Inspection on 28/11/05 for Fairlight & Fallowfield

This inspection was carried out on 28th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fairlight & Fallowfield 02/10/07

Fairlight & Fallowfield 08/11/06

Fairlight & Fallowfield 11/08/05

Fairlight & Fallowfield 20/04/05

Fairlight & Fallowfield 04/01/05

Fairlight & Fallowfield 20/07/04

Fairlight & Fallowfield 27/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Fairlight & Fallowfield Ashfield Lane Chislehurst Kent BR7 6LQ Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 28th November 2005 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 Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 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. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fairlight & Fallowfield Address Ashfield Lane Chislehurst Kent BR7 6LQ 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) 020 8467 2781 The Mills Family Limited Mrs Janet Bright Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 29 September 1998 Morning: 1 RGN and 1 EN and 4 Care Assistants Evening: 1 RGN and 1 EN and 4 Care Assistants Night: 1 RGN and 2 Care Assistants Fairlight and Fallowfield is to be registered for 68 places in total, of which 33 places can have a category of Nursing. 2. Date of last inspection 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 are on the ground floor of the home with additional quiet rooms. The home provides care for up to 68 residents 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 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. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced by three inspectors. One inspector focused on issues raised through a complaint which the CSCI had been copied into, although at that point was not investigating. The two other inspectors looked at care documentation, medication procedures toured the home and met with staff and residents. The findings of the day were generally satisfactory with the exception of those items detailed in the body of the report. The inspectors were able to speak with two trained nurses, one of whom was the deputy manager. All the staff were helpful and co-operative throughout the visit. The manager facilitated the inspection although she was not available for feedback at the end of the day. What the service does well: What has improved since the last inspection? What they could do better: The assessments and reviews of residents need to be robust enough to ensure that residents are within the registration category. The manager must endeavour to obtain all relevant information to assist the assessment process. In the event that residents needs change or cannot be met then the manager must start the review process in a timely manner. Care plans need to be maintained in a more orderly and manageable manner where by information is easily accessible. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 6 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. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 7 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 Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Assessment information was not readily available and it was difficult to establish how much involvement residents had in the choice of the home. Without detailed assessment information received from multi disciplinary team and a robust assessment conducted by the home staff, it would be difficult to confirm the home’s ability to meet the residents’ needs. EVIDENCE: The inspectors did not see any pre-admission forms in the care plans, and were unable to find out how much detailed information is obtained prior to admission. A notice, which referred to one of the residents on the residential unit, was displayed above the visitors’ book at that entrance. One of the inspectors examined his care plan. It was apparent from reading his documentation that this resident was no longer correctly placed in this unit, as care staff were unable to manage his behaviour. The resident had a deteriorating mental state, and wanted to go out unaccompanied. This meant that he was not safe, as he had episodes of confusion and agitation, and was also at risk of falling. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 9 Care staff have not been trained to manage this aspect of care, and a requirement was given for the management to arrange an urgent review of his care needs, and assist in arranging a suitable placement elsewhere. The home has actioned this as far as it was able to do so and assistance from the CSCI is now required. The placement of this resident has been addressed through separate correspondence to the home. Please see requirement 1. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9. The care plans, although comprehensive in their format, are cumbersome and difficult to extract information from. Auditing of care issues such as wound care was also difficult which has an impact on the ongoing monitoring and, on occasions, care practices. EVIDENCE: The inspector looked at five care plans for Fallowfield nursing unit, and one for Fairlight residential unit. A Standex system is used, whereby a number of care plans are grouped together in one heavy folder. This system does not enable easy access of information, it is cumbersome to manage, and does not assist with retaining confidentiality. If a resident wishes to see/sign their care plan, or a permitted next of kin/relative, the information would have to be removed from these heavy folders first, and given as loose leaf pages. These could easily be mislaid. Pages are removed from these on a monthly basis, and put as loose-leaf pages into suspension folders in a locked cabinet. This makes it very difficult to check Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 11 back for information about something that occurred in a previous month. The suspension files were extremely untidy and unsatisfactory as a way of storing information. There are many more systems readily available, and a review of the care planning system, needs to be undertaken, to make it easier to access information, and promote confidentiality. The inspectors who viewed these plans would suggest the management consider a system where each resident has individual folders. Care plans were drawn up by the trained nurses, and were being reviewed on a monthly basis. They were appropriately signed and dated. There was nothing to indicate that these plans were drawn up with the knowledge and consent of the residents or their next of kin/representative. Care plans commence with an admission sheet, which contains a summary of the resident’s assessed needs. The forms had been well completed, but did not leave much room for added pieces of information. Care plans are put into place from these assessed needs according to individual requirements. They include assessments of different aspects of daily living such as: personal hygiene needs, mobility, continence, medication, nutrition, sleep pattern, communication, history of falls, and social needs. A daily calendar system is used for care staff to record personal hygiene given (e.g. a bath or a shower), elimination, and if nail care has been given. Each resident has a named nurse and a key worker. Key workers have additional responsibilities for such items as ensuring that nail care has been given at least weekly, wardrobes are tidied, clothes properly labelled, and toiletries are available. Different coloured forms are used to record doctors’ visits, assessments, and daily reports. Doctors’ visits were well documented, but in the care plans viewed, the inspector was unable to find if other multi-disciplinary visits are recorded on this form or a separate one. Daily reports specified dates when visits such as dentist, physiotherapy or CPN had been carried out, so the inspectors were confident that these were taking place. However, the information was not easily available. Assessments were in place for dependency levels, moving and handling, nutrition, and skin integrity, and these were re-assessed and completed every month. In the event that a resident has an identified high risk, i.e. poor nutrition and associated weight loss, then reviews should be conducted as appropriate to the need and more frequently than monthly. Fluid charts were used to record intake and output for residents who are unwell, or those who needed additional fluids. Some of these charts were better completed than Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 12 others, staff must ensure that these are properly completed, added up, and the information used to assess the ongoing care needs. Wound care documentation was difficult to follow in some care plans, as the previous month’s sheet had been filed away, although information on this was still applicable to the ongoing situation. An example of this was when a wound had not healed, it was then difficult to follow the progress from the day when a wound was first identified to the current situation The inspector found that most wound care documentation had actually been carried out satisfactorily, but the poor standex/filing system caused difficulty in auditing and accessing the information. Some residents were noted to have had infections e.g. Urinary Tract Infections, (UTI), and these would be recorded once in the daily reports, with records indicating a doctor’s visit, and antibiotics prescribed. Additional care plans had not been implemented, and there were no ongoing daily records to show how residents had responded to the treatment, or when the antibiotics were finished, and if the infection had cleared. Records need to show ongoing care in any situation. A care plan should be developed to detail the action to be taken to address the need. One fluid balance chart indicated every limited fluid intake below the recommended level. Some key worker reports showed poor understanding of English grammar and spelling, and were not well written; further training in writing reports – remembering that these are legal documents - should be addressed. One form was viewed which referred to a resident self-medicating for one drug. The resident had signed to take responsibility for giving this medication, but there was no assessment seen to confirm that she understood the medication concerned and was able to administer it effectively. The manager must ensure that any resident who is self-medicating has a detailed assessment showing that they know what the medication is for, they know how to apply it, and they are able to know what time of day to take it. They must also be willing and able to store it in a locked facility, and manage the access to it without assistance. The missing residents’ procedure was pinned on the notice board. Please see requirements 2 and 3. Please see recommendations 1, 2 and 3. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Activities are provided within the home for residents to partake of if they so wish. EVIDENCE: The inspector chatted with the activities assistant, who works 30 hours per week, and has many years of experience in providing stimulating activities for this age group. The activities include opportunity for one-to-one sessions as well as group activities. Each new resident is assessed for their preferred choices, and for their ability to take part in group activities. There is a good range of activities available, and these include items such as crafts, reminiscence, games, and quizzes. The gardens are used extensively in the summer months for garden parties, barbecues, and the enjoyment of sitting outside with relatives and friends. The inspectors chatted with several residents in the lounge, and noticed that they were appropriately dressed for the time of year, and well groomed. It was evident that the men had been shaved, and residents had had their hair done, and teeth/dentures cleaned. Some ladies had recently visited the hairdresser, and looked very smart. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed in this section, although as part of the unannounced inspection the inspector followed up the issues detailed in a complaint, which the home was investigating. The issues related to basic care practices. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,25,26 The environment is homely and well maintained. Items of equipment required by residents was seen to be available and in use. EVIDENCE: During this tour, the inspectors noted that the premises were generally clean and well organised; there were no offensive smells, and the décor and furnishings were of good quality. The large gardens were well tended, and provided an attractive outlook. A maintenance man is employed to carry out routine maintenance in both units of the home, and was busy responding to a nurse’s request to check a lead on one of the hoists. Bathrooms are fitted with assisted baths with integral hoisting facilities, and there are also showers available. A suitable amount of equipment was observed, including nursing beds with bed rails, raised toilet seats, grab rails, and a number of different mobile hoists. Two care staff were observed using one of these to transfer a resident from a wheelchair to a Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 16 dining chair for lunch. They handled the situation very well, giving the resident their full attention, and calmly explaining to her what was happening. Other care staff were seen interacting well with residents – talking with them as they pushed them in wheelchairs or as they helped them to walk. There was a friendly and relaxed atmosphere in spite of having to carry out a lot of duties with many different types of residents. The laundry was seen to be in good order, in spite of the amount of laundry piling up to be dealt with in the afternoon. A red alginate bag system is in place for dealing with soiled clothing. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. Staffing numbers in the home are sufficient to meet residents’ needs however these should be reviewed and increased as residents’ dependency dictates. EVIDENCE: The inspector chatted with two care staff. One of these had only worked at the home for a week, and said that the induction time included shadowing different senior care staff. He had previously worked in care, and had shown certification of previously completed training. The other carer confirmed that care staff had some involvement in writing parts of the daily reports, and in taking responsibility for the personal care given. A kitchen assistant was assisting a carer in giving out hot drinks in the lounge. She said that her main employment was as a laundry assistant, but she was covering for an employee off sick in the kitchen, managing both roles that day. She showed good understanding of infection control procedures, explaining that she would not go to the laundry until she had completed duties in the kitchen after lunch. She would then change into a different disposable apron and gloves for the laundry area, and not go to the kitchen again that day. Minutes of the care staff meeting, held on 02.11.05, detailed twenty staff had attended. The minutes provided good information regarding items such as infection control, checking bed rails and teamwork. The next meeting is due December 05, and then they are planned to be held quarterly in 2006. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 18 Staff training courses were advertised for moving and handling. Ten staff had been identified as needing to attend on the given dates. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed in this section. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 20 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 X X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X 3 X X 3 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The Registered Manager must ensure that full assessment information is received, and a comprehensive documented assessment is conducted prior to admission of any residents. These documents must be available for reference. The Registered Manager must ensure that all care documentation is comprehensive in content, have supporting risk assessments as appropriate to needs, be accessible and maintained in an orderly manner. Previous time frame for 31/1/05.This is now outstanding. The Registered Manager must ensure that medication systems are safe with robust documentation in place, in particular assessment information for those residents who are self medicating. Previous time frame for action 31/12/04.This is now outstanding. Timescale for action 30/12/05 2. OP7 15 30/12/05 3. OP9 13 30/12/05 Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 22 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 OP7 OP7 OP15 Good Practice Recommendations The Registered Manager should review the care plan format to enable ease of access to information in more manageable system. The Registered Manager should organise training in report writing to include content of entries, use of language and grammar. The Registered Manager should ensure that all fluid balance charts are completed accurately and incorporated in to care planning where necessary. Fairlight & Fallowfield DS0000010134.V264921.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Sidcup Local Office 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 DS0000010134.V264921.R01.S.doc Version 5.0 Page 24 - 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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