Inspection on 30/06/08 for Fairholme House

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Adequate 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 House 21/06/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Fairholme House Church Street Bodicote Banbury Oxfordshire OX15 4DW Lead Inspector Delia Styles Unannounced Inspection 30th June 2008 11:00 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.V365323.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.V365323.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 jacquiemoss@btinternet.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.V365323.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. 21st June 2007 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 currently range from £695.00 to £850.00 per week. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The overall quality rating is made using ‘key lines of regulatory assessment’ KLORA – and a ‘rules base approach’. The ‘rules base approach’ means that we take particular account of how safe and how well managed a care service is. As they are especially important to quality, we have stricter rules for those outcomes relating to Health and Personal care, Complaints and Protection, and Management and Administration. Services are given an overall quality rating that can only be as good as their poorest rating in these outcome areas. This inspection of the service was an unannounced ‘Key Inspection’ during which we assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit took place over 5.5 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self-assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year; and any information that the Commission had received about Fairholme House since the last inspection. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. Talking with a number of residents and staff gave us information about the home and peoples’ opinions about what it is like to live here. Some of the Commission’s comment cards (surveys) were left at the home for residents, staff, relatives, and visiting health and social care workers to have an opportunity to have their say about the home. We received completed surveys from 3 residents, 5 relatives/carers/advocates and 2 health care professionals and their opinions are included in the report. We would like to thank all the residents, staff, and manager for their welcome and the time taken to help us with the inspection process. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Though improvements have been made to residents’ care records, further work should be done to make sure that these are written with enough 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. Some staff use a blood glucose meter to take ‘finger prick’ blood tests to measure the blood sugar levels of residents with diabetes, without having formal training in the correct use of the equipment. There is a risk that the test results may not be accurate and that the visiting doctor may alter peoples’ treatment on the basis of the results. All staff who use blood glucose meters must be trained in their use and there should be records to show that the staff are assessed as competent to do so. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 7 The home should have risk assessments in place for making sure that any resident who wants to continue to manage their own medicines is confident and able to do this so that the risk of someone accidentally (or intentionally) taking medicines intended for someone else is avoided. The registered provider has failed to meet a requirement made under Regulation 26 of the Care Homes Regulations 2001 which states that the proprietor (or one of the directors or other persons responsible for the management of the organisation) must make unannounced monthly visits to the home to inspect the premises, talk to residents, visitors and staff to get their views about the standard of care, and to write a report about how the home is managed. The Regulation 26 ‘provider visits’ are an important part of the way in which the registered provider can show that the standard of care and facilities provided in the home is meeting residents’ needs and expectations and that any concerns are followed up and resolved. The reports of the visits must be made available to the homes manager, any co-directors in the company and to us, the Commission, when we visit. 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.V365323.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.V365323.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. EVIDENCE: Since the last inspection, the home has reviewed and updated the written information – the Statement of Purpose and Service Users’ Guide – that it is required to make available to current and prospective residents. It is clearly written and accessible to readers though some information is missing – for example, room sizes are not listed; the range of needs that the home intends to meet and the criteria for admission to the care home, including emergency Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 10 admissions (if this is applicable). The website information about the home has not been updated for several years and should be reviewed to make sure that it accurately describes the current facilities. Residents and relatives’ surveys showed that they felt that they had enough information about the home before deciding to move here. One visitor said that they had not had much information because their relative had to be admitted as an emergency but they were pleased that they had chosen this home. Though there have been some improvements made to the written assessments, the sample of 3 looked at during the inspection were still scanty in detail so that care staff would have some difficulty in starting to plan for the care needs of residents before they came to the home. For example, one person had had a knee joint replacement in the past but the assessment did not say which knee, so that when this individual complained of pain, staff may not have been alerted to potential problem. The care needs and how the home would monitor one person’s diabetes was not described in the assessment information, other than that they had medication and a ‘diabetic diet’. One person’s assessment was incomplete and not signed but the manager explained that they had been admitted from a hospital as an emergency a few days ago and their medication and other important information about their care had been forwarded several hours after the person came into the home at the urgent request of the homes staff. The manager said that they very rarely accept emergency admissions. The homes AQAA tells us that there is sometimes a problem with information sharing between other health and social care professionals, especially when residents are discharged from hospital. The home should ensure that they take this up with the relevant hospitals and care professionals so that new service users are only admitted to the home on the basis that a full assessment has been undertaken and that the home can assure them that their assessed needs will be met. Fairholme House DS0000013085.V365323.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. Though improved since the last inspection, the written care planning system should be further developed to provide staff with more detailed information needed to consistently meet residents’ needs. Overall, residents’ health care needs are being satisfactorily met with evidence of good communication between the home and health and social care professionals about ways to improve peoples’ health and wellbeing. Personal support is offered in such a way that promotes and protects residents’ privacy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Though some improvements have been made in the written records of care, it was found that there are still no care plans as such, that set out each resident’s individual health, personal and social care needs. Some of the information written as ‘risk assessments’ (for example, personal care or falls) should more appropriately be set out as a care plan, with instructions for staff about what actions they need to take to meet the particular care need or ‘problem’ for the resident. There should be regular evaluation comments to show to what extent the care given has met the assessed needs of each person. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 12 In the sample of 3 care records examined, there were some important omissions about peoples’ health care needs – for example, the treatment for a resident with an acute skin rash was not included in a care plan and whether this was improving. One person’s blood sugar levels was being checked by staff taking ‘finger prick’ blood tests and using a blood glucose meter to measure the result four times a day. A district nurse had shown staff how to do this, but there were no instructions left with the meter to tell them about how to calibrate it to check that the results were likely to be accurate. A registered nurse or doctor usually does blood glucose monitoring. If care home staff are requested to do this, they must be trained and assessed as competent by a health care professional under the ‘shared care protocol’. There is a risk that if staff are not trained correctly and do not follow the manufacturer’s instructions about calibration, the readings they take might be inaccurate and a doctor may change the person’s treatment on the basis of wrong data. This was discussed with the manager who said she would try to access training for the staff if it was agreed that the resident continued to need this frequency of blood testing and/or community nurses could not visit to do this. Following a recommendation made at our last inspection, the home now uses a well-known method of assessing residents’ nutritional health and has purchased some ‘sit on’ weighing scales. However, the care records seen did not show the results of the assessment that is intended to show if people are ‘at risk’ of malnutrition. It was noted that some people’s fluid and food intake was being checked by care staff and that the manager had asked staff to be particularly careful to offer additional drinks to residents as it was a hot day. The surveys we sent out showed that overall people were satisfied that their care and medical needs are being met. One health professional wrote that in their view: ‘Staff [are] very confident and will readily feed back to DNs (district nurses) any queries or worries; [there] is good communication between carers and nursing staff. Clients always appear to be happy and health care needs met’. However, another health care professional was less confident about the staffs’ ability to cope with some residents who have dementia and who may be ‘challenging’ in their behaviour. The three residents’ surveys showed that 2 out of 3 felt their medical and care needs were ‘usually’ met and one person that this was ‘always’ the case. The AQAA information states that some of the issues that have made it hard for the home to improve as much as they would have liked included ‘communications with other health care providers has been unprofessional in several instances; hospital discharges can be inaccurate, not enough Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 13 information given or on occasions none at all; there are delays in accessing assessments for wheelchairs and other [disability] aids’. 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. The manager said that senior care staff receive appropriate training in medication administration through a local college. A sample of 3 residents’ medication records was checked. Two out of the three were correct but one person’s medicines were in a different cassette system because they had come from hospital three days earlier. The instructions on this individual’s Medication Administration Record (MAR) chart were to give the tablets from their cassette. This was potentially confusing because there were several tablets in each section for various times of the day and without the individual names of the tablets written out in full it was not clear what tablets the person was to take. Also, if the person did not wish to take some or all of their tablets, staff would not easily identify which tablet(s) had been omitted. The senior carer immediately took action to copy out the names of the various medicines and time they were to be given and described safe practice to have a second person check this with her. One resident manages their own medicines and keeps them securely in her room. Staff monitor that the correct amount of tablets have been ordered, delivered and used by this individual. However, the home does not have a risk assessment in place to monitor whether the person is still able to continue to self-administer their medication safely. The home should make sure it has a robust system in place with a record about how the person takes their medication and regular reviews held in their care plans. The home should ensure that staff are aware of and follow the practice guidance set out in the Royal Pharmaceutical Society document ‘The Handling of Medicines in Social Care’ and other information about medicines that can be found on the CSCI Professional website. From the survey comments and observations and conversation with the manager and staff during the inspection we think that the staff are very good at treating the people who live here with respect and dignity. Comments included: ‘Clients always appear to be happy and health care needs met; privacy and dignity always appear to be respected’. ‘Good homely atmosphere – residents treated with respect’. ’Good at communicating warmth and understanding to individual needs’. ‘The carers are all very caring and treat everyone in their care with respect’. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 14 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, we consider 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 shared room is used by one occupant) and staff were seen to knock and await an answer before going into residents’ rooms. Residents spoken with and who completed comment cards considered that staff listened to them and acted on what they said, though one person felt they ‘sometimes need to ask several times’. A relative’s comment card showed they valued the fact that ‘staff take the time to talk to all the people there’. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 15 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 residents have more opportunities to participate in stimulating and motivating pursuits. The meals are good offering both choice and variety and catering for special dietary needs. 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. The AQAA describes the different activities that are organised every afternoon for example, quizzes, Beetle Drive, Bingo, crossword puzzles, board games, painting and movie afternoons. Hand and nail care are included with the weekly visits from the hairdresser. There is also a weekly music and movement session led by a visiting therapist. The manager and activities coordinator have worked to develop activities that are more suitable to those residents who are mentally frail – for example, they have purchased different quiz materials and games items The homes own quality audit questionnaire responses (April 2008) showed that relatives and visitors considered that the range of activities are satisfactory, Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 16 though some suggested more outings and trips would be good. Most residents spoken to on the day said that they had enough to do – ‘there’s always something you can join in if you want to’. The 3 surveys completed by residents were divided in opinions about whether there are always activities organised that they can join in - one person felt this was ‘always’ the case, one ‘usually’ and one ‘sometimes’. 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 been improved since the last inspection with the planting of a raised bed with herbs and aromatic plants. The garden has steps and a narrow ramped path leading from a conservatory. The manager said that they are looking at ways to improve the access for people to use the garden by widening the ramped pathway. There are plans to refurbish this conservatory so that residents can use it for art and craftwork and potting up seeds and plants for the garden. Visitors to the home are made welcome – this was confirmed by observation on the day of the inspection and in peoples’ survey comments: ‘a good family atmosphere’; ‘We always feel welcome there when we visit.’ Residents’ family or friends are welcome to join them for lunch and to go out for special events and are always offered refreshments when they come. The dining room has been redecorated and carpeted since the last inspection and is a light and attractive room. Fresh vegetables and seasonal products are used whenever possible, and the menus showed a varied and nutritious diet is provided. Of the 3 residents who completed comment cards, 2 out of 3 ‘always’ liked the meals at the home and one ‘usually’. Some relatives’ comments confirmed that the home serves ’good food’ and ‘meals are cooked to order and fresh produce used’. Residents are involved in making decisions and suggestions about the menu and favourite foods. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 17 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 and 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 and 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’. 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. National Vocational Qualification (NVQ) training includes a core topic on the protection of vulnerable adults and new carers have undertaken this training. The manager confirmed that there are annual updates for staff in adult safeguarding issues. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 18 Replies to our surveys and conversation with some of the residents and a visitor during the inspection showed that people are confident about raising any concerns with the manager or the home owner and that these would be followed up and resolved. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 19 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 good with evidence of improvement through maintenance and future planning. 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: The standard of décor and furnishings is good. The home is an old building, with conservation ‘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 is kept clean and fresh and this was seen to be the case on the day of the inspection. Since the last inspection, both lounges, the dining room and front conservatory have been refurbished and all the carpets in the communal areas and corridors have been replaced. A new walk-in shower room has been created to aid less mobile residents and to give the choice of a bath or shower to all residents. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 20 New laundry equipment has been installed that meets the recommended disinfection and hygiene standards. Staff have access to protective clothing – gloves, aprons and alcohol-based hand cleansers – to reduce the risk of cross-infection. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 21 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 good. Since the last inspection, there have been improvements to the standard of vetting and recruitment of new employees. There are enough qualified, competent and experienced staff to meet the health and welfare needs of the people living here. 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 appear to meet residents’ needs. The 3 residents’ surveys showed that they felt staff are ‘usually’ available. Relatives’ comments suggested that staffing numbers were sometimes lower than expected, especially at weekends - ‘Perhaps a small increase in staff, particularly at weekends’; ‘sometimes there appears to be insufficient staff to tend all of the residents’. However one person felt that there was ‘good staff to client ratio’. Overall, standards of care are considered to be good, as shown by comments such as ‘‘The carers (being human) vary in skill and experience but all show T.L.C’ [‘tender loving care’] The AQAA tells us that 6 full time and 3 part time staff have left since the last inspection and that sickness and cost of training has had an impact on the numbers and skill mix of staff. However, 10 of the total of 21 permanent and bank care staff have National Vocational Qualification (NVQ) at Level 2 or above and a further 3 are working towards this, so that the home has almost Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 22 achieved the recommended percentage of 50 with an NVQ Level 2 qualification or above. A sample of staff recruitment files was examined. 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) before new workers started work in the home. Some progress has been made by the manager to improve the record keeping about the recruitment and employment of staff, but there is still no record of interview questions or interviewers’ assessment about prospective new employees suitability for the jobs they have applied for. This should be done to show that the employers have a consistent, fair and nondiscriminatory process for screening and recruiting new staff. The manager confirmed that all new staff receive induction training to the standard set out by the national training organisation, Skills for Care. Evidence of induction training and regular 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 adult safeguarding updates each year. Ten care staff had attended a palliative care course and had found this very helpful. The home is working with local NHS staff to improve the care for people nearing the end of their life through introducing the new national standards for ‘End of Life’ care. Eight care staff have also completed training in care of people living with dementia. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 23 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, 37 and 38. Quality in this outcome area is adequate. The manager and senior carers provide clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. The home promotes person-centred care and works in partnership with families and other representatives to support the best interests of the people who live here. More work is needed to improve and develop the systems to support and monitor the practice of staff in their work and to provide written reports of the visits by the registered provider. This judgement has been made using available evidence including a visit to this service. 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. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 24 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. Since the last inspection the home has introduced a system for getting relatives’ and residents’ views about the quality of the service through sending out questionnaires. The surveys were sent out in April 2008 and responses seen during the inspection showed that people were generally very positive about the welcome, communication between the homes’ staff and families, and food. There are also comment cards for visitors to complete in the reception area. Residents are involved as much as possible in decisions about changes made in the home - for example, choosing colour schemes for their own rooms and the décor for communal areas and suggesting new menu choices. Residents and their relatives do not favour formal meetings to discuss their views, though several relatives suggested in the homes questionnaire that having a newsletter would be a good way of keeping people up to date with news and views. The manager said this is being considered. The manager was not able to provide evidence that Regulation 26 ‘provider’ visits have been carried out. The registered person (Mr Gulamhussein or another director of the company) is required by law to visit the home ‘unannounced’, at least every month to inspect the premises, its record of events and records of any events, and to talk to residents and any visitors, and staff in order to get views about the standard of care provided in the home. He must then ‘prepare a written report on the conduct of the home’ a copy of which must be made available to the manager and the Commission (if we request it). In practice, Mr Gulamhussein does visit the home regularly and one resident and visitor spoken with said that he was very approachable and always took time to have a chat when he came. These ‘provider visits’ are an important part of the way in which the registered person can formally evidence that the standard of care and facilities provided in the home is meeting residents’ needs and expectations and that any concerns are followed up and resolved. There has been some progress made in introducing the programme of regular supervision meetings with all care staff, but the manager said that these were not happening as frequently as recommended because of staff changes and administrative workload. 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 Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 25 to discuss their work, progress and any concerns or training and development needs they may have, and that a record is kept of supervision meetings. The home does not employ an administrator and the manager says she does not always have sufficient time to carry out the necessary parts of her job such as reviewing and updating policies and procedures (these were up to date – reviewed in February 2008 according to the AQAA), and recruitment and employment paperwork for new staff and auditing staff practices for example. 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. Staff are not permitted to be involved with residents’ finances and this is made clear in the Service User’s Guide for the home. The home employs a contract cleaning and maintenance service, with local contractors to carry out any plumbing and electrical work that is required. Staff list any repairs/maintenance jobs that need doing in a workbook that is checked and signed when the work has been completed. Since the last inspection the home has acted on requirements we made and has consulted with the fire officer and fitted automatic door closers to room doors where residents want to keep their room doors open. Work was underway to make sure that window-opening restrictors are fitted to windows above first floor level (subject to risk assessment and if residents are able and wish to have their windows unrestricted) to reduce the risk of accidents to residents or their visitors. We received the homes AQAA just after the date when it was due to be returned. It was satisfactorily completed but more evidence could have been given to show what the service has done in the last year and how it plans to achieve the improvements that are to be made in the next 12 months. Overall, it gives us a reasonable picture of the current situation within the service. Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP30 Regulation 18 (1)(c)i Requirement Where clinical interventions such as blood glucose monitoring, are delegated to care staff, the staff must have training in the delegated intervention and be assessed as competent to do so by a suitably qualified health care professional The registered person must visit the home in accordance with Regulation 26 and ensure that evidence of these visits is available in the home and available for inspection. Timescale for action 01/09/08 2. OP33 26 and Schedule 4 (5) 01/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Pre-admission assessment information should be sufficiently detailed so that it provides the basis for drawing up care plans, and to demonstrate that the home DS0000013085.V365323.R01.S.doc Version 5.2 Page 28 Fairholme House can meet the prospective resident’s care needs. 2. OP7 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. * The procedures for recording medicines for residents admitted for short-stay, respite care or in an emergency should be reviewed. * Improve the risk assessment, review, monitoring and documentation in relation to those residents who wish to self-administer their medication. More information about the handling of medicines can be found on the CSCI website: www.csci.org.uk Implement a programme of regular formal staff supervision for care staff at the recommended frequency of at least 6 times a year and maintain records. Consider employing an administrative assistant to support the manager in her role. 3. OP9 4. 5. OP36 OP37 Fairholme House DS0000013085.V365323.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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