Inspection on 30/06/08 for Fairlight Manor

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Poor service.

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 Manor 13/05/09

Fairlight Manor 18/12/08

Fairlight Manor 14/10/08

Fairlight Manor 10/09/07

Fairlight Manor 04/12/06

Fairlight Manor 18/11/05

Fairlight Manor 22/04/05

Fairlight Manor 25/11/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Fairlight Manor 48 Fairlight Avenue Telscombe Cliffs East Sussex BN10 7BS Lead Inspector Judy Gossedge Unannounced Inspection 30th June 2008 11:55 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 Manor DS0000062060.V365324.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. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairlight Manor Address 48 Fairlight Avenue Telscombe Cliffs East Sussex BN10 7BS 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) 01273 582786 01273 582786 ashnazpatel@btinternet.com Fairlight Manor Ltd Ashraf Patel Care Home 19 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th September 2007 Brief Description of the Service: Fairlight Manor is located in a quiet residential area of Telscombe Cliffs, near to the seafront and local shops and amenities. The property comprises of two large semi detached houses, which have been made into a single building and extended. Residents’ accommodation is presented over three floors; a passenger lift is available to all floors. The home has a large sitting room with television and stereo, with a smaller dining room situated just off, between the sitting room and the kitchen. Residents have access to the garden at the rear of the premises that is equipped with garden furniture and umbrellas in the summer for them to use during the fine weather. The home provides personal care and support to residents who are both privately funded and those who are funded by Social Services. The home’s fees at the time of the Inspection range from £423.86 to £525.00 per person per week. Additional costs are charged for hairdressing; chiropody, newspapers, toiletries and contributions are requested for outside activities. The homes literature states that ‘the home is committed to working with these individuals, and believe that however impaired they are, they still deserve to be treated with respect and dignity’. Fairlight Manor DS0000062060.V365324.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 0 star. This means the people who use this service experience poor quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Fairlight Manor care home will be referred to as ‘residents’. This unannounced inspection took place over six hours on 30 June 2008 and was undertaken by two Inspectors. Mr Patel the Registered Manager/Provider was not present during the Inspection. Mr Patel has made a Manager responsible for the day to day running of the home with Mr Patel overseeing management matters through him. The Manager was on duty and facilitated the Inspection. Prior to the Inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and information detailed within is quoted in this report. A tour of the premises took place to look at communal areas and a selection of resident’s bedrooms and care records were inspected. Sixteen residents were resident, and residents were spoken with individually in their bedroom, or in the communal areas. The care that two of the residents received was reviewed as part of the Inspection process. The opportunity was also taken to observe the interaction between staff and residents in the communal areas. One care worker, the deputy manager, the cook, the domestic/maintenance person and the Manager were all spoken with during the Inspection. Four residents and eight care workers surveys were sent out on this occasion, but none were returned completed. One relative was spoken with during the Inspection. One health care worker was spoken with by telephone after the Inspection. What the service does well: What has improved since the last inspection? Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 6 A full needs assessment is completed by a competent person for each perspective resident. A record of the terms and conditions of residency agreed with each resident or their representative is held in the home. Individual risk assessments to highlight any risk of falls and nutritional screening have been implemented. The standard of cleanliness in the home has improved. The Manager confirmed that radiators identified as requiring replacement covers or repair to covers has been addressed. Complaints are recorded and record the action taken in response. What they could do better: There are a number of areas where improvements were required at the last Inspection, which have not been done or fully complied with. This has been a factor in the quality rating of poor and there is a need for urgent action to remedy these shortfalls. The Statement of Purpose and Service Users Guide needs to be updated and kept up-to-date to ensure prospective residents/representatives have accurate information to refer to. There was evidence of poor care planning, and individual care plans need to be developed to detail individual care needs, provide specific guidance for staff to follow and is devised in consultation with the resident or their representative. A system needs to be put in place to ensure that individual plans of care have been kept under review to ensure that all the care needs recorded are up-to-date and continue to be met. Individual risk assessments that cover resident’s risk are now recorded, but these should include risk of pressure sore development and where moving and handling issues have been identified. Persons undertaking moving and handling risk assessments should be appropriately trained and receive the required training updates. Clear criteria guidelines for medicine prescribed on a ‘when require’ needs to be developed, a record is kept of staff signatures who administer medication maintained and safe storage provided for medication awaiting collection from the pharmacist. The records of individual residents food consumption should be further developed to record all meals taken in the home to protect residents and evidence that an adequate and varied diet is provided. Resident’s should be able to access a range of social activities to ensure their individual social care needs are met. A number of the resident’s bedrooms overlook public areas and staff should ensure that the privacy and dignity of residents is promoted at all times and that privacy curtains (net curtains) are provided to all windows if wanted. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 7 A system should be put in place to enable the continual review of staffing numbers and skills to ensure appropriate staffing levels are maintained to meet the assessed care needs of residents in the home. A robust recruitment procedure should be followed to ensure the receipt of a satisfactory Criminal Records Bureau/POVA First check and two written references prior to new members of staff commencing work in the home to protect residents. Staff files need to be kept up-to-date and demonstrate the staff’s qualifications and training undertaken. Staff should receive induction training to meet the requirements of Skills for Care and within the required timescale. The management arrangements should ensure the home is run in an effective manner and the aims and objectives of the home are met. The quality monitoring of the care provided needs to be developed to enable other stakeholders such as health and social care professionals who visit the home to comment on the care being provided, with the outcome collated and made available to interested parties. Recorded visits to meet the requirements of Regulation 26 should be maintained. There should be recorded evidence of action taken in response to demonstrate ongoing review and improvement to the quality of care and services in the home. Further guidance needs to be sought from Environmental Health and the Health and Safety Executive as required and is acted upon to ensure a robust health and safety practice is adopted to include clear polices and procedures and thorough environmental risk assessment that are actioned as necessary. Risk assessments should be undertaken on the unguarded pipe work following work undertaken to fit thermostatic valves at hot water outlets accessed by residents should be guarded where any risk is identified to protect residents. Infection control procedures should be reviewed in the home to ensure an adequate supply and accessibility of liquid soap and disposable paper towels. 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. Fairlight Manor DS0000062060.V365324.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 Fairlight Manor DS0000062060.V365324.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, 2, 3 and 6. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is detailed information available for residents and/or their representatives to view, but this needs to be kept-up-to-date and provide accurate information. Potential new residents are individually assessed prior to an admission to ensure that their care needs can be met in the home. Intermediate care is not provided in the home. EVIDENCE: A copy of the Statement of Purpose and Service User’s Guide are available to reference in the home. Both the documents were read during the Inspection and are detailed and dated as having been reviewed. Both documents still refer to Fairlight Manor as a Nursing Home. This was discussed with Mr Patel following the last Inspection, when he stated that this would be addressed, so a Requirement has been made on this occasion. Staffing information detailed in the documents and the care to be provided also need to be reviewed to ensure the information is accurate and reflects current practice in the home. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 10 The AQAA details that a copy of the last Inspection report is available to reference in the home. A resident and relative spoken with during the Inspection stated said that they had enough information about the home and services it provides and the relative was able to visit the home on the prospective residents behalf. A sample of contract/terms and conditions were looked at for three privately funded residents and were in place. The AQAA detailed that no resident is admitted to the home unless a thorough assessment is undertaken prior to any admission. The Manager stated that he visits any prospective residents. This is to ensure individual residents care needs can be met in the home and to provide staff with information on the care to be provided. For the two new residents admitted to the home since the last Inspection there was detailed pre-admission information viewed, which had been completed. All residents should have a dementia type illness and the type of illness should be recorded as part of the assessment. The Manager stated that written confirmation is sent to the prospective resident or their representative with regard to the needs assessment completed and that the care needs of the prospective resident can be met in the home. This was not evidenced on the day and should be available to view. Intermediate care is not provided in the home. Fairlight Manor DS0000062060.V365324.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. People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was evidence of poor care planning. Whilst the care documentation provides a framework for the provision of care it needs to continue to be extended to detail individual choices and preferences and provide guidance to staff as to the care to be provided. Resident’s health and care needs are met with evidence of regular input from health care professionals as necessary. Medication practices need to be reviewed to ensure the safety of residents and residents are treated with respect and usually have their privacy and dignity maintained. EVIDENCE: A selection of four of the service user’s individual care plans was viewed and there was evidence of poor care planning. Each resident had an initial assessment from which the care plan was developed. The care plans are pre written and then adapted to detail individual residents care needs. These provide a good rationale to identify the care to be provided, however it was Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 12 highlighted again that the care plans were not fully completed, that guidelines for the provision of care was not specific and should record more of the resident’s individual care needs, preferences and choices. There was no record of when residents preferred to get up in the morning and go to bed at night, dietary needs or social care needs. Not all the residents had an up-to-date photograph in place. For the most recent admission to the home the information received as part of the assessment process had not been collated into a plan of care nor were supporting risk assessments in place until several weeks after the admission. The AQAA detailed that the residents or their representative are being involved in the planning of care, but there was no record of this. One resident was described as having challenging behaviour but there was no guidance for staff as to how to manage this. Risk assessments have been developed and include nutritional screening, mobility and the risk of falls. Not all of the four residents documents viewed had all the risk assessments, which were pointed out to the Manager during the Inspection, who agreed to ensure that this was addressed. Recording of regular checks of residents weights were viewed. In two instances residents had lost a significant amount of weight. This was discussed with the Manager during the Inspection and it was not evidenced that procedures were in place to seek guidance/address this issue. This was highlighted in the discussion with the Manager to be addressed. For one resident who requires two members of staff to provide their care a moving and handling risk assessment was not in place for staff to reference. For another resident they were observed being assisted by a care worker using an inappropriate moving and handling move. This was discussed with the Manager during the Inspection who agreed to address this with the member of staff. A risk assessment has not been put in place for pressure sore development. One resident with pressure sores has been provided with specialist equipment including a mattress. This was not documented on the residents care plan. The Manager confirmed that a system is not in place to update these documents at least monthly. The care documentation recorded regular contact with health and social care professionals and a visiting community nurse confirmed that they are involved as necessary with the residents care. The AQAA details that medication policies and procedures are in place. The home has a designated locked cupboard for the storage of medication and a sample of the storage and recording of medication administered was viewed. At the time of the Inspection none of the residents were self-administering their medication. A list of staff sample signatures for those administering medication was not in place and should be. There were two gaps in the administration records, which staff stated was due to in one instance where a medicine was late in being delivered to the home and in the other a change in administration as per GP instructions. Neither had this information recorded so it appeared these medications had not been administered. This was discussed with staff on the day to be addressed. Some residents are on medicines on an Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 13 ‘as required’ basis and the need to provide individual guidance to staff on when to give this medication was highlighted at the last Inspection. Discussions with the Manager, staff and records viewed did not evidence that this had been addressed. Staff confirmed that a pharmacist regularly visits; the records were not viewed on this occasion. One Inspector observed staff-administering medication after lunch in the dining room and the practice followed had meant medication was left in the home unsupervised for periods during the administration process. This was discussed with the Manager and was resolved during the Inspection with the delivery of a new medication trolley, in to which the Manager arranged for the medication to be stored. The Manager also stated he was aware of the new requirements in relation to the storage of any controlled drugs and that an appropriate cupboard and a control drugs register has been ordered and delivery awaited. So a Requirement has not been made on this occasion. During the Inspection it was noted again that medicines were awaiting return to the pharmacy and these were being stored in the Managers office, this was identified as a risk. The Manager was reminded that all medicines must be stored securely at all times even when awaiting collection and arrangements must be put into place to ensure this. The Manager stated that he would arrange to have the medication collected that day. The Manager stated that all staff that administers medication has received training provided by an external provider. There were no training records available to view to evidence this. The care worker administering medication during the inspection confirmed they had attended training. Staff was seen to be respectful to residents and visitors. It was noted that net curtains are not in place in resident’s rooms and this issue was highlighted at the last Inspection. The Manager stated that people were offered the choice of having net curtains however the care records did not record that this choice was given. As mentioned previously residents choices and preferences are not well documented. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents would benefit from opportunities to participate in social and recreational activities, residents are encouraged to maintain contact with family and friends as they wish and a varied diet is provided, but records should be developed to evidence that residents have received an adequate diet. EVIDENCE: The AQAA, Statement of Purpose and Service Users Guide all detail that individual and group activities are facilitated in the home. This was discussed with the Manager who stated that the activities co-ordinator had left working in the home about two months previously and efforts had been made to recruit again to this post. It was not possible to evidence the Requirement made following the last Inspection that the activities co-ordinator had received appropriate training, but the AQAA did detail that it is proposed to facilitate training for this member of staff. No activities were facilitated during the Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 15 morning and a care worker organised a game of skittles with a small group of residents in the lounge during the afternoon. Feedback received did not evidence that activities are being regularly organised in the home. One resident stays in their bedroom, a number were observed during the Inspection in their rooms lying on the bed sometimes asleep during the day. One resident stated that they preferred to stay in their own room and that they would not join in activities. Care plans did not detail residents individual social care needs, especially for the resident who spends most of the day in bed and for another who appears to spend a significant period of time in their bedroom. During the Inspection one relative was observed visiting the home. Staff was seen to be welcoming and they could see their relative/friend in private if they wished. The relative spoken with also confirmed there is flexible visiting. A cook was spoken with, who with a second cook works in the home seven days a week. The Manager was able to confirm that both of the cooks have a basic food hygiene certificate. The weeks menu was read, which the cook stated she had drawn up and may change around depending on food deliveries and the weather. Choices were documented to be available at all meals. Lunch on the day was vegetable soup or fruit juice, braised liver with boiled potatoes sprouts and swede, or macaroni cheese, and followed by tinned mandarins and ice cream. The cook stated that fresh fruit was also usually available in the home, but that due to popularity all the fruit had been used up and none was available on the day. Special diets are catered for. Residents were observed eating their lunch in the dining room or in their own bedroom and it was a relaxed environment taking into account the different length of time that individual service users would need to finish their meal. One resident was assisted with their meal and another was highlighted to the Manager as in need of some assistance, which was provided. Records viewed did not fully detail what individual residents had eaten during the day and should be further developed to evidence that residents have had an adequate and varied diet. Feedback from staff varied as to what was available for residents to eat at suppertime. The Manager agreed to look in to this and ensure that residents had a selection of options to meet individual residents dietary needs. One of the residents spoken with stated the food was good and another that they had enjoyed their lunch. One resident was not aware that a choice was available and it should be ensured that residents area aware at each meal of the choices available. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures are in place to enable residents or their representatives to raise any concerns about the care being provided, also to ensure that residents are protected from abuse but it should be ensured that these are followed to protect residents. EVIDENCE: The AQAA details that there is a complaints policy and procedure in place and a copy of the procedure was available to view in the entrance of the home. The AQAA detailed five complaints had been received at the home during the last year and the record for one of the complaints was viewed and this detailed the outcome of the investigation. The CSCI was made aware of four concerns in relation to the care provided at Fairlight Manor, which were investigated under safeguarding adult’s procedures. The AQAA detailed that there are policies and procedures in place in relation to the protection of vulnerable adults. The Manager evidenced that a copy of the new East and West Sussex County Council, Brighton and Hove safeguarding adults’ procedures is available to reference in the office. The Manager stated that both Mr Patel and himself have received training on facilitating training for staff in safeguarding adult’s procedures and whistle blowing procedures. That five staff have received the training this year and that further training is due to Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 17 be provided during the summer. But training records were not available during the Inspection to evidence this. A robust recruitment procedure to protect residents was not evidenced to be in place and is further documented under Standard 29. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Fairlight Manor provides residents with a homely and pleasant environment. Residents would benefit from further work to personalise their own bedrooms and some areas in the home were identified as needing further work to ensure the protection of residents. EVIDENCE: A tour of the building was made. The home has a light and airy feel to it and provides a pleasant environment for residents. There are seventeen single bedrooms and one double bedroom on all floors in the home. A number of bedrooms were viewed and some had been personalised with pictures and ornaments, but a number had not. For those that had not this was discussed with the Manager to help facilitate this with Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 19 residents and their representatives or by the staff where there are no relatives. All bedrooms have an emergency call bell system. The Manager stated that two bedrooms were due to be re-carpeted and one re-decorated before it is occupied again. One bedroom had damage to the décor on the ceiling from water damage, and from discussions with the Manager the damage had been there a significant period of time and should now be repaired. Five of the single bedrooms have en-suite facilities of a shower, wash-handbasin and toilet. Communal bathroom facilities are provided throughout the home. One is currently out of order as it is being updated and converted into a shower facility. This bathroom was due to have been upgraded before the end of last year. The Manager stated that there had been a delay in the completion of the work and that he was in the process of trying to ensure the work is now completed. The Manager stated that there are further proposals to update another communal bathroom in the home possibly to another shower facility and it was discussed with the Manager the need to ensure that residents are able to access a choice of bathing facilities. A passenger lift is available from the lower floor to the second floor. The main staircase now has stair gates on the first and second floors. There is no stair gate from the ground to first floor. This was discussed with the Manager who agreed to review this practice and undertake a risk assessment and provide a further stair gate if required. So a Requirement was not made on this occasion. The communal area is attractive and allows for flexible use and provides a lounge area and dining room area. This is where the majority of the service users congregate during the day. Heating is provided by a central heating system. During the last Inspection several radiators were found to be unguarded. The Manager confirmed that this work had now been completed and a sample was viewed during the tour of the home. The homes records of checks of the hot water supply were viewed and did show that there was some recording of temperatures lower than the recommended safe temperature of 43°C. The Manager stated this would be looked at and work actioned where needed to address this. So a Requirement was not made on this occasion. Work has also been completed to provide temperature controls at outlets accessed by residents. This has resulted in exposed pipework, which needs to be risk assessed and where any risks are identified be guarded to protect residents. There is a garden to the rear of the home, which has been made secure. The Manager stated further improvements to the garden area have been made since the last Inspection to make it more suitable for the residents in the home. Access to the garden is via the patio doors off the lounge by steps leading onto a patio area adjoining a sharp drop to the lawn. The Manager stated that it is planned to fix railings to protect the residents, but a risk Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 20 assessment to protect residents until this work has been completed was not in place. No residents were observed to go into the garden during the Inspection. The Manager stated that until a risk assessment had been completed any residents accessing the garden would be supervised. The Manager was subsequently contacted and confirmed that a risk assessment had now been put in place. There was some storage of rubbish in the garden, which the Manager stated would be removed. Clinical waste sacks were also being stored in the shed in the garden and should be stored in the dedicated waste container provided. The AQAA details that there is a policy in place for managing infection control and that the Department of Health Guidance has been used to assess current infection control management. The infection control procedures in the home need to be reviewed to ensure that staff have an adequate and an accessible supply of liquid soap and disposable paper towels for their use. The Manager also agreed to review with staff the use of disposable gloves. Since the last Inspection a part-time domestic/maintenance person has been recruited to work in the home five days a week. The majority of the home was clean and free from offensive odours at the time of the Inspection. There was an odour in three of the bedrooms viewed and in two the carpets were stained. The domestic/maintenance person was observed shampooing carpets in the home and when asked confirmed that after cleaning in the home he then cleans any carpets as required. The domestic/maintenance person also stated he has received training/guidance in infection control or the control of substances hazardous to health regulations (COSHH) and that he has good access to protective clothing. The AQAA detailed that all staff had received training in infection control, but records were not available to view during the Inspection to evidence this. The Manager stated that five staff have attended infection control training in May 2008 and further staff are due to attend training during the summer. The care staff undertake all the laundry duties in the home. The laundry room is very small and Mr Patel had stated at the last Inspection he was thinking about moving the laundry into the garage area. This has not been completed. The double bedroom was being used to store laundry waiting to be put away in the home. This was practice was discussed with the Manager to find more appropriate storage as the bedroom was occupied, and the resident was observed using their room during the day and to sit and eat their lunchtime meal. Recording was viewed of routine fire checks that had been carried out in the home. Staff confirmed the regular checks that are undertaken, which includes the checking of the emergency exits and door restraints, but the recording did not fully evidence these checks and should do. This was discussed with the Manager who agreed to address this so a Requirement has not been made on this occasion. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 21 Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 22 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. People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels must be continually kept under review to ensure that adequate numbers of staff are on duty to meet the care needs of the residents. A robust recruitment procedure needs to be in place to ensure residents are in safe hands at all times. Evidence that care workers are being provided with the required training to ensure they can meet the care needs of the residents should be in place. EVIDENCE: The AQQA detailed that the staffing levels had been reviewed with the Manager now working supernumerary in the home, with a deputy manager to provide further management cover and a part-time domestic/maintenance person now working in the home. Two care workers work in the home during the waking day and at night the home deploys two ‘waking night,’ staff. Staff spoken with during the Inspection also confirmed the staffing levels in place. The Inspectors had difficulty in accessing the home to start the Inspection as staff were busy caring for the residents and could not come to open the front door. Four residents were in their bedroom at the start of the Inspection, situated on all floors of the home. The AQAA details that two residents require two care staff to provide their care, that four residents need supervision and prompting with Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 23 eating their meals, which are not all eaten in the dining room, and all the residents need assistance with washing, dressing and bathing. This can leave periods during the day when other residents are not supervised. Feedback received stated that there is not always adequate staff on duty to meet all the care needs of the residents. The AQAA detailed that of the thirteen care workers working in the home five hold an NVQ Level 2 in care and four further care workers are working towards this qualification. The documentation was viewed for the two new members of staff, who had been recruited since the last Inspection. Both demonstrated the completion of an application form, one had had a written reference in place prior to commencing work, which had not been requested by the home. There was not a record that this reference had been verified and the Manager was not able to confirm if it had. Two written references were subsequently requested and received after this member of staff had commenced working in the home. For the other worker there were two written references viewed, which were not dated and again there was no evidence these had been requested by the home or verified. Both had had a Criminal Records Bureau (CRB)/and a Pova First check which had been requested and received after both staff had commenced work in the home. There was no evidence of the supervision provided to these staff whislt awaiting the receipt of the CRB checks. The recruitment information detailed that both members of staff had been given information on the General Social Care Council Code of Conduct. The AQAA detailed that that induction training for new members of staff is in place and that this meets the requirements of the General Skills for Care induction standards. This was discussed with the Manager who had a copy of the induction standards, but stated this had not yet been fully implemented in the home, but that staff had received an induction. There were no induction records to view, but one new member of staff spoken with confirmed that had completed an induction and was aware of the need to complete the full induction. It was also recommended that the Manager checked the induction information in the home is the latest information available, which he agreed to do. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 24 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, 36 and 38. People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Fairlight Manor is run in a friendly manner, but the current management arrangements have again identified a number of shortfalls in respect of the management for example the recruitment and health and safety practice in the home. Systems should be further developed to monitor the quality of care provided. Resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are not well protected in all areas. EVIDENCE: Although Mr Patel is the Registered Manager of the home it was clear from feedback with staff and relatives that he is not in the home very often and the Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 25 responsibility of the day to day management continues to be allocated to the Manager. The CSCI had expected an application for a new Registered Manager specifically to work in the home. The Manager who has worked in the home for nearly three years stated he has given notice and is due to leave in July 2008. The CSCI is awaiting an update of the management arrangements for Fairlight Manor. Prior to the Inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home. This was returned late and information the detail in the AQAA was limited and did not in all cases accurately reflect current practices in the home. This was discussed with the Manager to seek further guidance and improve the information detailed within future AQAA’s. Again this Inspection visit has identified a number of shortfalls in respect of the management for example the recruitment and health and safety practice in the home. Mr Patel needs to ensure the management arrangements are appropriate and that the Manager has the skills and time to manage the home effectively. Observation and feedback confirmed that the Manager had a good rapport with staff, residents and relatives. The AAQA detailed a quality assurance system is in place and that the results from the feedback received is displayed. The Manager was not able to produce this information during the Inspection. He stated that feedback has been sought from residents and their representatives, but this should also be extended to enable other stakeholders such as visiting health and social care professionals to comment on the care provided. The AQQA detailed policies and procedures are in place. Not all had recently been reviewed, and the Manager stated that all the homes policies and procedures are in the process of being reviewed and updated as required. Records of visits made by Mr Patel to the home to meet the requirements of Regulation 26 were viewed for January and February 2008. There were no further records to view for any further visits. The Manager confirmed that the home has no dealings with resident’s monies and that any extras costs incurred are paid by the home and then individually invoiced on a three monthly basis. The AQAA detailed that regular supervision and team meetings are facilitated to meet requirements, and staff spoken with a sample records viewed confirmed these forums occurred. Records viewed were limited and would benefit from further development to protect all staff. Training records were viewed, but these were not up-to-date and it was not possible to evidence if all staff had received training in moving and handling, basic food hygiene, and infection control within the required timescales. The Manager stated Mr Patel is trained to facilitate some of the training, but this was not possible to evidence during the Inspection. The Manager stated that Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 26 he and another member of staff were fully qualified first aiders, and agreed to check if an update is required. The last first aid training was facilitated in 2006, so not all staff have received this training. Further guidance should be sought as to how First Aid requirements are to be met in the home. A health and safety policy has been put in place in the home, but it was found to be very limited and further guidance should be sought to ensure all information as required is detailed. There is not a policy and procedure in place on the prevention of Legionnaires disease. The Manager stated that there are now regular checks of the water by an external agency. But further advice and guidance should be sought to ensure all precautions are in place as required. Risk assessments of the environment had been completed, and were viewed. Highlighted at the last Inspection was the lack of a safe bathing policy. Discussions with the Manager and records viewed did not evidence that this had been addressed. The AQAA did not detail and evidence that the maintenance of equipment and services in the home had all been carried out. A fire risk assessment is in place which the Manager stated had been drawn up by an external agency, but this has not been reviewed since 2006. The Manager agreed to ensure that this is reviewed. So a Requirement has not been made on this occasion. Records were viewed of regular weekly and monthly checks undertaken in the home. Records were viewed that evidenced that some staff had attended fire drills facilitated in the home this year, but there were no records of fire training provided and staff attendance. A sample of the recording was viewed of incidents and accidents. Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 27 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 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 3 X 2 Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 6 (a) Requirement That the Statement of Purpose and Service Users Guide are updated to ensure prospective residents/representatives have accurate information to refer to. That evidence is provided that the home confirms in writing that having regard to the assessment made the home can meet those needs to protect residents. That individual care plans providing specific guidance for staff to follow is devised for each resident in consultation with the resident or their representative. To protect residents and ensure that staff have guidance on all the residents care needs to be met. (This issue is outstanding from last Inspection with date of 1/12/07 not met) That an up-to-date photograph of each resident is kept on file. That individual risk assessments that cover all residents risks are recorded and responded to. DS0000062060.V365324.R01.S.doc Timescale for action 31/08/08 2. OP3 14 (1) 31/08/08 3. OP7 15 31/08/08 4. OP8 13 31/08/08 Fairlight Manor Version 5.2 Page 29 These should include risk of moving residents and pressure sore development to protect residents and staff. (This issue is outstanding from last Inspection with date of 1/11/07 not met) That the moving and handling risk assessments are undertaken by staff that have completed the required training to undertake this task. A system is put in place to ensure these are regularly reviewed to protect residents and staff. 5. OP9 13 (2) That clear criteria guidelines for medicine prescribed on a ‘when require’ basis are provided to protect residents and staff. That a record is kept of staff signatures that administer medication. That secure storage arrangements are made for the storage of medication awaiting collection from the pharmacist. That it is evidenced that staff ensure that the privacy and dignity of residents is promoted at all times and that privacy curtains (net curtains) are provided to all windows if wanted. 31/08/08 6. OP10 12(4) 31/08/08 7. OP12 17 (2) Schedule 4 (13) 8. OP12 16 That the records of individual 31/08/08 residents food consumption is further developed to record all meals taken in the home. To protect residents and evidence that an adequate diet is provided. That resident’s are able to access 31/08/08 DS0000062060.V365324.R01.S.doc Version 5.2 Page 30 Fairlight Manor a range of social activities to ensure their individual social care needs are met. 9. OP19 23 (2) (d) That the bedroom with water damage to the ceiling is repaired/redecorated to improve the resident’s environment. That risk assessments are undertaken for the unguarded pipe work following work undertaken to fit thermostatic valves at hot water outlets accessed by residents, and where any risks are identified the pipe work is guarded to protect residents. That infection control procedures are reviewed in the home to ensure an adequate supply and accessibility of liquid soap and disposable paper towels for staff, to protect residents and staff. That a system is in place to enable the staffing numbers and skills to be reviewed to ensure staffing numbers are appropriate to meet the assessed needs of residents in the home. Staff files show all relevant qualifications and training. (This issue is outstanding from last Inspection with date of 15/01/07 and 01/10/07 not met) That appropriate references are sourced for all employees before employment. (This issue is outstanding from last Inspection with date of 1/10/07 not met) That staff do not commence Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 31 31/08/08 10. OP25 13 (4) (a) 30/09/08 11. OP26 13 (3) 31/08/08 12. OP27 18 31/08/08 13. OP29 17(3)b 19 (1) (b) 31/08/08 14. OP30 18 (a) 15. OP31 10 work in the home before a satisfactory Criminal Records Bureau (CRB)/POVA First check has been received. If staff commence work following receipt of a POVA First check, appropriate supervision is provided until the full CRB check is received. To protect residents. That staff receive induction 31/08/08 training to meet the requirements of Skills for Care and within the required timescale. To protect residents. That the management 31/08/08 arrangements ensure the home is run in an effective manner and ensures the aims and objectives of the home are met. (This issue is outstanding from last Inspection with date of 1/10/07 not met) 16. OP33 24 That the information gathered 31/08/08 for quality monitoring is reported on made available to interested parties with recorded evidence of action taken in response to demonstrate ongoing review and improvement to the quality of care and services in the home. (This issue is outstanding from last Inspection with date of 1/12/07 not met) The other stakeholders such as visiting health and social care professionals are enabled to comment about the care provided in the home. 17. OP33 26 (1) That visits are undertaken and recorded to meet the requirements of Regulation 26. To ensure continuous quality DS0000062060.V365324.R01.S.doc 31/08/08 Fairlight Manor Version 5.2 Page 32 18. OP38 12 (1) 13 (5) 19. OP38 13 (4)(a) (b) (c) monitoring of the care provided. That further guidance is sought from Environmental Health and the Health and Safety Executive as required and is acted upon to ensure a robust health and safety practice is adopted to include clear polices and procedures and thorough environmental risk assessment that are actioned as necessary. To protect residents and staff. That it is ensured that all the equipment in the home have been serviced or tested as recommended. To protect residents and staff. 31/08/08 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Fairlight Manor DS0000062060.V365324.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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