CARE HOME ADULTS 18-65
Fairview 33 Bridgend Road Enfield Middlesex EN1 4PD Lead Inspector
Susan Shamash Unannounced Inspection 22nd November 2005 01:00 Fairview DS0000062524.V263548.R01.S.doc Version 5.0 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 Fairview DS0000062524.V263548.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 Adults 18-65. 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. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fairview Address 33 Bridgend Road Enfield Middlesex EN1 4PD 019 9271 1693 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) Avon Lodge UK Ltd Needyanand Raya Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th June 2005 Brief Description of the Service: Fairview is a care home registered to provide care for ten adults, aged 18 to 65, who have a learning disability. A private provider owns the home. Fairview is situated in a large purpose built care home, which also houses a care home for older people. The two homes are separated by a fire door. The home for older people is currently empty. There are eight single bedrooms and one shared room. The shared room is only used for one service user. The home is situated close to a busy road, Bullsmoor Lane in Enfield. The amenities of Enfield Town are a bus ride away. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was a routine visit to the home in order to check on compliance with requirements made at the previous inspection. The visit lasted approximately six hours. The manager was away from the home on the day of the inspection, and the inspector was assisted by the deputy manager throughout the inspection. The area manager (and responsible individual for the provider organisation) was also available on the day of the inspection. The inspector had the opportunity to speak with six residents independently, as some residents were out during the day. The deputy manager and two staff members were also spoken to during the visit. A tour of the building was conducted, although some residents’ rooms could not be inspected in their absence as their permission could not be obtained. Residents’ records, staff files and maintenance records for the home were also inspected. What the service does well:
The home provides a specialised service for residents with learning disabilities who also have mental health problems. Residents feel at home and have good relationships between themselves at the home. They speak positively about the support provided to them by staff. They attend a number of social groups and clubs and are encouraged to form networks outside of the home. Residents have the opportunity to go on holiday with others from the home every year. Recruitment procedures, admission and care planning processes are appropriate for the home. Care plans are in place for all residents and their progress in meeting goals set is reviewed regularly. They are encouraged to develop independence skills so that they can move on to more independent living settings. Residents are encouraged to be involved in all aspects of home life and a group of residents take pride in maintaining the home’s garden. The home exceeds the national minimum standard in the number of staff trained to NVQ level 2 or above. The home is inspected at least monthly by a responsible individual on behalf of the provider organisation, and copies of the reports for these visits are sent to the local CSCI area office. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Four requirements from the previous inspection remain outstanding. These include the need for recording of medicines administered at the time that they are being administered, to prevent mistakes being made and gaps in the records. It also remains required that all staff undertake training in protecting vulnerable adults from abuse. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 7 Several requirements are restated regarding the home environment including the need for the furniture in the lounge to be replaced, and the need for new lampshades, curtains and chairs to be provided within residents’ rooms. It also remains required that action be taken to ensure improved television reception in residents’ rooms, and provision of soap and hand towels in the kitchen, bathrooms, laundry and toilets. It is recommended that residents be encouraged to use the keys for their rooms, to further promote their independence. A number of minor maintenance issues must be addressed in identified residents’ rooms and a ground floor toilet, and the telephone box provided for the use of residents must be repaired or replaced. It also remains recommended that the kitchen be rearranged and refitted, so that the fridge/freezers can be moved out of the staff sleeping-in room. Finally sufficient first aid supplies must be provided to cater for the needs of staff and residents in the home. 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. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. An adequate system is in place to assess service users’ needs and goals effectively and ensure that these can be met. EVIDENCE: All service users’ files included detailed assessments of their needs. Service users spoken to advised that they were involved in the assessment process. As noted at the previous inspection, the admissions procedure remains satisfactory. No new service users had been admitted since the previous inspection. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Service users’ needs and goals are assessed and responded to effectively ensuring that they are met. Risks are recorded appropriately with strategies in place to ensure that service users are protected as far as possible, whilst being encouraged to develop independence skills. Service users are encouraged to be involved in all aspects of home life. Satisfactory procedures are in place to protect service users’ confidentiality. EVIDENCE: Service users told the inspector that they were free to come and go and make their own decisions with support from staff as needed. Regular service user meetings are held, in which they are encouraged to participate. Support provided by the home in assisting service users with their finances, is documented, and service users are encouraged to be involved in the food shopping for the home. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 11 As required at previous inspections, limitations placed on individual service users are recorded within service user plans. Three care plans were inspected and were found to be satisfactory including regular reviews, records of one-toone sessions with service users and risk assessments. Detail assessments was sufficient within risk assessments clearly specifying control measures. As required at the previous inspection, the use of a bound book to record daily notes for all service users, had been discontinued and separate recording sheets were in use instead, thus protecting service users’ confidentiality as appropriate. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Service users have varied lifestyles with access to meaningful activities both in the community and in the home and are supported to maintain links with their friends and families. They are encouraged to take responsibility for the running of the home and to develop independent living skills. Dietary needs of service users are catered for with a balanced and varied selection of food available that meets their nutritional needs. EVIDENCE: Staff and service users spoken to confirmed that service users are encouraged to go out and follow their individual interests. Most go out independently, and are involved in activities including various clubs in Enfield, Edmonton and Palmers Green, playing snooker, going to the cinema, shopping and meeting friends. No service users attend college or employment activities at present. Most service users spoken to indicated that they had active social lives. They are also supported to maintain contact with their relatives. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 13 Service users spoken to said that the improvement in food provision noted in the home at the previous inspection had been sustained. Service users are able to help themselves to food from kitchen cupboards and support is available from staff in cooking food, thus encouraging greater independence. Two service users told the inspector ‘the food is good here.’ One service user cooks meals for themself with support from staff in the home. Stocks of food in the home included fresh fruit, vegetables and snacks. The inspector observed that a number of service users are involved in working in the garden (watering the garden on this occasion). One service user told the inspector ‘I like looking after the garden – it keeps me busy.’ Service users told the inspector that they had enjoyed their holiday in August, during which time a number of improvements had been made to the home. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Service users receive appropriate physical and emotional support and are supported to take their prescribed medicines. However inadequately followed medication procedures may place service users at risk of not having their medication needs met. EVIDENCE: Service users expressed satisfaction that their choice of time to go to bed, get up, take meals etc. were respected. The home seeks specialist support from external agencies where needed, to meet service users’ needs. As required at the previous inspection, an approved medication cabinet had been obtained for the home for the storage of all medicines. Medication records were generally satisfactory, however the inspector noted a small number of gaps in the medication administration records. As required at the previous inspection, medication administration records must be completed at the same time as medication is administered, and this requirement is restated. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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 and 23. The home has a satisfactory complaints procedure to ensure that the concerns of service users are acted upon effectively. Although procedures are in place, staff require adult protection training to ensure the protection of service users from abuse. EVIDENCE: The home had appropriate procedures for investigating complaints and addressing adult protection and whistle blowing. The manager advised that staff had not yet received training in the protection of vulnerable adults, although training was scheduled for early in 2006. This requirement is restated. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30. Although significant improvements have been made, there remains further room for improvement to the environment in which service users live, in order to improve their quality of life. Further replacement of furniture and fittings is required in specified areas. There was a significant improvement in the cleanliness in the kitchen and the home in general. Fitted hand-washing and drying facilities in all toilets, the laundry and kitchen, are required to ensure hygienic procedures for service users within the home. EVIDENCE: Eight single and one shared bedroom are provided along with five toilets, three bathrooms and adequate communal space. A number of requirements from the previous inspection had been met. These include the provision of lockable storage space for each service user, the renewal of furniture in service users rooms, and redecoration of the majority of service users’ rooms. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 17 The registered provider, had provided the Commission with a proposed schedule of redecoration and renewal for the building during the new registration of the home in his name, and advised that service users would be consulted regarding the redecoration of their home. Service users confirmed that they had chosen the carpet colours for their rooms but advised that they had not yet chosen curtain colours. The cleanliness within the kitchen was considerably better than at the previous inspection. A recent environmental health officer inspection had been generally positive. A new larger toaster had also been purchased for the kitchen to meet the needs of up to ten service users. The provider is aware that the kitchen cupboards will require replacement in the near future, as they are worn and do not close effectively. It is recommended that a full review of the layout of the kitchen be undertaken so that space can be found for both refrigerator/freezers. General cleanliness in the home had also improved and a new vacuum cleaner had been purchased for the home. It remains required that adequate hand washing and drying facilities be provided in the kitchen, laundry and toilets/bathrooms in the home. It is required that soap and disposable hand towels be made available in these areas. The deputy manager advised that paper towel and soap dispensers had been ordered for the home but these had not yet been fitted. It remains required that the lounge furniture be replaced, and new chairs, curtains and lamp-shades be provided in service users’ rooms according to their preferences. The windowsill in room 4, the headboard on the bed in room five, the window handle in room six and the toilet seat in the identified ground floor toilet must be repaired. Redecoration must also be completed in room 4. The public telephone for service users in the home must be repaired and television reception in service users’ rooms must be improved. It is recommended that service users be encouraged to use the keys for their room doors in order to increase their independence. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. An adequate recruitment procedure is in place to safeguard service users and staff are supervised effectively. The home is staffed appropriately although staff members require further training to ensure that the needs of service users at the home are met. EVIDENCE: Four staff files were inspected, and they were found to include the necessary documentation as required under the Care Homes Regulations 2001 Schedule 4 as appropriate. Two staff members were spoken to, and appeared to be knowledgeable about their role and responsibilities at the home. They advised that they were receiving sufficient support and supervision from management at the home as appropriate. Records indicated that regular supervision sessions are occurring. The manager advised (in the pre-inspection questionnaire) that sixty-six percent of staff are trained to NVQ level 2 or above, which exceeds the national minimum standard. A requirement is outstanding regarding the need for food hygiene training for all staff. The deputy manager advised that staff had undertaken this training recently but their certificates had not yet been received. It remains required (under Standard 23) that adult protection training be provided to all staff at the home. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. There is consultation with staff and service users regarding the way in which the home is run, and the Commission is informed of any serious incidents in the home, to ensure that service users are not placed at risk. Regular monitoring visits are undertaken on behalf of the provider organisation. There has been an improvement in health and safety checks and procedures within the home to safeguard service users from harm. EVIDENCE: The registered manager of the home was not available on the day of the inspection, however having managed the home over several years, the inspector is satisfied that the home is managed effectively and competently with the best interest of service users in mind. The temperature from baths and showers is thermostatically controlled to a maximum of 43 degrees Celsius, and temperatures are tested regularly. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 20 Service users spoken to advised that they were consulted with regard to their views about the home at regular meetings. Records of staff meetings also indicated their consultation about the way the home is run. A report was available from a recent visit from the local fire prevention unit, and no requirements were made regarding Fairview, although some were made regarding the home for older people that shares the building. There was a record of fire extinguisher and fire alarm servicing, fire alarm testing and drills at the home, and fire alarm testing was now taking place weekly as required. Up to date insurance, gas and electrical wiring and portable appliances testing safety certificates were available. As required at the previous inspection (under Regulation 37 of the Care Homes Regulations 2001) the inspector had been notified in writing of any serious incidents affecting service users. The inspector also receives regular monitoring visit reports from the responsible individual on behalf of the provider. Food stored in the freezer was wrapped and labelled appropriately as required, and chemical cleaning materials are now stored in the locked shed when not in use. Inadequate first aid supplies are available for the home and a requirement is made accordingly. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 2 X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Fairview Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 3 2 X DS0000062524.V263548.R01.S.doc Version 5.0 Page 22 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 YA2020 Regulation 13(2) Requirement The registered persons must ensure that medication administration records (MAR sheets) are signed at the time that prescribed medicines are administered, to prevent errors or gaps in the recording. (Previous timescale of 08/07/05 partially met). The registered persons must ensure that all staff undertake training in the protection of vulnerable adults. (Previous timescale of 16/09/05 not met). The registered persons must replace the sofas and chairs in the lounge with new items. (Previous timescales of 1/12/04 and 16/09/05 not met). The registered persons must ensure that new chairs, curtains and lampshades are provided in service users’ rooms according to their preferences. The registered persons must ensure that the windowsill in room 4, the headboard on the bed in room five, the window handle in room six and the toilet seat in the identified ground floor
DS0000062524.V263548.R01.S.doc Timescale for action 23/12/05 2 YA23YA35 13(6), 18(1)(c) (i) 23(2)(d) (i) 03/02/06 3 YA24 20/01/06 4 YA24 23(2)(d) 16(2)(c) 24/02/06 5 YA26YA27 23(2)(b) 23/12/05 Fairview Version 5.0 Page 23 toilet are repaired. 6 YA24 23(2)(b) The registered person must ensure that the public telephone for service user’s use is repaired and television reception in service users’ rooms must also be improved. The registered persons must ensure that soap and disposable hand towels are available in the laundry, all toilets/bathrooms and in the kitchen. (Previous timescale of 19/08/05 not met). The registered persons must ensure that fully stocked first aid boxes (with sufficient supplies to meet the needs of the home) are provided, and that their contents are monitored to ensure that they are kept well stocked. 23/12/05 7 YA30 16(2)(j) 23(2)(d) (5) 30/12/05 8 YA42 12(1)(a) 13(4) 30/12/05 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 YA24 YA24 YA24 Good Practice Recommendations It is recommended that a full review of the layout of the kitchen be undertaken so that space can be found for both refrigerator/freezers. The registered persons should remove the fridge and freezer from the staff sleeping-in room. It is recommended that service users be encouraged to use the keys for their room doors when they leave their rooms. Fairview DS0000062524.V263548.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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