CARE HOMES FOR OLDER PEOPLE
Fairhaven Lodge 7/9 Fairhaven Road St Annes Lancashire FY8 1NN Lead Inspector
Mrs Lillian McMullen Unannounced Inspection 10:30 8 February 2006
th 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 Lodge DS0000064686.V269329.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 Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Fairhaven Lodge Address 7/9 Fairhaven Road St Annes Lancashire FY8 1NN 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) 01253 720375 01253 720375 Dr Morgiana Muni Nazerali-Sunderji Carol Elizabeth Williams Care Home 24 Category(ies) of Dementia (24) registration, with number of places Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 24 service users in the category DE (Dementia) 1st September 2005 Date of last inspection Brief Description of the Service: Fairhaven Lodge is registered to accommodate 24 residents who have a mental disorder. The new homeowner has made improvements to the environment and a number of rooms have recently been decorated. Much investment has also been made in training for the staff in order to develop the service and equip the staff with the skills and knowledge required to provide the optimum quality of care. The home continues to be managed by the registered manager who has developed good relationships with social workers and health professional which has resulted in full occupancy. Evidence found during the inspection indicates that residents are viewed as individuals and are free to express themselves without fear of ridicule. Staff are instructed to be flexible in their approach and to ensure that the service provided is needs led. There is an activity programme in place that provides motivation and stimulation. The staffing levels at Fairhaven Lodge allow for a member of staff to be assigned to stay with the more dependent residents at all times in order that they constantly receive direction and support. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a period of five hours. The Inspector spoke to four staff members, three residents, one relative, a district nurse and the manager. Part of the inspection was spent on looking at the assessment and care planning process together with the system in place for monitoring and recording resident’s personal monies. Prior to this inspection, resident and relative comment cards provided by the Commission For Social Care Inspection were sent to the home for completion. At the time of writing this report six relative comment cards have been returned, all contained positive comments. What the service does well:
The residents at Fairhaven Lodge are well looked after and staff work hard to provide a good quality service. The staff team are led by an experienced manager who has developed good relationships with all the people who live at the home as well as the staff team. The staff show a good understanding of the needs and wishes of each individual resident. A relative spoken to said, “my mother is extremely well looked after and I have no complaints”. The assessment process and care planning is good and ensures the needs of individual residents can be met. The manager has developed good relationships with social workers and it is routine practice for the social worker to attend the care plan review. The health needs of residents are well met with evidence of a good working relationship with medical staff such as the district nurses and doctors who visit the home. The home has good systems in place to make sure that service users are kept safe. As all the residents at Fairhaven Lodge suffer from some cognitive impairment, staff work hard to make sure that people living at the home are involved as much as possible in how they spend their time. An activity programme is in place that ensures residents remain motivated and stimulated. Residents are encouraged to be independent as far as they are able. The staff was seen responding to the residents needs appropriately and all tasks of a personal nature were carried out in a sensitive and caring way. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 6 It is to the credit of the registered manager that the home has just achieved the ISO 9001-2000 quality assurance certificate following a reassessment of the standards required of this award. What has improved since the last inspection? What they could do better:
The daily diary sheets should be completed in greater detail in order that a complete and informative log is maintained of the resident’s wellbeing and daily living pattern. Whilst the environmental standards at Fairhaven Lodge have improved the programme of refurbishment must continue in order that overall standards are improved. In particular the small downstairs bathroom requires a refit. It is pleasing to note that the homeowner has started on plans to improve the exterior of the home. Plants have been purchased for the garden and a landscaper has been consulted on designing the garden. Please contact the provider for advice of actions taken in response to this
Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 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 Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 The admission and assessment procedures were clear to ensure the care needs of residents are met. EVIDENCE: The records of three residents were examined all had good pre admission information and a full assessment. The information was comprehensive and included detail of specialist needs. There was also evidence of other professional assessments being carried out to supplement the home’s assessment. Residents are only admitted to Fairhaven Lodge following a pre admission assessment of current strengths and needs by the home’s manager or senior staff member. This collated information, evidenced at inspection, enables the manager to make an informed decision as to whether Fairhaven Lodge could satisfactorily address the prospective service user’s current strengths, needs, wants and wishes. This collated information forms the basis of the initial plan of care. In addition to the assessment information relatives are asked to
Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 10 complete a questionnaire giving detail of the residents previous life history. Due to the cognitive impairment of the residents admitted to Fairhaven Lodge this information is invaluable to establish a care plan based on what the individual likes and dislikes and what may be important in the life of the person. Staff members confirmed they had access to this information and could describe in detail the care needs of residents. People are not admitted to Fairhaven Lodge solely for intermediate care. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 There is a consistent care planning and risk assessment process in place to ensure the assessed needs of the residents are met. The health care needs of residents are well met with evidence of good multi disciplinary working taking place as required. EVIDENCE: Individual records are kept for each resident with a plan of care setting out in detail the action that needed to be taken by care staff to ensure all aspects of health, personal and social care needs of the residents were met. Significant events had been recorded, however daily entries were in the main brief and the manager was advised to instruct staff to make detailed diary entries in order that a complete and informative log is maintained of the resident’s wellbeing and daily living pattern. Evidence was seen to confirm that relatives are invited to the care plan review it was pleasing to note that that the placing social worker and general practitioner are invited to an annual review. A relative spoken to stated, “I am very pleased with care my mother receives, this home is one of the best and I
Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 12 took months looking at care homes before choosing this one, I have not been disappointed”. Risk assessments accompany the care plan and are reviewed also on a monthly basis. The health needs of the residents are closely monitored and records provided evidence that other professionals are regularly consulted and their advice incorporated into the individual residents care plan. At the time of the inspection a district nurse was in the home conducting an annual health check. The district nurse commented that she has never had any concerns regarding the standard of care the residents receive at Fairhaven Lodge. Residents regularly attend the memory clinic at Lytham Hospital, staff always act as escort and the consultants advice incorporated into the care plan. Staff spoken to had a good understanding of the care needs of the residents and confirmed that they have good management support. The inspector observed staff assisting residents and was pleased to see they had good relationships with residents and carried out all tasks in a friendly and sensitive way. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 13 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): 12,13 and 14 The staff have a good understanding of resident support needs. This was apparent from the comfortable relationships that have been formed between staff and residents. Residents are encouraged to maintain contact with family and friends and visitors are welcome at any time. There are no restrictions on maintaining contact with family, ensuring social interaction. . EVIDENCE: There was a visitor in the home, who spoke to the inspector and confirmed, “that she visits two or three times a week and is always made to feel welcome and that staff always keep her informed of her mothers care needs. Staff spoken to confirmed that there are no restrictions on visiting and that they do everything possible to build positive relationships with relatives and encourage the maintenance of significant relationships between residents and their loved ones. There was evidence that the activity programme is in place with a number of planned activities taking place. Staff have implemented a number of initiatives, which include painting, reading, knitting and puzzles. A physiotherapist visits weekly and a number of residents enjoy this activity however due to the
Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 14 cognitive impairment of the residents group activities are not always successful and staff also spend time with residents on a one to one basis. Medication is administered by senior staff that has undertaken training in the safe handling of medication. Steps are now being taken to access training for all staff. Arrangements have been made to upgrade the medication system. A blister monitored dosage system is to be introduced and a new medication trolley is to be purchased. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: All the above core standards were assessed at the previous inspection. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 16 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): EVIDENCE: All the above core standards were assessed at the previous inspection however the inspector was pleased to note that improvements have been made to the decorative standards of the home and that plans are in place to continue the refurbishment programme. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Staff are provided with training opportunities to ensure they have the knowledge and skills to meet the needs of the residents. EVIDENCE: Staffing levels are satisfactory to meet the needs of the residents and staff spoken to said they are well supported and there is always enough staff on duty to spend time with residents. A relative spoken to said that, the staff are very kind and that they “cannot do enough for you”. The inspector observed staff working with residents and was satisfied that all tasks are carried out in pleasant and courteous way. Currently approximately 45 of the care staff team have now achieved an NVQ qualification in care. In addition, other staff are pursuing this award and once completed the home will have achieved well over the required 50 of the staff group that holds an appropriate qualification. Further training opportunities are provided in order that staff have the skills and knowledge to meet the needs of the residents. The registered manager was reminded of the mandatory core training that staff are required to undertake. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 35 The home is well managed and run in the best interests of residents. The manager is qualified and well experienced. Resident’s financial interests are protected by the procedures in place. EVIDENCE: The registered manager is competent and experienced to run the home she has many years experience and is committed to supporting staff in order that the residents receive the best possible care. The registered manager has successfully achieved a National Vocational Qualification Level 4 award in care and is now working towards completing the management element of the Registered Managers Award. In addition, the registered manager is keen to undertake additional training in order to build on her existing skills and knowledge. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 19 Staff and relatives spoken with were very positive with regard to the support of the manager with one member of staff stating the manager was ‘very good and always goes the extra mile’. It was clearly evident from observation that there is a good rapport between residents, staff and visitors that helps to create sense of belonging. The relative spoken with felt that her mother was well looked after in the home and a staff member also commented that the residents want for nothing. None of the residents are able to retain responsibility for their finances, therefore relatives or a solicitor are asked to assume this responsibility. The manager only involves herself in handling a small amount personal pocket money. Resident’s financial interests are safeguarded by the financial procedures adopted by the manager. Records and secure facilities are in place that ensures all expenditure is accounted for with receipts held. It is to the credit of the registered manager that the home has just achieved the ISO 9001-2000 quality assurance certificate following a reassessment of the standards required of this award. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 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 X X 3 X X N/A 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 x 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 21 No 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 OP38 Regulation 18 Requirement All staff must receive training in all mandatory subjeects. Timescale for action 31/03/06 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 2 Refer to Standard OP27 OP7 Good Practice Recommendations the NVQ training should continue to ensure at least 50 of the staff group hold an appropriate qualification. Daily diary sheets should be maintained in greater detail. Fairhaven Lodge DS0000064686.V269329.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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