Inspection on 28/10/08 for Fairholme

This inspection was carried out on 28th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fairholme 14/11/06

Fairholme 27/10/05

Fairholme 21/06/05

Fairholme 22/11/04

Fairholme 30/06/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fairholme Morda Road Oswestry Shropshire SY11 2AP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joy Hoelzel     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Fairholme Morda Road Oswestry Shropshire SY11 2AP 01691653499 01691654247 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Coverage Care Services Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Dementia (DE) 40 Date of last inspection Brief description of the care home Fairholme is registered to care for a maximum of forty older people; within this number up to fourteen of the service users may have dementia care needs. The care home provides both long term and respite care, there is a designated respite unit. All of the rooms within the home are single and all meet the National Minimum Standards. The Registered manager Mrs Denise Morris has been at the home since June 2003. The registered provider is Coverage Care Services Ltd - a `not for profit organisation registered with the Register of Industrial and Provident Societies and has a charitable trust status. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been Care Homes for Older People Page 4 of 27 40 0 Over 65 0 40 Brief description of the care home revised and are readily available. The service user guide has details of the weekly fee for the service, from four hundred and twenty five pounds per week. The reader may wish to obtain more information from the care service Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place over four hours on Tuesday 28th October 2008. Thirty nine people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The registered manager was on the premises supported by a duty manager, six care staff, support workers and ancillary staff. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen Care Homes for Older People Page 6 of 27 included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it to us. Comments from the AQAA are included within this inspection report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. Evidence: Details of the service provision are available in the statement of purpose and service user guide; both documents have recently been updated and are available on request at the home. There is information of the current level of fees and what is and what is not included in the fees. The case file of the person who recently moved into the home was looked at to see if information had been sought regarding this persons needs prior to moving into the Care Homes for Older People Page 11 of 27 Evidence: home. Information had been gathered from various outside agencies and an assessment of care needs had been conducted by the home. Other case files looked at contained a pre admission assessment conducted by a member of staff from the home and information from previous placing authorities. The Annual Quality Assurance Assessment completed by the manager records and describes the admission procedures and the action the service to takes to ensure that care needs can be fully met. During the next twelve months the service plans to Continue to promote an open and welcoming home and provide honest and up to date information about our services. Two people discussed how they came to the decision to move into the home and stated that they found all aspects of the home very satisfactory and the staff extremely helpful. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The plan is person centered and focuses on the individuals strengths and personal preferences. The delivery of personal care is individual and is flexible, consistent, reliable, and person centered. Staff respect privacy and dignity and are sensitive to changing needs. Evidence: All people living at the home have a plan of care that is based on the information gained prior to admission. The plan is reviewed at the point of admission to the home and then on a regular basis. The plans selected for inspection all evidenced that the individual and relative or representative had been involved with the care planning process. The plans were very specific to the individual and recorded the actions to be taken by staff to meet the health, personal and social care needs. The files contained an account of the life and social history, the monitoring required for specific medical conditions and the equipment needed for maintaining independence. A persons Care Homes for Older People Page 13 of 27 Evidence: preferences for end of life care were included in the plan, this will ensure that a persons wishes are respected One plan detailed very clear instructions for staff of the action needed when a person occasionally experiences periods of distress. Staff described the action they took to help and support this person. The plans record regular contact with external health care professionals and the assistance needed to maintain adequate nutrition. The Annual Quality Assurance Assessment completed by the registered manager describes the process for providing good health and personal care Comprehensive care planning and review. Care plan reviews monthly involving service user. Thorough medication procedure with all staff receiving regular training and spot checks. Staff trained through induction and NVQ in providing personal care, treating service users with dignity, respect and ensuring privacy. Families are involved in end of life plans and these are drawn up in accordance with the Liverpool Care pathway. Support is accessed from specialist agencies as required. Not all people living at the home were able to fully comment on their experiences of home life, those who were able to offer an opinion stated that they were very happy and satisfied with the care they were receiving. Observations of the people who are unable or unwilling to speak were that they appeared well cared for, well nourished and they looked contented. The home operates a twenty eight day prescribing regime for the administration of medication using a monitored dosage system with the additional use of boxes and bottles of medicines. The carers administer the medications, following an assessment of their competency, this continues at frequent intervals with records of the assessment kept. The Medication Administration Record, MAR, had a photograph attached of the person, for identity purposes, to reduce the risk of administration errors. The MARs appeared to be fully completed, and no gaps in the recording sheet were seen in the selection viewed. Observation of staff working practice and during the tour of the premises evidences that the privacy and dignity of people is upheld at all times. Staff were very respectful when speaking with residents and it was obvious that very good relationships had been developed and maintained. People were very relaxed and appeared comfortable. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community Evidence: Currently the staff arrange and facilitate social and leisure activities both in house and in the community. The manager is hopeful that a social activities coordinator will be recruited in the near future. The AQAA completed by the manager describes the some of the activities that are arranged Provide beauty therapy, hairdressing, Tai Chi and Extend weekly, provide a range of religious services to meet service users needs. Organise activities and social events in the home which are relevant to service users needs and preference. During the past twelve months the service has accessed new entertainment opportunities, belly dancers visited the home, we had a Body Shop demonstration, a group of EMI service users attended Chance to Dance at the Alzheimers Society meeting. During the time of this inspection people were engaging in a variety of activity in each Care Homes for Older People Page 15 of 27 Evidence: of the three units. People were reading the newspapers, listening to music watching television, receiving hand massage and chatting with each other. Staff were observed to be attentive and supportive to the differing needs of the people. Each unit has been supplied with a variety of reading material, games, music and videos. the gardens are well maintained and accessible, the manager discussed the greenhouse and the opportunity people have for growing fruit and vegetables. The manager discussed the many opportunities available for people to express their preferences both in the formal and informal arenas. Residents meeting and the newly formed ideas meetings are well attended with any suggestions being acted upon. Relatives and friends are free to visit the home at times suitable to the resident. People living at the home expressed a satisfaction with these arrangements and went on to say how important it was to be able to see their relatives regularly. There is a selection of communal areas both inside and outside of the home, this means that people have a choice of place to sit quietly, to meet with family and friends or be actively engaged with other people who use the service. The main entrance to the home is not locked during the day, visitors are requested to sign the register at the reception. A number key pad is sited on the exit doors of the dementia care unit to ensure the safety of the people living in the unit. The garden area outside this unit is freely accessible and safe for people to enjoy. No other doors were seen locked with the exception of some private bedrooms and storage cupboards. People have free access to areas. The home operates a rotational menu with the weekly fare being displayed in each unit. The dining areas are well furnished and prepared in advance of the midday meal. Many people are encouraged to sit at the table but people can have their meal at their place of preference. Some people had their lunch in the lounge and others were in their bedrooms. People commented that the food was very good and that they were totally satisfied with the meals provided. Staff were observed to be patient and understanding when assistance was needed with the meal. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. Residents in the home understand how to make a complaint and are clear about what will happen if a complaint is made. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Evidence: Details of how to make a complaint are included in the statement of purpose and service user guide and a copy of the procedures is displayed at the entrance to the home. All people living at the home have been supplied with these documents. One lady stated that if she any concerns she would be quite at ease to discuss with the manager but really had nothing to complain about and everything was satisfactory. The homes own policies and procedures as well as the local authority safeguarding adult protection procedures are readily available for reference if there is a suspicion of any wrong doing. Care staff were able to explain the actions they would take if they had any suspicions or worries in this area. One safeguarding referral was made recently to the local authority multi agency team. The manager discussed this referral and stated that the outcome was inconclusive. Care Homes for Older People Page 17 of 27 Evidence: The AQAA completed by the manager ensures the safety of people by All staff trained in adult protection in the home and manager and assistant managers regularly attend POVA training by Adult Protection team. Detailed policies and procedures available for all staff to follow about service user protection. Adult protection discussed at staff meetings and in supervisions. Printed information about abuse and protection of vulnerable adults in all welcome packs and reception. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. All transactions are recorded on individual balance sheets with invoices and receipts kept. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. Evidence: Fairholme is situated close to Oswestry town centre. It is a well maintained property providing accommodation and personal care for up to forty people. The home is divided into three units each with their own facilities, dining area, lounge, bedrooms bathrooms and toilets. All areas are well furnished, clean and homely in character. There are a variety of sitting areas so people are able to choose where they sit and either be alone or with other people. The garden is well maintained and accessible. There is a secure garden area for people who may be at risk of becoming lost but can enjoy the freedom of being outdoors. Of the bedrooms seen many reflect the individuality of the occupant with many personal items and possessions. A day centre operates from the service in a dedicated area. The manager stated that some residents attend on occasions and the centre is staffed separately. Care Homes for Older People Page 19 of 27 Evidence: The Annual Quality Assurance Assessment completed by the manager discusses the improvements made during the past twelve months Outside of whole home redecorated, new windows on Primrose unit and vegetable garden developed With compost bins to produce our own. New wood sculpture purchased for the patio and a second ordered for the dementia care unit garden. Recreation room created from disused smoking room at service users request. People said they were very satisfied with the accommodation and were very comfortable and satisfied with the arrangements. All areas of the home were spotlessly clean, the staff responsible for the household cleaning must be commended on maintaining such high standards. Infection control measures were much in evidence with hand wash facilities provided at every outlet. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has plentiful staff available at all times to support the needs, activities and aspirations of residents in an individualised and person centered way. There is evidence that they demonstrate a thorough understanding of the particular needs of individuals, and can deliver highly effective person centered care. Evidence: A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. During the morning of the inspection the registered manager confirmed that thirty nine people were in residence being cared for by a staff team consisting of a duty manager, six care staff, four support workers, catering staff, administrator and handyman. The staffing levels are reduced at night, an on call duty system is in operation should an emergency arise. General observations of staff working practice and home life, discussions with people living and working at the home suggests that the staffing complement is satisfactory for the needs of the current resident population. The AQAA completed by the manager indicates that 90 of the care staff team have a National Vocational Qualification in care at level 2 or above. The care staff discussed the opportunities they have for this training and in other areas that are relevant to the Care Homes for Older People Page 21 of 27 Evidence: service. Two staff personnel files were selected for inspection and indicated that suitable recruitment procedures are in place. Each file contained references, criminal record bureau disclosures and confirmation of identity. Each staff member has an individual training file indicating the training and development needs for the year. Included were certificates and accreditations of training including dementia awareness, person centered planning, medication safety, and the protection of vulnerable adults. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance Evidence: Mrs Denise Morris is the registered manager of the service and has been at the home for a period of time. Mrs Morris is experienced in social care management and works hard to improve the standard of living for people. She is very innovative on how to improve the service and has recently introduced an ideas meeting to increase the opportunity for people to communicate their ideas and how they find life at the home. The manager completed the AQAA, it contains excellent information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to people living at the home. Care Homes for Older People Page 23 of 27 Evidence: People living and working at the home offered positive comments about the style of management and expressed a satisfaction with the service. The service has an effective quality assurance and monitoring system that makes certain the home is operating as it states it does and meets its stated aims and objectives. Results of the most recent satisfaction survey are included in the service user guide. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. The office is very well managed and organised , all documents requested for this inspection were readily available, up to date and in good order. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept and available for inspection. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!