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Inspection on 20/04/05 for Fairlight & Fallowfield

Also see our care home review for Fairlight & Fallowfield for more information

This inspection was carried out on 20th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is part of the Mills Family group of homes. The company have in place many structures to support the home. The Mills Family have their own personnel department who deal with all staff recruitment. The administration team in the home organises the maintenance and servicing of equipment, allowing the manager more time to provide support and guidance to staff.

What has improved since the last inspection?

The appointment of a new manager has brought leadership to the home and changes. The new manager is addressing many of the issues identified at previous inspections. The records and documentation were better organised and information readily available.

What the care home could do better:

The home must work to its staffing notice in order that all care and supervision of residents can be provided. The lack of qualified staff input was noticeable particularly in the recording of information and care plan documentation. In addition, care staff need to be supported and supervised and this would be difficult with one qualified staff in such a large home.

CARE HOMES FOR OLDER PEOPLE Fairlight & Fallowfield Ashfield Lane Chislehurst Kent BR7 6LQ Lead Inspector Rosemary Blenkinsopp Unannounced 20 April 2005 10:00 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 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. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Fairfield & Fallowfield Address Ashfield Lane, Chislehurst, Kent, BR7 6LQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8467 2781 The Mills Family Limited Post Vacant Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 Staffing Notice issued 29 September 1998 Morning: 1 RGN & 1 EN & 4 Care Assistants Evening: 1 RGN & 1 EN & 4 Care Assistants Night: 1 RGN & 2 Care Assistants 2 Fairlight & Fallowfield is to be registered for 68 places in total, of which 33 places can have the category of Nursing Date of last inspection 04/01/05 Brief Description of the Service: The home is located in a residential area of Chislehurst. It is an older style building with new bedroom and communal facilities having recently been added. Bedroom accommodation is located on all floors. The main communal areas on the ground floor of the home with additional quiet rooms. The home provides care for up to 68 service users in the category of old age. The home is in two separate sections and provides nursing and residential care. Initially the home had been two facilities although some two years ago had revisions made to the building including an adjoining walkway. The home has one registration and is managed as one facility. However it is often referred to as two homes and staff tend to maintain it as such. The staffing for the home is organised in two separate sections i.e. Fairlight and Fallowfield. The newly appointed manager started in February 2005. Staffing levels for Fallowfield should be maintained as per the staffing notice issued under the previous regulating authority. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced visit. The two inspectors conducted a tour of the home, one on Fairlight unit the other on Fallowfield side. The morning and lunchtime routines were observed. A selection of care plans and supporting documentation was viewed from both the nursing and residential side of the home. The lunchtime medication administration was observed and medication charts inspected. Documentation relating to health and safety was inspected. The staffing rota was inspected. Residents were spoken to as well as two visitors on the Fallowfield unit. Three residents and two regular visitors provided verbal feedback on the Fairlight side. The residents on Fallowfield were more dependent and limited information was obtained. The findings on the two units were in some cases different and this is reflected in the evidence. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 7 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 standard(s) EVIDENCE: No standards were assessed in this section. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 8 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 standard(s) 7,8,9,10 The care documentation was not sufficiently comprehensive to address the residents’ needs. The medication systems were not sufficiently robust to ensure safe administration. EVIDENCE: The home uses a comprehensive care planning system namely the Standex. The format contains sections for identified care issues, supporting risk assessments and other information in relation to the activities of daily living. The completion of this information is time consuming although once completed would give a very comprehensive picture of the resident. On the Fairlight side care plans were very basic and did not reflect the residents’ needs. The daily records provided far more information and demonstrated the good care being provided by care staff. Three care plans on the Fallowfield nursing unit were inspected. In the care plans viewed, completion was patchy and when issues had been identified there was no action taken. One example of this was a resident who was gradually losing weight, and the indication was that dietetic advice should be Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 9 sought. This had not been followed up nor was there any other specific action in respect of the weight loss. Those residents on fluid charts did not have the reason for the monitoring stated in the care plans. The home should also ensure that residents’ weights are monitored and recorded and that appropriate scales are used e.g. seated scales. Observation of medication administration took place during the lunch time period on both units. On the Fallowfield side, the procedures were relatively satisfactory with drugs stored securely, records completed and photographs in place. The inspector noted from a care plan that one resident was having her medication disguised in food. In the cases that covert administration of medication is used, and the resident is not able to consent to this, a full multidisciplinary discussion including next of kin, needs to occur and a decision made as a result of this. This must be kept under review and have comprehensive records to support the decision. On the Fairlight side the actual procedure for administration did not promote safe practices with the member of staff undertaking the administration handling the medication themselves before dispensing it to residents. Information was satisfactory although occasional gaps were evident. Please see requirements 1 and 2. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 10 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 standard(s) 12,13,15 Activities are available, however, more effort is required to address the needs of the more dependant residents. EVIDENCE: As the inspector arrived on the Fallowfield side, 15 residents were in the lounge, many were sleepy and it was difficult to engage residents in a conversation. Staff were not in this area except on two occasions when they popped in very briefly. Residents and visitors to the residential unit,Fairlight, provided positive comments regarding the quality of care provided. Interaction between staff and residents was warm and friendly promoting a safe, relaxed and comfortable environment. The lunch was observed in the dining room. The residents were offered choices of the main meal. Serviettes, salt pepper and fluids were available. Plate guards were in use for some residents. Staff were present at each table to assist those residents who needed it. Two relatives, who were visiting, stated that in their opinion the food had improved. Tea was served following the meal. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 11 On the Fairlight side, the feedback from residents on the quality of food was mixed. Some were satisfied with the quality whilst others felt hot meals could be hotter. One resident thought that the home could offer a more varied breakfast such as “bacon and eggs”. Other residents agreed enthusiastically. The inspector also noted that staff were not offering second helpings, even where it was obvious that one resident would have readily accepted the second offering. The mealtime was a relaxed and pleasant occasion, ending with tea and coffee served. Residents appeared to be quite happy with the activities provided although many of these were undertaken within the home. The participation in activities offered is down to the choice of the residents. One resident said that she preferred not to join in, much preferring her own company and interests. Some residents do go out, mainly with family or friends but rarely with staff. It was pleasant to see that musical entertainment had been arranged for that afternoon. It was disappointing that staff did not join in with the activity. Please see recommendations 1 and 2. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 12 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 standard(s) EVIDENCE: No standards were assessed in this section. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 13 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 standard(s) 19,20,21,22,23,24,25,26. Residents individual and communal accommodation is satisfactory, however storage for necessary equipment is limited. EVIDENCE: The home is a mix of old and new facilities. The home has had additions made to the existing two buildings, which are joined by a walkway. Bedroom accommodation is offered either single or double on both sides of the home. Some bedrooms were quite personalised. In double bedrooms individual nameplates were in place to identify individual residents toiletries etc. Call bells are available in bedrooms although some were out of reach for residents. Water jugs in bedrooms, again were not placed close to the resident. There is a lift to access all areas and stairs. A selection of mobility and pressure relieving equipment was seen to be in use. Storage is limited in this home. In bathroom 21, equipment was stored making it hazardous and congested. Equipment was found to be parked in corridors as well as bathrooms and some individual bedrooms. In several bedrooms the inspector found air freshener aerosols. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 14 There were some individual clocks and calendars however these should be maximised to aid orientation. Please see requirement 3. Please see recommendation 3. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. The current staffing levels are not sufficient to meet the needs of the residents or in line with the staffing notice. EVIDENCE: The home has a staffing notice for the nursing home side which is a condition of registration . The staffing notice states the number and qualifications of the staff required during the day and night period. The home is not meeting its staffing notice for the afternoon period which states that two qualified staff are required. The off-duty rota and staff confirmed, that one qualified staff is on duty during the afternoon period. This staffing level had been agreed by the owner, Mr Mills, in 1998. Extra care staff are on duty during the day time period however, this does not compensate for the shortage of qualified staff. Please see requirement 4. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,38 The home is managed appropriately with health and safety measures addressed satisfactorily. EVIDENCE: The manager has recently taken up post in the home. The manager has had a lot of experience managing nursing homes in the independent sector of similar bed numbers. The manager has applied to under take the CSCI registration process which once completed, will be included on the registration certificate. A selection of health and safety records were viewed including those for fire, gas and electricity. The fire records detailed weekly fire alarm testing and the fire risk assessment was current. All day staff must have a fire drill every six months, whilst those staff on night duty, every three months. During the tour the inspector noted several hazards within the environment including those related to COSHH. All hazards must be identified and as far as possible eliminated. Please see requirement 5. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x x x x x 3 Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 18 yes. 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 7 Regulation 15 Requirement The Manager must ensure that all care documenatation is comprehensive in content and has supporting risk assessments as approprite to needs. Previous time frame for action 31/1/05 The Manager must ensure that medication systems are safe with robust documentation in place. Previous time frame for action 31/12/04. The Registered Person must ensure sufficient storage space is available and safely stored. The Registered Person must ensure that the staffing notice is adhered to at all times. The Registered Manager must maintain the environment hazard free at all times. Residents must be able to access assistance Timescale for action 30/9/05 2. 9 13 30/6/05 3. 4. 5. 22 27 38 23 18 23 30/6/05 31/5/05 31/5/05 Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 12 15 22 Good Practice Recommendations The manager should review activities available for more dependant residents. The manager should devise a menu of residents choice with appropriate ammounts of food as decided by residents. The manager should maximise domestic style orientation aids. Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 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 Fairlight & Fallowfield G51-G01 s10134 Fairlight Fallowfield UI v211803 200405 Stage 4.doc Version 1.20 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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