10 It was reported that specific staff had received training at the local hospital to enable them to support a resident who has food via a gastrostomy tube. However there did not appear to be a record of delegation to new staff by the community nurses or NHS professional who remain responsible for the procedures carried out in a care home. Guidance available to CSCI inspectors has been sent to the manager to enable her to take this forward. The treatment room is due to be moved to a more suitable area. However currently it is in the kitchen, which is hot and humid. The manager needs to record the temperature of the medication storage areas to ensure that medicines are stored at the correct temperature. Medication stored incorrectly may compromise its effectiveness. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not fully inspected. A recommendation made following the last inspection under standard 12 to consult residents about how they spend their time was followed up. The residents spoken with felt happy with the arrangements as they were and discussed outings and events they had taken part in over the last few months. Following a general discussion with residents about their arrangements for meals recommendations under standard 15 have been made. EVIDENCE: Informal arrangements to provide supper and snacks on request appears to be based on the staff knowledge of resident preferences. There did not appear to be a supper menu or details of drinks or snacks available in the evening. Staff need to ensure residents, particularly those with a degree of memory loss, are offered drinks and snacks in the evening rather than waiting for them to ask. The residents didn’t raise any issues about their meals or selections offered but it did appear from discussions with staff that some residents were choosing not to have drinks after 6pm. Staff need to look at the frequency and gaps between meals and drinks. It is recommended that the manager looks at providing a wider choice of home cooked alternative dessert dishes for diabetic residents similar to the dishes served to other residents.
Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. No complaints have been received by the Commission, or raised by other health and social care professionals in contact with residents in the home, between inspections. EVIDENCE: Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The building work within the home appears to be continuing with minimum disruption to residents who did not raise any concerns. EVIDENCE: The completed building work and new furnishings are of a high standard. The registered manager reported that regular checks are made on the builders and how they leave the site at the end of the day to ensure the safety of residents. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 & 29 Residents are supported by staff who have qualifications at the level required. The recruitment procedure in place protects residents by checking staff before they work in the home. EVIDENCE: Five out of the nine care staff employed have qualifications equivalent or above the required standards. The registered manager is aware of the need to maintain a level of 50 of care staff with qualifications at NVQ level 2 or above as the staff team changes. A recently recruited member of staff already had this qualification. The personnel records of two new care assistants were reviewed confirming that the required information was obtained before they had contact with residents. These included references from previous employers and enhanced criminal records bureau checks. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 35 A requirement made under standard 38 and linked to standard 29 on promoting the safety of residents through robust recruitment practices was reviewed and met on this occasion. To meet standard 31 care home managers need to have achieved the NVQ Registered Managers Award by the end of 2005. The home has a system for monitoring the quality of the service provided to residents, which includes seeking their views, the views of relatives and other professionals involved with the home. Producing an annual report for residents, relatives and the Commission on the surveys carried out and outcome of the quality reviews was discussed with the manager While residents are supported to continue to manage their own finances staff do not hold money for safekeeping. This remains the responsibility of relatives or legal representatives. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 16 EVIDENCE: Mrs Fletcher anticipates completing the required work by the end of March 2006. Discussions with Mrs Fletcher confirmed arrangements for residents to receive support from relatives or legal representatives where they were unable to manage their own finances. No issues were identified which would indicate residents were not being protected or receiving the required funds. Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 17 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x x x x x x x STAFFING Standard No Score 27 x 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x x Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? 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. 1 Standard OP9 Regulation 13(2) Requirement The manager must ensure that the “Jevity feed” is recorded on the MAR chart when administered. Brought forward from 4.7.05 Record the temperature of the treatment room to ensure medicines are stored at the correct temperature. Timescale for action 10/02/06 2 OP9 13(2) 10/02/06 Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations The manager needs to update the record of delegated accountability and training between the community nurses / NHS and the home for the management of a gastrostomy tube. Put together a supper menu based on resident choice and preferences. Review the frequency staff are offering snacks and drinks to residents in the evening. Where residents have a degree of memory loss evening snacks should be presented to them they are aware of the choices available. Consider extending the range of home cooked diabetic desserts so they are offered similar choices to other residents. Set a target date for providing residents, relatives, stakeholders and the Commission with a report on the outcome of any surveys and quality reviews carried out as part of the annual quality assurance programme. 2. 3. OP15 OP15 4. 5. OP15 OP33 Fairhaven DS0000019346.V282323.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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