Inspection on 21/06/07 for Fairholme House

This inspection was carried out on 21st June 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 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 House 30/06/08

Fairholme House 23/08/06

Fairholme House 10/11/05

Fairholme House 05/07/05

Fairholme House 09/11/04

Fairholme House 06/05/04

Fairholme House 06/02/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Fairholme House Church Street Bodicote Banbury Oxfordshire OX15 4DW Lead Inspector Delia Styles Unannounced Inspection 26th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairholme House DS0000013085.V342918.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. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairholme House Address Church Street Bodicote Banbury Oxfordshire OX15 4DW 01295 266852 01295 266954 info@fairholmehouse.com 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) Oxford Care Homes Limited Ms Jacqueline Moss Care Home 22 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (22), of places Physical disability over 65 years of age (2) Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 22. 23rd August 2006 Date of last inspection Brief Description of the Service: The home is situated in a village location on the outskirts of Banbury. The village has a post office, church and a public house. The home has 7 single bedrooms with en-suite facilities on the ground floor; upstairs, there are 13 single bedrooms, and one double bedroom all with en-suite facilities of toilet and washbasin. There are also three separate bathrooms. Stairs and a lift provide access to the first floor. There are two lounges, a dining room and two conservatories on the ground floor providing comfortable communal accommodation. The home provides entertainment and activities for those wishing to take part. There is a pleasant garden at the back of the home for residents to use. The fees for this home range from £630.00 to £695.00 per week. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service, during which the inspector assessed how well the home is meeting those national minimum standards for care homes for older people considered to be the most important for ensuring the health and well-being of residents. The registered manager, Ms Jacqueline Moss, was not available on the day of the inspection (21/06/07), but the inspector fed back to the representative of the company that owns the home, Mr Gulamhussein, when he visited the home during the afternoon. The inspector arranged to complete the inspection and feedback to the manager at a short second visit on the 26/06/07. The inspector asked the views of the people who use the service and other people seen during the inspection, or who responded to questionnaires that the commission had sent out. Comment cards from 3 residents (completed with the help of their relatives), 2 relatives and 3 GPs from 3 different Banbury surgeries were received. All responses were good indicating that people using the services were satisfied with the way in which the home was managed and the standard of care given to residents. Information required to be provided by the home – the Annual Quality Assurance Assessment (AQAA) – was not available before the inspection, because the home had not received the questionnaire in the post. An electronic version of the AQAA was sent to the proprietor on 25/06/07 but was not returned before this report was completed. The inspector would like to thank all the residents, staff and managers for their welcme, time and assistance during the inspection process. What the service does well: The home has an experienced manager who is well supported by her staff. The inspector spoke to a number of staff and they all said they liked working in the home. It was apparent that staff morale was good. The following are comments made by people who returned comment cards directly to the commission: ‘The home makes the residents feel very comfortable to be there and visitors are allowed at any time’ ‘They care for my [relative] in such a way that she is happy and content at Fairholme House.’ Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 6 ‘The family is very pleased with the attention, care and supervision our [relative] is receiving in Fairholme House’ ‘The food is excellent’ – ‘very good standard and choice’. ‘The staff at Fairholme are always co-operative and seem very caring. I never have any complaints from patients’ What has improved since the last inspection? What they could do better: The standard of the written records of residents’ pre-admission assessment of their care needs should be improved; and each resident should have a written plan of care. Currently there is too little detail about the actions care staff need to take to make sure that they are meeting all the health, personal and social care needs of residents. The home is required to include a photograph of each resident and member of staff in the records held in the home: photos were not included in the records seen by the inspector. Further improvements should be made to the record-keeping systems in the home, for example, the staff files to show that staff have been employed following a fair and rigorous process of checks and an interview, and have received the necessary training and supervision to provide a good standard of care for residents. There is still no formal system in place for getting the views of residents or their families about the home and care they receive. This needs to be developed to show how far the home meets the aims and objectives set out in its information and further develop its quality. Some room doors were propped open and not held open with the type of automatic closer approved by the fire service and that shut the doors automatically in the event of the fire alarm sounding. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 7 If doors are propped open they will not act as a barrier to the spread of smoke and flames in the event of a fire and will put residents and staff at risk. The fire safety officer must be consulted about fitting suitable closers to doors, where residents want to keep their room doors open. Some first floor windows are not fitted with window opening restrictors and this means there is the potential for residents to fall out of windows that are open. Window restrictors should be fitted to upper floor windows, unless a risk assessment, based around the individuals that use the service, indicates how windows are otherwise safe. 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. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is adequate. Prospective residents and their families and representatives have sufficient information about the home before they come to stay to make an informed decision about whether it is likely to suit them. The written pre-admission assessment information should be more detailed to enable staff to have sufficient information upon which to draw up care plans and for staff to be able to assist residents in the most effective ways to meet their assessed care needs. This judgement has been made using available evidence including a visit to this service. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has produced a Statement of Purpose and Service User guide as required since the last inspection, under Regulations 4 and 5 of the Care Homes Regulations 2001. The documents are combined, but provide clear information about the services and facilities and include a sample of residents ‘Contract of Residence’. Of the 3 residents’ comment cards received 2 out of 3 said they had received a contract. All felt they had received enough information about the home before moving in; one person wrote they were ‘lucky to find a vacancy at Fairholme House – it came well recommended from several sources’. On the first day of the inspection, a prospective resident and a relative were being shown round the home. Other comments indicated that residents or their relatives had been made welcome and encouraged to visit the home before moving in for a trial period of a month. The manager assesses all prospective residents to ensure that the home is able to meet their needs. The inspector examined the assessment and care records for 3 residents. The assessment document has topic headings and a very brief description of the person’s needs. Other assessment information from care managers or hospital units was included in 2 residents’ records. Assessment information was incomplete in the sample of records seen, which meant that care staff did not have sufficient information on which to draw up care plan – and there were no care plans as such to describe how the care staff should assist the residents. One person with mobility and continence problems had not been assessed in relation to how the layout out of the room and access to the toilet would best help him or her to remain independent. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Residents’ health care needs are being met. Personal support is offered in such a way that promotes and protects residents’ privacy. The care planning system does not adequately provide staff with the information they need to consistently meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All 3 residents and 2 relatives who returned comment cards to CSCI said they were satisfied with the care provided. Doctors also expressed satisfaction and made comments such as ‘the staff at Fairholme are always co-operative and seem very caring. I have never had any complaints from patients’. The inspector examined a sample of care records. There were no specific care plans – that is, there were no detailed written directions for care staff to follow where a resident had a specific care need or problem, for example, incontinence; or where the district nurse was attending a resident regularly. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 12 One resident’s care record included a Macmillan nurses’ contact number, indicating that they had been assessed by palliative care services, but there were no written records of assessments or indication about the resident’s wishes about their last care. One resident who had been admitted 3 weeks before the inspection had incomplete assessment details, no personal history, record of preferred activities, or risk assessments. Care staff complete a daily communication sheet for each resident but in this resident’s case, there were no entries for 2 consecutive days, although in the last entry a carer had recorded that the resident had a gastric upset. The inspector also noted from the accident records that the same resident had fallen but this had occurred on a day when the communication record had not been completed. It is important that all staff are aware of the importance of all residents having a care plan that sets out their health, personal and social care needs in detail, so that care staff are aware of the action they need to take to ensure all aspects of residents’ care are met. Some basic risk assessments for ‘personal care’ and ‘falls’ were included in 2 of the 5 care records looked at. There were no specific nutritional risk assessments in place. One resident had not been weighed since February 2007, perhaps because this individual is unable to stand on scales independently and the home does not have sit-on weighing scales (this was a recommendation made at the last inspection). There was no evidence that residents and their representatives are directly involved with drawing up their care records or in reviewing these. The homes statement of purpose and service user’s guide states that the home is ‘committed to providing a holistic care and the individual service user’s agreed care plan provides the basis on which its care service is delivered. Each service user’s plan includes a description of their preferred daily routine …a risk assessment and any risk management needed.’ From the sample of care records seen the inspector considers that they are inadequate because they do not identify the residents’ needs in sufficient detail and do not provide staff with enough information for them to be able to identify any improvements or deterioration in residents’ care needs over time. However, from conversations with the manager and staff it was clear that resident’s individual care needs are generally well understood and catered for. The written records should be improved to reflect the standard of care given in practice. Residents’ care records did not include a photo: this is a requirement under Regulation 17 and Schedule 3 which lists the records that must be kept in the home in respect of each service user. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 13 The home uses a blister pack system for residents’ medication, provided by a large high street chemist. There are appropriate procedures in place to manage the storage, recording and distribution of medication. Senior care staff receive appropriate training in medication administration through a local college. The medication administration record (MAR) charts seen were up to date. It is recommended as good practice that the home maintains a record of the signature and usual initials for staff who are responsible for the administration of medication, to enable correct identification of the member of staff who has signed the MAR records and to avoid any confusion between staff initials and the code letters entered on the MAR to denote the reason for omitting a dose of prescribed medication. As is the case in many care homes and NHS health care facilities, there is a wider range of racial, ethnic and faith backgrounds represented within the staff group compared with the current residents. From the evidence seen and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Residents have single rooms (the double room is used by one occupant) and staff were seen to knock and await an answer before going into resident’s rooms. Residents spoken with and who completed comment cards considered that staff listened to them and acted on what they said: ‘staff are generally very attentive and caring’. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. The home is improving the frequency and range of activities available for residents so that they have more opportunities to participate in stimulating and motivating pursuits. The meals are good offering both choice ad variety and catering for special dietary needs. Mealtimes are leisurely and social occasions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs someone as an activities coordinator for 20 hours a week and the scope of activities for residents is improving. Residents’ and relatives’ comments in the completed surveys indicated that people felt there were ‘usually’ activities organised that they could join in on a ‘few days each week’; ‘Bingo and quizzes are regular – other events occasionally’. One person wrote that they felt that ‘the more able residents could perhaps have more stimulation although this has improved recently with activities most afternoons’. One resident spoken with told the inspector they were ‘bored’ but this was because their usual family visitor(s) were on holiday. Staff were aware of this and during the report handover discussed the need to support this individual and spend as much time as they could with him/her. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 15 The inspector noted that there was a word game/puzzle on a whiteboard on display with invitations to ‘everyone’ to have a go. At various times in the day residents were occupied with reading their papers, books, watching TV, or listening to music in the lounges. Residents who wished to joined in Holy Communion in the lounge or were ministered to in their rooms. It was clear that the activities organiser is working hard to arrange more individual and group activities based on things residents would like to do or to try. One relative wrote about the positive effect this was having – ‘X is a very private person, but the staff have persisted and now X gets involved in afternoon activities which [s/he] quite enjoys’. The manager said that they had just been offered a collection of large-print library books from a local library. During the morning of the second half of the inspection, several residents had joined in an art group. There is a pleasant garden that is well used by residents in good weather, as well as two conservatories providing quiet surroundings. The garden has a sloping path from the conservatory. The inspector suggested that a handrail might improve the access for residents to this garden. On the first day of inspection the inspector joined residents for lunch in the dining room. The food looked and smelled appetising. The dining tables were attractively set out and the mealtime was a leisurely and sociable event. Most residents had decided to eat lunch in the home’s dining room, although meals can be served anywhere in the home to meet residents’ individual wishes. The first course was home made parsnip soup, or grapefruit salad, followed by steak and mushroom pie, with cauliflower, broccoli, carrots and potatoes. An alternative dish was chicken pasta and pepper. The dessert was a lemon, cream and meringue; or a choice of yogurt, fresh fruit, or cheese and biscuits. Coffee and tea were served at the end of the meal. Fresh vegetables and seasonal products are used whenever possible, and the menus showed a varied and nutritious diet was provided. Of the 3 residents who completed comment cards, 2 out of 3 ‘always’ liked the meals at the home and one ‘usually’. Comments were that ‘the food is excellent’ and ‘of a very good standard and choice’. There was a menu on display in the main corridor, but the cook explained that she had had to make alterations to the planned menu for that day. Residents were not aware about the menu choices for the day, but were confident that the meal would be enjoyable. Residents spoken with said the standard of food was good and they always enjoyed their meals. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Residents, relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. There are procedures in place to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a copy of the homes complaints procedure displayed in the corridor near the kitchen, though this is in small typeface and difficult to read for most residents. However the homes complaints procedure is clearly set out in the Statement of Purpose/Service User Guide. These documents also describe the homes ‘whistle-blowing’ policy that encourages staff to bring to the attention of managers ‘any wrongdoing or suspected wrongdoing which they feel could affect the reputation of the home, other members of staff, visitors, residents or any other organisation or persons connected with the home’. Residents and their relatives’ comment cards indicated that they would know how to make a complaint if they needed to. A care leader was not aware of there being any record of concerns or complaints maintained in the home. The manager said that concerns or ‘grumbles’ are dealt with promptly by personal contact and discussion with residents and their families. The home should maintain a record of any concerns and complaints and the action taken to address these. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 17 Neither the manager, nor CSCI, has received information about any formal complaint since the last inspection. The manager has a copy of the Oxfordshire multi-agency codes of practice for the protection of all vulnerable adults from abuse, exploitation and mistreatment. These codes are discussed with new staff during induction. NVQ training includes a core topic on the protection of vulnerable adults and new carers have undertaken this training. The manager confirmed that there would be annual updates for staff in adult safeguarding issues. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The standard of décor in the home is satisfactory with evidence of improvement through maintenance and future planning. Overall, the home provides residents with an attractive, comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall, the standard of décor and furnishings is good. The home is an old building, with listed status in parts and with interesting original features in many of the rooms. Residents and relatives’ comment cards indicated that they felt the home was ‘usually’ kept clean and fresh, but two out of the five added additional comments: ‘can get dusty, but generally very good’ and ‘’the only criticism I would make is that the décor of the building is looking very tired. The cleanliness of the rooms could be better but again this is not about ‘caring’. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 19 On the day of the inspection the home was clean and tidy in most areas; one first floor room smelled unpleasantly, but staff were aware of this and the home is considering replacing the carpet with washable floor covering with the agreement of the resident and their family. The inspector also noted that parts of first floor corridor and one lounge carpet were stained and the stair carpets worn. The carpet was torn at the entrance to the dining room and in one conservatory the carpet has gaps caused by shrinkage caused by water damage from a leak in the roof. These damaged areas of flooring could be a trip hazard to residents and should be repaired or replaced. Individual residents visited were pleased with their rooms and appreciated that they could add their own small pieces of furniture and ornaments to personalise them. There is a programme of refurbishment and redecoration in place and one of the two ground floor lounges is next to be redecorated the manager said. The plans for continued redecoration and refurbishment were discussed with provider and manager. Staff said that the creation of a ‘wet room’ to replace an outdated bathroom on the first floor had been very useful in improving the access and providing a shower facility for residents. Access to the laundry is from a corridor near to the main lounge. The laundry room is small but was clean and tidy; new washing and drying machines have been provided. Storage space for clean towels and flannels is limited so that shelving and the floor were used for clean laundry in the Parker bathroom. Since the last inspection the inspector was informed that the laundry room and cleaning product cupboard are kept locked when the laundry assistant is not working there, to reduce the risk of confused residents accessing this area. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Since the last inspection, there have been improvements to the standard of vetting and recruitment of new employees. Further action is needed to provide adequate records of the recruitment process and to demonstrate that the home operates a consistently robust selection process that protects residents from potentially unsuitable employees. The staffing numbers and ratio of staff with national vocational qualifications in care, is good and meet the care needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comment cards from relatives and residents showed that staffing numbers in the home ‘usually’ met residents’ needs and that ‘staff are generally attentive and caring’. Standards of care are felt to be good, as shown by comments such as ‘[we are] very pleased with the attention, care and supervision our [relative] is receiving’; ‘they [staff] care for my [relative] in such a way that s/he is happy and content’; and ‘the home makes the residents feel very comfortable to be there’. On the morning of the inspection there was one senior carer and 3 care assistants on duty from 07.30 am to 14.30 pm and one senior carer and 2 care staff on duty from 14.30 until the night staff (2 care assistants) took over. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 21 The manager was on annual leave but was available for a ‘feedback’ meeting with the inspector in the week following the inspection. There was a cleaner, laundry worker and cook on duty during the morning. A kitchen assistant/cook works from 16.30 to 19.00 preparing the evening meal. Staffing numbers and skill mix appeared to be sufficient to meet the care needs of the residents. The inspector checked the training file for staff, but this did not appear to be complete; for example, the senior carer on duty confirmed that she had completed training in a number of topics but this was not recorded in the file. The manager said that the record was still being updated and she had requested that staff bring in their certificates of attendance or completion for courses attended. The inspector looked at a sample of staff recruitment files. There was evidence that the required checks had been obtained in relation to Criminal Records Bureau (CRB) and including checks against the list held for individuals barred from working with vulnerable adults (PoVA). The process of recruitment was not clearly evident from the files seen – there was no record of interviews, job offer letters or confirmation of staff appointment, for example. There were no photos of staff members on file – this is required under Regulation 19 and Schedule 2. The homes system for documenting the recruitment and selection of staff should be improved to demonstrate that managers are operating a thorough and robust employment system to protect residents from potential harm. The manager confirmed that all new staff receive induction training to the standard set out by the national training organisation, Skills for Care. The inspector was unable to see evidence of individual staff members’ induction training as they keep their own training booklets. The manager confirmed that all care staff receive mandatory training in moving and handling, fire safety, food hygiene, first aid (a full days training is undertaken by all the senior care staff); and that staff will be given adult safeguarding updates each year. Care staff are encouraged to undertake National Vocational Qualifications (NVQ) in Care and on the day of inspection the inspector met an NVQ Assessor who was visiting care staff undertaking NVQ training at the home. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. The manager provides clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. However, there are still some issues about which recommendations were made in relation to staff supervision and health and safety issues that have not been addressed since the last inspection and have the potential to put residents at risk. This judgement has been made using available evidence including a visit to this service. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has considerable management experience and has worked with older people for a number of years. She has the Registered Manager’s Award (level 4 NVQ in management) and has completed Level 4 NVQ in care. Comments received in writing and during conversations during the inspection were positive about the way the home is organised and the manager and home proprietor’s availability to discuss any aspects of the care and facilities with residents, their families and representatives. The manager obtains informal feedback from residents and their visitors during general conversation, but there are no formal quality assurance systems in place. These systems should be implemented to assist in the future development of the quality of the service for residents. This was a recommendation also made at the last inspection. There was no record of formal supervision meetings for 3 of the 4 staff whose files were looked at. Another staff member spoken to during the inspection confirmed that she had not had formal supervision. The manager confirmed that the programme of formal staff supervision is not yet fully in place. This also identified at the last inspection. Though the home is small and the manager and carers meet informally and discuss residents care and training issues at meetings and staff handovers, it is important that each carer has the opportunity to have individual time with the manager and/or senior care staff to discuss their work, progress and any concerns or training and development needs they may have and a record is kept of supervision meetings. Residents are encouraged to manage their own finances for as long as they can before involving the help of a representative. The manager arranges for day-to-day incidental expenses to be paid out of a ‘float’ provided by the owner and residents are invoiced monthly for payment. The manager does not permit staff to be involved with residents’ finances and this is made clear in the Service User’s Guide for the home. Outside, some of the wooden window frames are rotten and in need of replacement. A number of first room windows have not been fitted with opening limiters and there were no written risk assessments to indicate whether individual residents or their visitors are safe from accidents in rooms where windows open widely. As recommended at the last inspection, opening limiters should be fitted to upper floor windows, unless a risk assessment, based on the abilities and wishes of the residents using these rooms, indicates that the windows are safe. The home employs a contract cleaning and maintenance services, with local contractors to carry out any plumbing and electrical work that is required. Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 24 Staff list any repairs/maintenance jobs that need doing in a workbook that is checked and signed when the work has been completed. As recommended at the last inspection, the manager now routinely checks and records the hot water temperatures at bath and shower outlets to ensure that the temperature is kept at the recommended ‘safe’ range of close to 43°C to avoid accidental scalds to residents. The inspector checked the records and randomly checked 2 hot water outlets – the temperature was found to be satisfactory. The manager said that temperature-limiting valves are still to be fitted to taps in some rooms, but work was underway to complete this. One resident’s first floor room felt excessively hot (it was a warm summer day) and their room heater was on. It was not clear whether s/he could alter their room radiator setting independently. The inspector considered that this resident could be at risk from hyperthermia especially in hot weather. This was pointed out to the manager who said she would ask for the plumber to check the radiator and setting. The records for fire alarm tests, fire drills and emergency lighting checks were seen and were up to date. The inspector noted that old flat irons were used to prop the kitchen and kitchen storeroom doors open because of the heat. During a walk around the home other door wedges were seen in residents’ rooms and at least one person asked if they could have their door propped open again, indicating that this is their usual practice. In other parts of the home, doors were held open with automatic door closers of a type approved by the fire service. Fire doors should not be wedged or propped open because in the event of a fire the door would not act as a barrier to slow the spread of smoke and flames and so could endanger the lives of residents and staff. The home must consult with the fire service about fitting additional appropriate door closer devices to doors where the residents’ care needs or their preference is to have their room doors open; and for the comfort of staff in areas where they are working in enclosed areas or where ventilation cannot be improved. A record of any accidents affecting residents is maintained; in one entry examined by the inspector there was no cross-reference in the resident’s care file, so that it was not clear what action had been taken, if any, to check whether the resident had any resulting significant injury or had required further follow-up treatment (see Standard 7 and recommendations in relation to care plans). Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 25 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 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 26 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. 2. Standard OP37 OP37 Regulation 17; Schedule 3 (2) 19 (4b); Schedule 2 Requirement A photograph of each service user must be included in the records kept in the home. Information and documents in respect of persons carrying on, managing or working at a care home must, as part of their proof of identity include a recent photograph of each person The home must consult with the fire authority to ensure that adequate arrangements are in place for containing fire and the means of escape. Timescale for action 30/09/07 30/09/07 3. OP38 23 (4) 30/09/07 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 OP3 Good Practice Recommendations Pre-admission assessment information should be sufficiently detailed that it provides the basis for drawing up care plans, and demonstrate that the home can meet the prospective resident’s care needs. DS0000013085.V342918.R01.S.doc Version 5.2 Page 27 Fairholme House 2. OP7 3. OP8 4. 5. 6. 7. 8. 9. OP9 OP16 OP19 OP29 OP30 OP33 Care records: * Each resident should have a written plan of care that sets out in sufficient detail how the resident’s needs, in respect of his or her health and welfare, are to be met. * Care plans should be drawn up in consultation with, and involving the resident and their relative or representative and should be agreed and signed by the resident whenever capable and/or representative. * Records should be complete and signed and dated by the staff member making the entry. * Nutritional screening should be undertaken on admission preferably using a validated tool such as the Malnutrition Universal Screening Tool (MUST), and regularly reviewed and updated. * Consideration should be given to providing ‘sit-on’ weighing scales. Maintain a list of the usual signatures and initials of all staff authorised to administer medicines in the home. Ensure that all staff are aware of, and record any complaints made, in a complaints record kept in the home. Repair or replace damaged carpets, to reduce the risk of trips and falls. Improve the standard of record keeping and tracking of information in relation to staff recruitment and employment. A record of training should be kept for each member of staff and kept up to date. Residents should be provided with an opportunity to give formal feedback, anonymously if they wish, on the care and services provided. Implement a programme of regular formal staff supervision and maintain records. Window restrictors should be fitted to upper floor windows, unless a risk assessment, based around the individuals that use the service, indicates how windows are otherwise safe. 10. 11. OP36 OP38 Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Fairholme House DS0000013085.V342918.R01.S.doc Version 5.2 Page 29 - 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. 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