CARE HOMES FOR OLDER PEOPLE
Fairholme Roskear Camborne Cornwall TR14 8DN Lead Inspector
Lowenna Harty Unannounced Inspection 4th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairholme DS0000008893.V292953.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. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Fairholme Address Roskear Camborne Cornwall TR14 8DN 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) 01209 714491 01209 711169 fairholmeuk@tiscali.co.uk Mr Jaspal Singh Mangat Mrs Bhupender Kaur Mangat Mr Douglas Graham Hastings Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (57), Terminally ill (57) of places Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service users to include up to 60 adults of old age (OP) some of whom may have nursing needs Service users to include up to 57 adults with a physical disability (PD) some of whom may have nursing needs Service users to include up to 57 adults with a terminal illness (TI) some of whom may have nursing needs Total number of service users not to exceed a maximum of 60 Date of last inspection 2nd November 2005 Brief Description of the Service: Fairholme Nursing Home has been operating since 1988. The home is registered to provide residential and nursing care to sixty service users who are in need of personal care by virtue of being elderly, or adults some of whom may have a physical disability or a terminal illness. The home provides long term and respite placements. The home aims to avoid emergency admissions wherever possible. The home was a former purpose built childrens home. Therefore the structure of the building is challenging in attempting to meet the needs of this current service users group. The home is spread over two floors, lifts allow access to the first floor. The home has ramps to allow access for people with a physical disability but some parts are difficult to access in a wheelchair due to the narrow corridors and size of rooms. The grounds have been developed to improve access to the garden areas. Fairholme has undergone a major building and redecoration programme which has improved the entrance to the home, lounge areas, updated some bedrooms some of now have en suite facilities and new office space. Fairholme is located near the town centre of Camborne and has access to local amenities with good transport links. Information about the home is available in the form of a service users’ guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the main entrance hall. Fees range from £293.25 to £550.00 per week according to the registered manager, who supplied this information to the Commission on 10 May 2006. Additional charges are made in respect of private healthcare provision, escort services and personal items such as newspapers, confectionary and toiletries. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection, which was unannounced. It took place on 4 May 2006 and lasted for approximately seven hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. The inspection included interviews, service users who consented to be interviewed and visiting relatives who were present in the home at the time of the inspection. Care and nursing staff representatives were interviewed and there were opportunities to directly observe aspects of service users’ daily lives in the home. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered providers and registered manager. The principle method of inspection was “case tracking”. This involved interviews with service users; staff caring for them and their representatives, where possible and examination of records relating to their care. This provided a useful impression of how the home is working for service users overall. Four service users were case tracked at this inspection. Service users and their representatives expressed satisfaction with the care and services provided to them at the home. Overall the home is providing an adequate quality of care to the service users placed there, with notable improvements since the previous inspection. What the service does well:
Service users have their care needs assessed as part of their admission to the home so that they can be confident it will be suitable for them and staff are informed about what their needs are, when planning their care. Pre-admission assessment and planning considers service users’ personal, social and health care needs, including needs relating to their individual diverse backgrounds, such as cultural issues and their religious beliefs. Service users and their relatives confirmed that their health and personal care needs are well met and staff treat them with respect so that the quality of their lives is made as good as possible. This was observed at the time of the inspection. Service users are helped to maximise the enjoyment and quality of their lives. They are able to come and go from the home independently or with staff support if they wish and can access a range of activities in the home or choose
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 6 to occupy their own time in the ways they prefer. Visitors are welcomed to the home and there were several coming and going at the time of the inspection. All of the service users who were interviewed on the subject said that food provided to them is good and care is taken to ensure their nutritional needs are met. The home has a pleasant, recently refurbished dining room, in which service users can take their meals if they wish. The tables were attractively laid for lunch, with laminated menus setting out the food options for the day. There are formal and informal systems in place so that service users can make their views heard and influence the running of the home. There is a formal complaints procedure and regular meetings are held with service users and their representatives. Service users can also make comments anonymously via a post box in the main entrance hall, if they prefer. Most of the service users and relatives interviewed at the time of the inspection said that they are satisfied with the care and services provided to them at the home. The home is well situated for service users to access the local community. It is safe and well maintained, with an ongoing programme to ensure it is kept that way and to improve it further. They have a choice of communal areas, inside and outside of the home, where they can meet together or with friends and relatives, as well as their private accommodation. It was clean and tidy at the time of the inspection, which was unannounced and service users said that they are satisfied with the accommodation provided to them. There are enough staff, working in a variety of capacities to work effectively with service users, which service users and staff working in the home confirmed during interviews with them. They were observed to work well as a team and undergo regular training to update their knowledge and skills. The home’s recruitment procedures set out how new staff should be recruited fairly and on the basis of their suitability to work in a care setting. The home is well managed for the benefit of service users and there are opportunities for them to influence this in the form of regular formal meetings during which they can make comments about the quality of the services provided to them and anonymous surveys, should they prefer not to be identified. Service users’ financial interests are protected so that they are not exploited and the home’s environment is kept safe for them and staff working with them. What has improved since the last inspection?
Prospective service users are provided with clear and accurate written information about the home in the form of a service users’ guide, so that they can make an informed decision about whether it will be suitable for them before they move in. This information has been updated and improved since the last inspection and was further improved during the inspection so that it now contains a clear statement about the fact that intermediate care is not provided. There are no service users in receipt of oxygen at the moment, but there is improved signage in case any should need it, so that it can be used more safely. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 7 Some improvements have already been made to improve the safe handling of service users’ medicines in response to some specific incidents when items of medication have gone missing recently. The home’s dining area has now been refurbished and is very attractive. There are facilities for service users to make their own hot drinks, if they wish. Formal systems to protect service users from exploitation and abuse have been improved. Staff have been given clearer written guidance and training so that they can be confident of what they should do if they suspect a service user is being abused. Staff interviewed during the inspection sounded confident about the procedures and said that they would use them to protect service users, if necessary. Further improvements have been made to the home’s environment to make it safer and more comfortable for service users. More rooms have been redecorated and maintenance staff were working on an empty room to refurbish it at the time of the inspection. The home’s lighting has improved with the provision of new light covers and more radiators have been covered to protect service users from risks of burns from hot surfaces. Visitors to the home are now provided with anti-bacterial hand solution in the home’s main entrance hall to encourage good hygiene and prevent the spread of infection in the home. The home’s manager has been registered with the Commission so that service users can be confident that he is a fit person to be in charge of a care home. There are records to show that staff are well supported and supervised so that service users can be confident that their competence to work effectively with them is reviewed on a regular basis. What they could do better:
Systems for handling service users’ medicines should be improved further so that the manager is clear about which member of staff is responsible for medicines on each shift and where errors are made, it is possible to clearly identify the source of them. Recruitment records for newly employed staff should include full information on their previous employment, including any gaps in their employment so that it can be verified against their references and police record checks. This is an important aspect of protecting service users and ensuring that only people who are suitable to work with vulnerable adults in a care setting are employed to work with them. The home is very large and service users and visitors would benefit from improved signage so that they can find their way around it more easily and safely, particularly when the environment is new to them. The home’s programme for covering radiators to protect service users from risks of burns and from hot surfaces should continue, although progress is being made towards covering them all. Copies of professional and trained staff qualifications need to be retained in the home so that they can be verified if necessary and service users can be confident of the competence of the people working with them.
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 8 Interview records should also be retained so that the home can demonstrate that recruitment is fair and in line with its policies and procedures. The registered provider is in the process of undertaking a risk assessment of the home’s environment to confirm that it is safe for service users and staff, which should be completed. 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. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 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 Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Service users are provided with clear information about the services the home provides so that they can make an informed choice about their admission. Service users needs are assessed so that they can be confident that the home will be able to meet their needs, before their placements in the home are confirmed. The home does not provide specialist intermediate care, so this standard was not assessed. EVIDENCE: Evidence was provided in the form of records, interviews with service users, observation of activities in the home and discussion with the registered manager and providers. A copy of the home’s revised statement of purpose was sent to the local offices of the Commission prior to the inspection. Information provided in the course of the inspection accorded with this. There was information on the service users files, of those who were case tracked, that they had been assessed prior to their admission to the home so
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 11 that they could be confident it would be suitable for them. This was confirmed during interviews with service users and their relatives. The home’s assessment format considers service users’ personal, health and social care needs, including needs relating to their diverse backgrounds, such as their religion and cultural backgrounds. These were completed in full in respect of the service users who were case tracked during the inspection. Service users interviewed were positive about the home’s ability to meet their needs. The home does not have specialist facilities for intermediate care, although there are facilities for respite care, depending on vacancies and service users have facilities in the home’s communal area to prepare themselves drinks and snacks so that they can retain some of their independence and skills. The home can also provide them with access to specialist health professionals, such at physiotherapists. The home’s statement of purpose was amended at the time of the inspection to provide prospective residents with clearer information about the extent to which the home can support respite/ rehabilitation and that this does not amount to intermediate care. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this area is adequate. This judgement has been made using available evidence including a visit to the service. Service users’ health, personal and social care needs are set out in individual care plans so that care staff are well informed of how they need and wish to be cared for. Their healthcare needs are met in ways that consider the quality of their lives, independence and dignity. Systems to protect them from medication errors are in need of specific improvement. Service users and their relatives confirmed that they are treated respectfully. EVIDENCE: Evidence was provided in the form of records, interviews with service users and their relatives, interviews with staff working with them, inspection of the premises, observation of activities in the home and discussion with the registered manager and providers. Service users have detailed individual care plans, which set out their personal, health and social care needs in detail, including needs relating to their individual and diverse backgrounds such as their age, cultural background, physical and sensory ability, sex, sexuality and religion, as appropriate. Their care plans are backed up by detailed daily care records, which clearly
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 13 demonstrate how their care plans are put into practice. Service users and their relatives who were interviewed at the time of the inspection confirmed that their care needs are mainly well met. Service users’ care plans and daily care records set out how their healthcare needs are met. Interviews with them, visiting relatives and staff working with them confirmed that they are well cared for and able to access a range of NHS care providers, such as dentists, doctors, chiropodists and physiotherapists when they need to. The home’s written procedures and records, including staff training records and inspection of storage facilities provide evidence that service users’ medicines are mainly managed so that they are protected from medication errors. No service users are currently in receipt of oxygen, but there is now improved signage, which can be used if the situation changes. There have recently been some improvements to handling of medicines, in response to specific incidents of service users’ medication going missing of late, and the registered manager has taken appropriate action in reporting this. Further improvements are needed to ensure a clear audit trail, such as ensuring that only nominated key holders have access to medication in the home’s safe-keeping. Service users interviewed at the time of the inspection confirmed that their privacy is respected and staff treat them courteously. This was observed at all times during the inspection and noted during interviews with staff, managers and the registered providers. For example, there are door locks with over-ride facilities for emergencies on bedroom doors so that service users can safely choose the level of privacy they wish to enjoy. They are able to make a choice about whether or not to share bedrooms and have adequate facilities to ensure their privacy when they do so. There are sufficient bathrooms and toilets to ensure that they are able to receive intimate personal care in private. There is appropriate consideration of the gender of staff providing them with intimate personal care. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 14 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, 14 & 15 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Service users are able to enjoy a good quality of life in accordance with their individual needs and wishes. They are able to receive visitors in private and are assisted to make decisions about aspects of their lives that are important to them. They are provided with a varied range of wholesome foods to maximise their health and enjoyment of meals. EVIDENCE: Evidence was provided in the form of records, interviews with service users and their relatives, interviews with staff working with them, inspection of the premises, observation of activities in the home and discussion with the registered manager and providers. Service users’ care plans consider their individual and diverse needs so that they can be met in ways that are acceptable to them. Examples include ensuring that service users with physical disabilities are able to access the local community independently if they wish or with staff support if this is required. The home caters for service users with a broad range of ages and care is taken to ensure that age appropriate activities are provided. Service users are assisted to access facilities to practise their religion should they wish to do so. Service users interviewed stated that they are satisfied with the activities the
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 15 home provides and confirmed that they are able to choose whether or not to join in with them. Records of visitors to the home, observation during the inspection and interviews confirmed that there are plenty of visitors; they are made welcome and able to meet with service users in private or in the communal areas of the home. Service users were observed coming and going from the home independently and confirmed that there are no unreasonable restrictions on them doing this if they wished. Service users confirmed that they are able to make decisions about important aspects of their lives. Their individual care plans and care records demonstrate this. Service users and their relatives all stated that they are satisfied with the food provided to them at the home. There is a choice of food and adequate records available to provide evidence that service users are well nourished, in accordance with their individual choices, needs and cultural backgrounds. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 16 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): 16, 17 & 18 Quality in this area is adequate. This judgement has been made using available evidence including a visit to the service. There are satisfactory systems in place to enable service users to make comments and complaints so that they can influence the management and running of the service. Their legal rights are protected to reduce the risk of exploitation and they are protected from abuse so that they can feel safe in the home, although there should be improvements to staff recruitment records to improve formal systems to protect them. EVIDENCE: Evidence was provided in the form of records, interviews with service users and their relatives, interviews with staff working with them and discussion with the registered manager and providers. The home has a formal written complaints procedure, which is given to service users as part of the home’s service users’ guide. Records of complaints are maintained although there have not been any recent formal complaints. Service users and relatives interviewed at the time of the inspection stated that they are well cared for in the home, that they would know how to go about making a formal complaint if they wished to do so, but had not had any cause to do this. There are relatives and service users’ meetings in which they can make their views known and comment cards are provided in the entrance hall so that they can make comments anonymously if they prefer. Service users’ legal rights are protected and they are informed of them in their written contracts and service users’ guides. The home’s written procedures on the management of service users’ financial affairs have been amended so that
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 17 they provide clear guidance to staff and reduce the risk of mismanagement of service users’ personal finances. The home’s written procedures for the protection of vulnerable adults from harm and abuse have been amended so that they provide staff with clear guidance on what to do if they suspect a service user is being abused. Service users who were interviewed during the inspection stated that they feel safe and well cared for in the home and this was confirmed in interviews with staff, who appeared confident about the systems for protection of service users. There has been internal training for them in the home and they have been able to access local multi-agency training so that they can learn how different agencies work together to protect vulnerable people. Staff recruitment records indicate that important safety checks are made, but there should be a full employment history provided in relation to new employees, with explanations of any gaps in their employment in every case, which can be internally verified against the external references and police records checks that are completed. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 & 26 Quality in this area is adequate. This judgement has been made using available evidence including a visit to the service. The home is mainly safe and well maintained and there is an ongoing improvement programme in place so that service users benefit from a comfortable and homely environment. There is a range of attractive communal facilities so that service users can meet together and with relatives in pleasant surroundings. It is well lit and ventilated, clean and hygienic so that service users are protected from infections. EVIDENCE: Evidence was provided in the form of records, interviews with service users and their relatives, inspection of the premises, observation of activities in the home and discussion with the registered manager and providers. There is an ongoing programme to maintain and improve the home for the benefit of service users and maintenance staff were present during the inspection. Several bedrooms have been refurbished to make them more comfortable and attractive. Service users interviewed said that they are
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 19 satisfied with the accommodation provided to them. The home is well located for the centre of the local town and all its amenities, so that service users can easily access them if they choose to do so. Service users were observed making good use of the range of comfortable communal spaces available to them, including three main lounges and the newly refurbished dining room. There are quiet areas with seating at strategic points around the home and service users have a separate smiling room with a pool table in it, which they can make use of. There are large notices with activity schedules, so that they can easily read about what is going on in the home. The main entrance hall is attractively decorated and contains a copy of the home’s most recent inspection report to inform service users and visitors. The home has a large, well-maintained garden with seating outside. The home is very large and service users and visitors would benefit from better signage so that they can find their way around it more easily and safely. The home’s lighting has been audited and new covers have been purchased so that the home looks brighter and more attractive and service users can find their way around it more easily. Radiator covers are being fitted on a rolling programme, which is ongoing. Some have been completed since the last inspection, but more are needed. The home appeared clean and tidy at the unannounced inspection. Staff are provided with training, written guidance and the equipment they need to maintain hygiene in the home. Visitors are now provided with anti-bacterial hand lotion in the main entrance hall to encourage good hygiene and prevent the risk of infection entering the home. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 20 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): 27, 28, 29 & 30 Quality in this area is adequate. This judgement has been made using available evidence including a visit to the service. There are sufficient staff working in a variety of capacities to meet service users’ needs but improved evidence of their qualifications is needed in some cases so that service users can have confidence in their competence to work effectively with them. The home’s recruitment policies set out fair, safe and effective procedures for staff selection but records should demonstrate how this is carried out in practice. Staff are well trained to meet service users’ needs. EVIDENCE: Evidence was provided in the form of records, interviews with service users and their relatives, interviews with staff working with them, observation of activities in the home and discussion with the registered manager and providers. Staff records in the form of duty rosters and the home’s statement of purpose provide evidence that there are sufficient staff on duty at any one time, to meet service users’ needs. Staff are employed in a variety of capacities, including nursing, care, housekeeping, catering and maintenance. Service users interviewed stated that there were sufficient staff to care for them and staff who were interviewed said that there were enough of them to work effectively as a team. At the time of the inspection, two staff members had left suddenly and the registered manager was in the process of recruiting staff to
Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 21 replace them. The remaining staff were able to cover their shifts in the meantime. There are sufficient numbers of qualified nurses, assisted by care staff who are qualified to at least NVQ level2 to meet service users needs skilfully and effectively, although copies of their qualification certificates should be retained so that they can be verified, if necessary. The home’s recruitment policies and procedures are clear and show a commitment to equal opportunities so that service users benefit from staff who are employed fairly and on the basis of their suitability to work with vulnerable adults in a care setting. Staff records should demonstrate how these procedures are put into practice, but did not in every case. Interview records should be retained, in addition to full employment histories and copies of qualification certificates previously mentioned in this report. Staff are provided with good access to ongoing training so that they maintain and develop their skills and are able to work effectively with service users. There is a whole team training plan and records of training that staff have attended. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. The home is well managed for the benefit of the service users. Their views are taken into account in the planning and management of the home. Service users’ financial interests are safeguarded so that they are protected from financial exploitation. Staff are well supported and supervised to ensure they remain effective. The home is mainly safe for the benefit of service uses and staff although the environmental risk assessment should be completed. EVIDENCE: Evidence was provided in the form of records, interviews with service users and their relatives, interviews with staff working with them, inspection of the premises, observation of activities in the home and discussion with the registered manager and providers. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 23 The registered providers were both at the home at the time of the inspection and are clearly closely involved in its management and day-to-day running. They were well informed and able to provide useful information to assist the inspection process. The Commission has registered the home’s manager as fit to manage the home, since the previous inspection. Service users and their representatives are consulted about their views and preferences, individually, as part of the care planning process and collectively as part of the home’s formal quality assurance programme. There are regular meetings with service users and their relatives with minutes kept. Service users’ views are included in the home’s annual development plan, which was available for inspection. Records of service users’ personal finances, where the home assists them are clear and there are written procedures to guide staff on how to manage them, if they require assistance, and to protect service users from financial abuse. There are records of staff supervision and staff who were interviewed at the time of the inspection confirmed that they have good access to ongoing formal supervision and support. Records of regular safety checks demonstrate that service users and staff are protected from fire risks and other environmental hazards. The registered provider is in the process of completing an environmental risk assessment now that the dining room refurbishment is done and this needs to be completed. Staff records indicate that they are provided with the training they need to keep service users safe. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 18 2 3 2 X X X X 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 25 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 OP18 Regulation 19 Requirement Staff must not be employed to work in the home unless they provide a full employment history with a satisfactory explanation of any gaps in their employment, in writing. Copies of staff qualification certificates must be held in the home. Timescale for action 01/06/06 2. OP28 17(2), 19 01/06/06 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. Refer to Standard OP9 Good Practice Recommendations Handling of medicines should ensure that there is a clear audit trail, including recorded key holders in respect of medicines held for service users. Signage in the home should be improved so that service users and visitors can more easily find their way around it. The planned installation of radiator covers on surfaces that service users have access to should continue. 2. 3. OP20 OP25 Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 26 4. 5. OP29 OP38 Interview records for newly recruited staff should be retained in the home. The home’s environmental risk assessment should be completed. Fairholme DS0000008893.V292953.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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