Inspection on 28/09/07 for Fairhaven Care Home

This inspection was carried out on 28th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fairhaven Care Home 27/09/06

Fairhaven Care Home 17/01/06

Fairhaven Care Home 27/01/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Fairhaven Nursing Home 43/44 Laidleys Walk Fleetwood Lancashire FY7 7JL Lead Inspector Denise Upton Unannounced Inspection 28th September 2007 09:00 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 Nursing Home DS0000062791.V347902.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. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairhaven Nursing Home Address 43/44 Laidleys Walk Fleetwood Lancashire FY7 7JL 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 772341 01253 772018 North Fylde Care Ltd Mrs Toni Ann Davidson Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 24 in the category OP. A full inspection of the electrical wiring system must be carried out and an electrical certificate must be obtained by 1 February 2005. A full inspection of the gas appliances and boilers must be carried out and a gas safety certificate must be obtained by 31 December 2004. A fire risk assessment must be carried out and appropriate consultation with the fire department be arranged by 1 February 2005. Mattresses must be assessed and where necessary replaced by 1 June 2005. Lounge chairs must be assessed and where necessary replaced by 1 June 2005. Bed linen that contains an old health authority monogram must be replaced by 1 June 2005. A programme for replacing carpets and decorating service users accommodation should be worked towards as per action plan submitted. Windows that are in need of replacing should be replaced within the timescales set out in the action plan provided. 27th September 2006 2. 3. 4. 5. 6. 7. 8. 9. 10. Date of last inspection Brief Description of the Service: Fairhaven Nursing Home is registered to provide nursing and personal care for up to twenty-four older people. Currently however there are no people living at the home that have been assessed as requiring nursing care. Fairhaven Nursing Home is situated on the promenade at Fleetwood overlooking the boating lake and sea and in close proximity to local community facilities and resources. Fleetwood town centre is approximately five minutes away by car. The home is arranged over three floors with the majority of residents accommodated in single bedroom accommodation. Only two bedrooms are for shared occupancy. Communal areas of the home consist of a lounge, separate dining room and two conservatories that overlook the sea. Although bedroom accommodation does not provide an en-suite facility, bathing and toilet facilities are sufficient in number, conveniently situated and provided with Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 5 appropriate aids to promote independence. A passenger lift is provided to enable ease of access throughout the building. Visitors are welcome at any time of the resident’s choice and can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place during the course of two mid-week days and in total spanned a period of approximately thirteen hours. The twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with an additional standard. This included a re-assessment of the requirements and recommendations identified in the last inspection report. The inspector spoke with the registered manager, a senior carer, two care assistants, the cook on duty and a member of the domestic staff team. In addition, individual discussion took place with three people living at the home that were, ‘case tracked’. Case tracking involves looking at these residents individual care files to make sure that the correct information is recorded and in the individual care plan. These should tell staff what each resident’s wishes and choices are and what the resident can do for themselves and what help may be required. The individual care plan should also be reviewed on a regular basis and kept up to date. Several other residents were also spoken collectively with in a communal area of the home. A number of records were also examined and a tour of the building took place that included communal areas of the home, the laundry and kitchen and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the homeowners. In addition, a number of residents and relatives/friends also completed a Commission for Social Care Inspection survey forms that helped to form an opinion as to whether resident’s needs and requirements were being met. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The current fee for residential care at Fairhaven Nursing Home is £386.00 per week. There is an additional charge for such items as personal newspapers and magazines, hairdressing, chiropody and personal toiletries. What the service does well: The registered manager at Fairhaven Nursing Home is experienced in running a care home for older people and helps staff to understand the needs of older people by providing a variety of different training. The staff group is enthusiastic and work well together to provide a good quality of care for people who live at the home. It is very clear that good relationships exist between Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 7 residents and staff. This helps people living at the home feel comfortable and secure. Residents are encouraged to have their say and help make decisions about the running of the home and were pleased with the accommodation provided. Residents said that they were able to make choices about what they did, for example what time they choose to get up or go to bed. Residents could receive visitors of their choice at a time to suit them and felt confident that any concern they might have would be taken seriously and acted upon. One relative wrote that the home “Has a welcoming atmosphere and the surroundings are well kept”. Another relative wrote that she liked the manager and staff and the home itself and felt that the staff were offering the best care they could. Residents were also complementary about the staff group describing them as “Very good, try their best, kind and respectful”. Those spoken with were very pleased with the level of care provided. What has improved since the last inspection? What they could do better: The manager and staff at Fairhaven Nursing Home work hard to make sure that the needs of residents are well met and that people living at the home feel comfortable and secure. However there are a number of things that could be improved. Care plans that tell staff about each individual residents requirements and direct staff as to what they should do and how they should do it, could be more detailed. This would help ensure a consistent service. The Service User Guide that is given to each newly admitted resident should be reviewed and amended to make sure it contains accurate information. It should also be written in style that residents could easily understand. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 8 In order to ensure privacy for people living at the home, all bedroom doors should be fitted with an appropriate lock. Unless it is not safe to do so, the individual resident should be given the key to their individual bedroom accommodation. Improvements must be made to the way handwritten medication instructions are recorded on the drug administration record and care staff that have not done so must be provided with first aid training. 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. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 10 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 in part & 3. Quality in this outcome area is adequate. The home’s Service User Guide is comprehensive and detailed in content, however the document provides some inaccurate information to the reader and is at times not easy to read. The home has a good system in place to assess the needs and requirements of prospective residents prior to admission. However this should include details regarding religious and cultural needs and requirements. This would help to ensure that Fairhaven Nursing Home could provide the individual level of care required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An individual copy of the home’s Service Users Guide is provided to each resident and retained on the individual care file. Although providing a considerable amount of information, the Service Users Guide’s seen did contain Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 11 a small amount of detail that was not accurate. The Service Users Guide was also written in a way that residents and or their relatives might not easily understand. It is recommended that the Service Users Guide be reviewed and amended where necessary. It is also recommended that the Service Users Guide be written in an easy read format using plain language that can be easily understood by people living at the home. Detail of what should be included in the Service Users Guide and the Statement of Purpose can be found in Standard 1, Regulations 4 & 5 and Schedule 1 of the National Minimum Standards – Care Homes for Older People and Care Homes Regulations. Case tracking confirmed good practice. In order to ensure that residents are only admitted to Fairhaven Nursing Home if their health, personal and social care needs can be met, the registered manager undertakes a pre admission assessment of current strengths and needs to determine if the level of care and support required can be provided at the home. This is coupled with an invitation for the prospective resident and/or their family to undertake an introductory visit to the home to assess the accommodation for themselves, meet staff and existing residents in order to make informed choice about living at the home. The pre admission assessment carried out by the registered manager, is in some instances, further supplemented by information made available from professional assessments undertaken by Care Managers or through hospital discharge information. This combined information is then collated and provides a basis for the initial care plan. However the pre admission assessment provided little, if any, information about cultural or religious need or requirements and not always meaningful information about personal wants and wishes or social interests or hobbies. Although there is no suggestion that the needs and requirements of newly admitted people are not being met, the written information recorded during the pre admission assessment is currently somewhat limited and should be more detailed. The written information from the pre admission assessment process should be holistic in content and sufficiently detailed to clearly identify if all current strengths, needs wants and wishes could be fully met by the home. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 12 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 adequate. There is a routine care planning system in place. However care plans do not necessarily provide sufficient detail or give specific guidance to staff in order for them to provide a holistic or consistent service. The health care needs of people using the service are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is well managed promoting good health. Personal support is provided in such a way as to promote and protect the privacy, dignity and independence of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care of three people living at the home was ‘case tracked’ during the course of the site visits. All three care plans contained a lot of information Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 13 about health and personal care needs but no specific information about social, religious or cultural care needs and preferences or the specific wishes of the individual resident. This did not provide a holistic care plan that would inform or guide staff about the whole person. The senior carer spoken with explained that the individual care plan is discussed with the resident and/or their relative to help ensure that the content is understood. The resident/relative can then take away the care plan to read at their leisure before they sign the document if they are happy with the content. Whilst some of the care plans evidenced had been signed by the resident or their relative, some had not. If a resident does not wish to become involved in the development of their care plan or does not have capacity to understand the content, this should be clearly recorded. There was evidence that care plans are reviewed on at least a monthly basis. Personal risk assessments are in place however these again in the main detailed risk to physical health or personal care. For example, one resident spoken with explained that staff escorted him across the road in his wheelchair so he could sit on the promenade. This is clearly good practice that benefits the gentlemen in question however he is unable to cross the road unescorted. A risk had been identified, staff were taking appropriate action but there was no risk assessment in place to explain why this person was unsafe to cross the road on his own or formally direct staff on what they should do. A formal risk assessment should always be undertaken when ever a risk is identified with significant outcomes identified in the individual care plan. As previously stated, the care plans observed contained a lot of information regarding health and personal care needs however in the main this was written using professional language and was not written in a style that would have been easily understood by people living at the home. Care plans in the main, focused solely on ‘problems’ and gave no indication of the individual’s personal strengths. One carer spoken with said that although she could read the individual care plans she never did because she did not understand some of the content and relied totally on verbal information sharing in order to address residents individual needs and requirements. All care staff should feel comfortable and informed when reading care plans. Detail on the care plan should be specific to the needs and requirements of that individual. Whilst verbal information sharing can be a useful tool, information can get changed in the telling. Staff should be encouraged to read individual plans of care for themselves in order to be clearly guided as to what they should do and how they should do it. This would also help to ensure that residents receive a consistent service. Never the less it was clearly evident that resident’s individual needs are being addressed well in practice. Staff spoken with were familiar with the preferences Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 14 and wishes of each resident and residents spoken with were very pleased with the quality of care provided. One resident said that the carers were “very good, they try their best” and “are kind and respectful”. Another resident commented that, “staff know what they are doing” and a third resident said, “I am quite happy living here and can do as I want and get all the help I need”. Through discussion with residents and staff and observation of documentation, it was clear that resident’s health care needs are fully met. There is a good relationship with health and social care professionals in order to maintain health and social well-being. Comments on the Commission for Social Care Inspection, survey forms also confirmed that residents felt that they receive the medical support that they needed when they needed it. One resident spoken with said that staff, “were good at getting the doctor out, they (the staff) are round you like fly’s when you are ill”. As there are no current residents assessed as requiring nursing care living at the home, except for the registered manager, there are no nursing staff employed. In consequence, it is only the registered manager and senior care staff that administer and record medication. Senior care staff have undertaken an extended, externally assessed medication course to ensure they have the understanding, skills and abilities to administer and record medication. All senior care staff with responsibility for the administration of medication were also directly supervised by the registered manager on completion of their medication-training course to ensure competence prior to administering medication independently. In line with the home’s medication policy, it is understood that all residents who wish to and have capacity to do so would be enabled to self-administer their own prescribed medication following the outcome of a specific risk assessment to ensure that the individual is competent. However currently no resident has elected to self-administer their own prescribed medication. A locked facility is provided in individual bedroom accommodation for the safe storage of medication. There is a clear audit trail of medication into the home, medication administered and a record is kept of any medicines returned to the pharmacist for disposal. Medication is stored in a locked, metal medication trolley that is chained to a wall when not in use and housed inside a locked medication room. A medication fridge is available along with appropriate controlled drug storage facilities. Controlled drugs medication was appropriately recorded. In the main the drug administration record was accurate however care must be taken when hand written instructions are recorded on the MAR sheet. In one instance although the dosage of a particular medication was recorded correctly, the time the medication was to be administered was not recorded. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 15 This could lead to medication been given at an inappropriate time. It is imperative to ensure safety, that an exact copy of the pharmacist dispensing label is accurately recorded on the MAR sheet. It is also important that whenever a hand written medication record is placed on the MAR sheet, the detail recorded is checked and countersigned by another member of staff to ensure accuracy. Residents spoken with felt their privacy and dignity was well respected and that staff were sensitive when they needed help with personal care. One resident spoken with stated that staff were very respectful when assisting him with personal care tasks and that residents could select a preference for a male or female member of staff when assistance is required with personal care. Staff had a good overall understanding of the needs of people who lived at the home and were seen to be patient, kind and respectful when interacting with residents. All care staff receive training in respect of maintaining privacy and dignity during induction training, National Vocational Qualification (NVQ) training and through regular supervision. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 16 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 good. There are a number of staff led social activities made available however as social activities were not recorded in the care plan, these may not directly relate to the social interests of individual residents. This could lead to a number of residents experiencing a lifestyle that did not satisfy their social, cultural, religious or recreational interests and needs. Residents are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. Dietary needs of residents are well met with a balanced and varied selection of foods served that residents enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several residents spoken with confirmed they are able to exercise choice in all aspects of their daily life and choose to do what they want to do. As observed at the time of the site visits, social relationships are encouraged either through family/friends visiting at a time of the resident’s choice or social stimulation in Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 17 the wider community accompanied by relatives/friends or by staff. A substantial number of relatives visited at various times throughout the course of the site visits. All were warmly welcomed and had a good relationship with the staff team. One relative briefly spoken with during the first site visit confirmed that he was always kept informed of any changes and always felt that he could talk to a member of the staff team if he required any information. It was difficult to establish if the range of activities provided ‘in-house’ reflected the individual preferences of people living at the home. This was because preferred social activities, religious or cultural needs, requirements and preferences were not identified on the individual care plans. However residents and staff did confirm that some social activities did take place that include card making, bingo, yoga in chairs, massage, reiki and dominoes. In addition, singers visit the home to entertain residents occasionally. Families are encouraged to go along when trips are organised to shows and to stay for lunch or dinner for special events such as birthdays or Christmas. Whilst one resident individually spoken with confirmed that “there is something going on most days”, she went on to say that she was not interested in joining in and that this was respected. There is also regular weekly communal worship that takes place in the home for residents who would like to attend. One resident spoken with confirmed that he takes Mass every Friday morning at the home that was very important to him. The home also has close links with a local secondary school. A number of students from the school visited over a period of time as part of their course of study and provided a range of activities and companionship for people living at the home. It is understood that this proved to be a great success and benefited both residents and students. It is hoped that this could be arranged again in the foreseeable future. It is recommended that that the social, religious and cultural interests of residents are incorporated in their individual care plan. This should also include detail of how staff are to enable the resident to enjoy activities of their choice either collectively with other people or individually. All residents are encouraged and enabled to retain independence in respect of their financial affairs for as long as they wish to and as long as they are able to or alternatively assisted in this task by a member of their family. Information regarding local advocacy services is available for residents or their family to access independently. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 18 Through discussion with a number of residents and observation of some bedroom accommodation it was confirmed that residents are encouraged to take personal possessions with them into the home to make their individual space more homely and comfortable. Meals and mealtimes at Fairhaven Nursing Home are given priority with a varied and balanced menu provided that is designed around the known likes and dislikes of people living at the home. Residents individually spoken with were all pleased with the variety and quality of the meals served. People described the meals as “very good” and said that meals was “cooked to their liking”. Discussion with the cook on duty confirmed that there is a four weekly rotating menu although this is sometimes changed to reflect what residents say they would like to eat. Most residents enjoy a cooked breakfast and although the menu for the midday and evening meal is a set meal, there is always an alternative of the resident’s choice made available if required. During the course of the inspection the mid day meal was observed over a brief period of time. Residents were very comfortable and ‘chatty’ sitting at the table enjoying their meal. The atmosphere was relaxed and staff were encouraging, sensitive and discrete when assisting individual residents to eat their meal. The meal in itself was a social event and the food well cooked and presented. One resident was seen to be eating a different meal of choice. It is understood that residents were recently asked what meals they would like to be incorporated in the menu and this has now been done. The cooks also try out new meals based on what staff notice residents really liked. This helps to ensure that residents are provided with meals they enjoy and that food is not wasted. Fresh fruit and vegetables were in evidence supplied from a local greengrocer, and fresh meat and eggs and cheese are obtained from local suppliers. Specialist diets in respect of medical need are provided and diets in respect of religious or cultural requirements could also be accommodated. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 19 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 good. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff have a good knowledge and understanding of adult protection issues, which helps to protect people living at the home from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Fairhaven Nursing Home has a comprehensive complaint policy and procedures, which outlines the home’s commitment to resolving complaints within 28 days. The complaints procedure is incorporated in the Statement of Purpose and Service Users Guide and displayed in a communal area of the home to inform residents and their relatives how to make a complaint should the need arise. Since the last inspection no complaints have been received. Residents spoken with were positive about living at the home and raised no concerns but confirmed that they would have no hesitation about speaking with the registered manager if they had a concern and felt confident that any concern would be taken seriously and acted upon. One resident stated, “You cannot have a row with them because there is nothing to row about. The only worries are the one’s you make yourself – no worries”. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 20 The home also has a policy in place, which contains robust procedures for responding to an allegation of abuse. Since the last inspection, an issue was raised under the adult abuse procedures regarding a resident who was living at the home. This issue did not involve any staff working at the home or concerns about the level of care or support received. The management team however acted appropriately and fully co-operated in the investigation. All care staff, with the exception of newly appointed care staff, has now undertaken mandatory adult abuse training. Discussion with a member of the care staff team confirmed that she was aware of what to do if a complaint was made to her or if there was an allegation of abuse. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 21 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 & 26. Quality in this outcome area is good. The standard of the environment within this home is good providing residents with a safe, comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents at Fairhaven Nursing Home live in comfortable, well maintained and homely accommodation. Bedrooms are comfortably furnished and personalised to reflect the needs and wishes of the occupant. Communal space is welcoming consisting of a lounge area, separate dining room and two conservatories that look out towards the promenade and sea. There is a passenger lift for ease of access throughout the building. Since the last inspection the remaining bedrooms have been redecorated and new carpets laid. Some new items of furniture have been purchased that Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 22 includes bedroom furniture and chairs and additional new bedding has been provided. A number of toilets have also been replaced. It was noted however that no bedroom doors were fitted with an appropriate lock to ensure privacy for the occupant. It is recommended that the doors to all resident’s private accommodation be fitted with an appropriate lock suited to the occupant’s capabilities and accessible to staff in an emergency. All residents should be provided with a key unless their risk assessment suggests otherwise. In instances where an existing resident refuses to have a lock fitted to their private accommodation, this should be recorded and their decision reviewed on a regular basis. There is an expectation that once vacant, a lock would be provided before another resident occupies the bedroom. It is then the resident’s choice if they choose to use the lock provided or otherwise. A locked facility is provided for the safe storage of items of a personal nature inside all resident bedroom accommodation. All radiators in bedroom and communal accommodation are fitted with guards to prevent the risk of accidental injury and thermostatic devises have been fitted centrally to control the temperature of hot water delivered from all hot water outlets in resident accommodation to prevent the risk of accidental scalding. There were various aids and adaptations around the home to assist residents to remain independently mobile. The home is clean, pleasant and hygienic and free from offensive smells with a variety of policies and procedures to advice staff in the control of infection. Laundry facilities are sited away from the main area of the home and do not intrude on residents accommodated. The industrial washing machine has the capacity to meet disinfection standards and wall and floor finishes are easily cleanable. Residents spoken with were all very satisfied with both their private bedroom accommodation and the communal areas of the home. The registered manager explained that it is intended to further develop the external communal areas of the home to create a seating area and a flowered garden area. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 23 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 good. Arrangements for attaining the National Vocational Qualification (NVQ) training in care are good with staff demonstrating a clear understanding of their roles. Induction training is provided to ensure that care staff have the basic skills to provide a good quality service. However the current induction-training programme should be mapped against the ‘Skills For Care’ nationally agreed common induction training standards for care staff to ensure compliance. There is a structured process for the recruitment of staff that includes obtaining satisfactory references and clearances in order to protect people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments written on the Commission for Social Care resident survey forms confirmed that residents who had completed the survey questionnaire considered that there was an adequate number of staff on duty at all times or most of the time to make sure that residents received the attention that they needed at the time that they needed it. This was also said by residents individually spoken with. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 24 Staff spoken with also stated that usually there were sufficient staff on duty to ensure residents care needs were addressed. The registered manager did however say that consideration was being given to increasing staffing levels during the busy periods of the day. Staffing levels should always be determined by the dependency needs of residents accommodated rather than a ratio of staff to the number of residents accommodated as individual dependency needs can vary quite considerably. The management team does already have access to a number of ‘bank’ staff that will work when additional staff are required. All night staff have ‘waking watch’ responsibility and there are sufficient ancillary staff employed to ensure standards in respect of domestic tasks and catering are maintained. One resident spoken with stated that she was “quite satisfied with the level care” and that she got all the help she needed”. Since the last inspection further members of the care staff team have achieved a nationally recognised qualification in care. Currently eleven of the thirteen care staff employed at the home have now achieved at minimum, a National Vocational Qualification (NVQ) Level 2 qualification in care that is commendable. This exceeds the recommended minimum number of care staff that should have obtained this qualification. In addition, a number of care staff have also achieved the more advanced NVQ Level 3 of this award. This shows that staff training is given priority to ensure there is a competent and skilled staff group. Fairhaven Nursing Home has in place a structured recruitment policy and procedure that helps to protect residents. Since the last inspection, a number of new members of staff have been appointed. From observation of two recently appointed staff member’s personnel file, it was evident that the recruitment policy and procedures had been followed. This included an application form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) POVA first clearance that had been obtained prior to the applicant actually taking up post at the home. A recently appointed member of staff confirmed that procedures had been followed and she was not allowed to take up post at the home until satisfactory references and the POVA first clearance had been received and deemed to be satisfactory. Although there was written evidence of recently appointed staff having undertaken induction training, it is understood that the training provided, although quite comprehensive, had not been mapped against the ‘Skills for Care’ common induction training standards for care staff to ensure compliance. It is recommended that the current induction training programme be evidenced against the National Training Organisation (NTO) induction standards to ensure that the induction training provided covers at minimum, the principles of care, safe working practices, the organisation and worker role, the experiences and Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 25 particular needs of the service user group and the influences and particular requirements of the service setting. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 26 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, 36 & 38. Quality in this outcome area is adequate. The registered manager is qualified, experienced and has a clear development plan and vision for the home that is effectively communicated to other interested parties. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents and relatives. Financial procedures in respect of residents’ monies and the safekeeping of valuables are robust to protect the interests of people accommodated. Formal one to one staff supervision should taken place at least six times a year. This would provide opportunity for individual discussion including at minimum, practice issues, career development needs and the values of the home. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 27 Systems are in place to ensure the health and safety of people living at the home, staff and visitors, however all care staff that have not done so must receive basic first aid training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager at Fairhaven Nursing Home is experienced and well qualified in managing a care home for older people. The registered manager is a first level nurse and has also achieved a Certificate in Management in Health and Social Care, a Bachelor of Science degree in Health Studies and has obtained a D32/33 trainers certificate. In addition, the registered manager has completed a variety of other courses relevant to the care of older people. Staff and residents spoken with all spoke positively about the registered manager and felt well supported by her. One resident spoken with said of the manager and staff that they were very good, “they will go out of their way for you, will run a mile, it’s nothing to them” .A member of staff spoken with also felt the manager and staff group were very good and supportive when she said, “This is a very good place to work, all staff get on well and support each other, I enjoy working here”. Quality monitoring and quality assurance systems are in place and the home has achieved the ‘Investors In People’ award. The home regularly reviews aspects of its performance through a programme of self-review and consultation. This includes regular resident feedback questionnaires. At the time of the visit, quality assurance questionnaires were freely available in a communal area of the home for resident and relatives to access. A number had been completed and returned that provided positive comments. The outcome of the recent residents questionnaires should be incorporated in the revised Service User Guide At present there is no formal system for eliciting the views of other people who visit the home such as District Nurses, Chiropodist, hairdresser and trades people. It is suggested that this is an area that could be developed to help inform the internal quality audit. Consideration could also be given to designing a specific questionnaire for relatives tailored to their perceptions of whether the home is meeting resident’s needs and providing a high quality service. In the past, resident meetings were introduced but these did not prove to be successful. Current residents prefer informal day to day dialogue in order to have their say and a number of residents were quite vocal in expressing their views. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 28 Resident’s financial interests are safeguarded by the financial procedures adopted by the home. People living at Fairhaven Nursing Home are, wherever possible, encouraged to remain financially independent or assisted in this task by a family member or independent advocate. When the home does retain any monies or valuables in respect of a resident, this is appropriately recorded and secure facilities are provided for the safe keeping of monies and valuables held on behalf of the individual. There was evidence that formal documented one to one staff supervision had taken place but less frequently than the recommended minimum of at least six times a year. When planned one to one formal staff supervision does take place, the person to be supervised is provided with a supervision form to self identify his or her own strengths and needs prior to the meeting. These were evidenced. Individual annual staff appraisal is also planned and all staff are informally supervised as part of the day-to-day management role. As recommended in Standard 36.3, formal one to one staff supervision should take place at least six times a year and cover at minimum, all aspects of practice, philosophy of care in the home and career development needs. Whilst except for senior care staff, the registered manager can delegate the supervision of other staff to other people, it is important that the supervisor is competent to supervise others and understands the philosophy of formal supervision. The registered manager ensures the health, safety and welfare of residents, staff and visitors through a variety of policies and procedures and staff training initiatives. All staff undertake a variety of health and safety training. From information contained in the Annual Quality Assurance Assessment (AQAA), twelve members of staff have undertaken infection control training. It is recommended that any members of the care staff team who have not done so, be provided with this training. From discussion with the registered manager, it is understood that all care staff have also received moving and handling training and fire safety training. One member of staff is a qualified first aider and a number of other staff have also undertaken the basic first aid course. However there is requirement that all care staff must undertake a basic first aid training course. It is also recommended that any member of staff that has not done so, that assist in meal preparation, serve food or assist residents during meals times should receive food hygiene training. Maintenance records were available to confirm that various routine health and safety checks are maintained on a regular basis to the internal and external environment of the home. It was also noted that equipment is regularly serviced. In addition, risk assessments are available in respect of fire, health and safety issues that are regularly reviewed. It was noted however that stair gates are in situ. It is recommended that a specific risk assessment be carried Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 29 out to establish if these continue to be required or if there is an environmental risk or a personal risk to any resident as a result of the provision of the stair gates. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 30 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES 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 Directions on handwritten MAR charts must be identical to those on the medicine labels. (Timescale of 20/09/06 not met) All care staff that have not done so must be provided with first aid training Timescale for action 31/10/07 2 OP38 13(4) 31/01/08 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 3 Refer to Standard OP1 OP3 OP7 Good Practice Recommendations The Service User Guide should be reviewed and amended where required. Plain English should be used to ensure that residents understand the contents. The pre admission assessment should include clear details of religious and cultural requirements and social interests, wants and wishes. All individual care plans should be holistic in content and include social, religious and cultural needs and requirements. Care plans should identify strengths and well as needs. Wherever possible care plans should be signed by the resident/relative. If a resident does not want DS0000062791.V347902.R01.S.doc Version 5.2 Page 32 Fairhaven Nursing Home 4 OP7 5 6 7 8 9 10 OP9 OP19 OP27 OP30 OP33 OP38 to become involved in the care planning process this should be clearly recorded. Whenever a risk has been identified, a formal risk assessment should be completed with significant outcomes incorporated in the care plan. Care plans should be written in a style that residents could easily understand. Any hand written entries on the MAR sheet should be witnessed and countersigned by a second member of staff to ensure accuracy. All bedroom doors should be fitted with an appropriate lock with the resident retaining the key unless the risk assessment suggests otherwise. Staffing levels should be kept under constant review and determined by the dependency levels of residents accommodated. The current induction-training programme should be evidenced against the ‘Skills for Care’ induction training standards to ensure compliance. Consideration could be given to developing a specific questionnaire for relatives and other interested stakeholders to help inform the internal quality audit. It is recommended that a risk assessment be undertaken with regard to the stair gates. Care staff that have not done so should undertake infection control training and food hygiene training. Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Fairhaven Nursing Home DS0000062791.V347902.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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