Inspection on 23/08/06 for Fairview

This inspection was carried out on 23rd August 2006.

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

Fairview 25/07/08

Fairview 27/07/07

Fairview 17/02/06

Fairview 19/09/05

Fairview 11/01/05

Fairview 10/08/04

Fairview 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Fairview 42 Hill Street Kingswood South Glos BS15 4ES Lead Inspector Wendy Kirby Key Unannounced Inspection 23rd August 2006 09:30 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 Fairview DS0000034844.V305944.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. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairview Address 42 Hill Street Kingswood South Glos BS15 4ES 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) 0117 9352220 0117 9476234 Mrs June Phillips Mr Gordon Norman Brooking, Mr Derek Marsh Mrs Jacqueline Yvonne Reed Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 24 persons aged 65 years and over requiring personal care May accommodate one named individual aged under 65 years with a physical disability, this condition will be removed when this resident leaves the Home or reaches the age of 65, whichever is the sooner 17th February 2006 Date of last inspection Brief Description of the Service: Fairview is situated in a quiet cul-de-sac in Kingswood and is close to local shops and amenities. Private parking is available in the front of the house. The home is registered to provide personal care and accommodation for up to 24 persons who are over 65 years of age. The home is an older property arranged over three floors. There is a large communal space separated into a lounge and dining area. Bedrooms have been refurbished. There is a shaft lift servicing all floors except for bedrooms 20 and 21. These two rooms are accessed by a small flight of stairs and can only be used by ambulant residents. The cost per week to reside at Fairview will range from £348.00-£480.00. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted as part of the annual inspection process. The inspection lasted one day. Prior to the visit the inspector spent some time examining documentation accumulated since the previous inspection, including the pre-inspection questionnaire, notified incidences in the home, (Regulation 37’s) and the unannounced reports conducted by the Registered Providers (Regulation 26’s). The inspector sent twenty-four questionnaires “Have your say” to residents in the home prior to the inspection and ten were completed and returned. Relatives and visitors completed eight “Comment Cards” and health professionals who have direct contact with the home completed two. Information from these has been collated and is detailed throughout the report. The inspector spent time throughout the inspection in discussions with the manager and a number of records and files relating to the day-to-day running and management of the home were examined. Four residents were case tracked. Their care plans, care files and medication records were examined. The inspector had discussions with the residents and observed them indirectly going about their daily routines. Evidence was gathered from discussions with visitors and staff members. The inspector toured the premises accompanied by the manager. Feedback was given to the manager on the outcome of the inspection. What the service does well: Admission procedures were resident focussed and supportive to residents. Care plans accurately reflect the residents’ needs and how they will be met. Residents and their families are involved in this process wherever possible. Staff have a good awareness of individuals’ needs and treat the residents in a warm and respectful manner. There are safe systems of medication. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 6 Meals were well presented and menus verify a healthy well balanced diet for all residents who benefit from a wide variety of choice. The home is comfortable, well decorated and furnished. It provides a safe, peaceful and well-maintained environment for the residents. All complaints or concerns are documented, dealt with effectively and outcomes are recorded. Adequate staffing levels help to ensure that resident’s needs are met. Staffing levels are increased when the dependency levels of the residents change. Staff training is well attended and should ensure that residents are supported by competent and qualified staff. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ personal money. The home was well organised and managed by an effective team that promotes the views and interests of the residents. What has improved since the last inspection? What they could do better: The service user guide needs to be updated with regards to the reference made about residents contacting The National Care Standards Commission. The home needs to continue to develop the residents care plan using the new format and ensure that all information in the care files is reviewed and updated where needed on a monthly basis. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 7 Although improvements have been made, further development must be made to improve record keeping within the home. In some areas of work practice there is insufficient evidence to demonstrate that the home is meeting with nationally recognised minimum standards. Residents’ bedrooms continue to be used for training and to conduct interviews. In order to protect residents’ privacy and dignity, this practice should cease. To further ensure the resident’s safety, comfort and wellbeing a number of requirements have been made regarding the environment in some of the bedrooms. These are detailed at the end of the report. 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 DS0000034844.V305944.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 Fairview DS0000034844.V305944.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents and/or their families receive relevant information to make a decision about the nature of the home. Residents receive a contract/statement of terms and conditions on admission. Prospective residents’ needs are assessed prior to admission to determine the suitability of placement to ensure that their needs can be met. Trial visits give prospective residents an opportunity to assess the nature of the home. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 10 EVIDENCE: A statement of purpose and service user guide is made available at the initial stage of enquiry to prospective residents/families. The service user guide includes valuable information on the facilities and services available to them within the home. Information in the guide does not give the correct details about the Commission for Social Care Inspection should residents, families or visitors to the home wish to contact us, a requirement will be made to amend this. Nine residents stated in their surveys that they had received a contract and that they had enough information given to them to assist them in deciding if the home was where they wanted to live. During the case tracking process of four residents it was noted that all residents had a contract/written terms and conditions. Needs are thoroughly assessed by the manager pre-admission to ensure that the home can meet those needs. The prospective resident, family and carers are involved in this process. Where relevant the manager also obtains comprehensive assessments and care plans from other professionals involved for example, social workers and hospital staff. The manager was able to demonstrate a sound knowledge of the current residents, their medical history, personal background and their subsequent needs. The information gathered preadmission provides a sound benchmark of the resident’s ability and state of health prior to admission. Prospective residents are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. A month’s trial period on both sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. One family stated in their survey, “We had a very supportive, informative discussion with the manager, prior to admission”. Fairview DS0000034844.V305944.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The service has good systems for meeting and monitoring residents’ health and personal care needs in consultation with residents. There are safe systems of practice in receiving, storing, administering, and disposing of drugs. Staff have a good awareness of individuals’ needs and treat the residents in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. EVIDENCE: The home has recently started using a revised care plan format and due to time constraints not all residents’ new plans had been completed and they had not be reviewed and updated on a monthly basis. However residents’ plans seen with the new format were very good. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 12 The plans were very personalised and demonstrated that the staff had a great awareness of the residents’ needs and how to meet those needs. The content was written clearly with good detail. Plans were completed with regards to social needs including, psychological, emotional, and cultural needs which demonstrates that the home takes a holistic approach to the provision of care. Risk assessments included the risk of falling and manual handling. In addition to this there are some risk assessments that were written specifically tailored to individual preferences. One resident likes to take part in cooking and whilst this presents some risk, the home has endeavoured to make it safe in order that the residents’ wishes are respected. Most residents surveys stated that they were very satisfied with the care and support they receive at Fairview and included comments, “Staff are always there to help you”. Health Care needs were evidenced and included, nutritional, pressure area care and pain assessments, however these had not be reviewed and updated regularly. Records of the General Practitioner (GP) visits with residents and the outcomes were documented. Specialist referrals and visits from other professionals including District Nurses, Chiropractors, Dentists and Opticians were also seen. District Nurses were visiting on the day of the inspection and it was noted that good professional relationships had been forged. One comment card completed by a visiting health professional to the home stated, “I have always found the manager of the home very understanding and accommodating of the care needs of the residents and she communicates well with our team and families”. Although one resident had stated they wanted to change their GP, nine residents’ surveys stated that they always felt that they received the medical support they needed. One resident stated, “The staff will always call my doctor if I am feeling unwell”. During the inspection it was observed and noted that all staff on duty had identified one resident was feeling very poorly. The staff showed great empathy to the resident, giving reassurance and comforting him. The resident was immediately referred to the GP for a visit. This clearly indicates an efficient process whereby residents’ needs are continually monitored, assessed and managed. All residents’ files had a daily record and key worker section. These gave very good informative accounts of how the residents were that day, what they had done and how they were feeling. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 13 Opportunity was taken to inspect the medication system. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. Records held in relation to the storage and administration were accurately maintained and met with the requirements of the legislation. The home also keeps an accurate stock check of medicines given on an as required basis. Fridge temperatures are recorded daily. Staff were witnessed knocking on residents doors before entering confirming respect for the residents individual privacy and dignity at all times. All rooms have a telephone point from which residents can make and receive calls. Private telephone lines can be installed. A payphone is available on the ground floor. It was noted at the previous inspection that interviews and staff training were taking place in a resident’s bedroom. This practice is unacceptable and in order to protect residents’ privacy and dignity, alternative arrangements were requested. The Registered Providers are in the process of opening a new home next door to Fairview where accessibility of a training room will be acquired. However this will result in further action if this requirement remains unmet. The atmosphere in the home on the day of the inspection was relaxed. Staff, the manager and residents were observed to have good relationships. Staff responded to residents in a sensitive and professional manner. Fairview DS0000034844.V305944.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Residents maintain family contact and staff encourage family and friends to join in with activities and any outings. Residents receive a varied and wholesome diet that they are able to influence EVIDENCE: In consultation with the residents’ staff develop a monthly timetable of activities and forthcoming events. A copy of this is usually placed on a notice board in the main hall to ensure that all residents and visitors are aware of the planned activities. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 15 When the inspector asked to see the activities arranged the manager explained that she had been asked to remove the board by the Group Manager. This is a great shame and raises concerns as to how residents and visitors will be kept informed. The board was seen by the inspector in the staff office. The board also contains other news, information, useful leaflets and details about CSCI. The manager is trying to keep people informed without the board and posters were seen on communal doors about a forthcoming fashion show. However it was recommended that the manager consult with the Group Manager to try and find an alternative place for the notice board in order that this good practice of effective communication can continue. Some residents go out regularly and it was apparent that residents are encouraged to be actively involved in the local community if they are able and choose to do so. One resident told the inspector that they regularly go to “The Mall” and enjoy shopping at the local high street. Weekly trips are arranged and residents like to go to local public houses for lunch, visit garden centres and places of interest. Musicians also visit the home on a regular basis. The residents enjoy music played on the harp, acoustic guitar, and musical percussion. The home provides activities throughout the week, which include, bingo, indoor games, quiz time, and reminiscence therapy. Following a comprehensive course in dementia care the home has looked at ways in which residents with dementia can receive stimulation. A “rummage box” has been provided which contains various items that residents can relate to. These items provide memories and topics of conversation for residents where they are able to reminisce. The home is in the process of developing a new initiative to complete a social assessment of each resident. It is a comprehensive document and should enable the staff in the home to relate to residents in a personalised way. It should also create topics of conversation, encouraging life review and reminiscence, which will have meaning to that resident. Some families had taken the assessment home with them and completed them in their own time. Information was very useful including important life events, special anniversaries and personal preferences. The inspector looks forward to looking at the progress of this initiative and its effectiveness at the next inspection. As stated in the service users guide residents are supported to attend their local place of worship. Residents are free to worship as they wish and any arrangements for services or communal prayers within the home are made in accordance with residents’ wishes and are entirely voluntary. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 16 The home operates an open door policy for visitors to the home; they do request that if anyone wishes to visit after 9.30pm, notification is made in advance. Restrictions on visiting are only imposed when a resident makes a request. One resident told the inspector, “My family are always made very welcome at any time”. Visitors were spoken with during the inspection and were complimentary of the staff and care their relatives receive. Staff were seen offering cups of tea and coffee to visitors. The inspector looked at new documentation in the residents care files entitled “Daily Routine”. Each resident had completed this with a member of staff which detailed preferences such as when they like to get up, where they prefer to have breakfast and what time they liked to go to bed. Some daily routines contained more detail than others and the manager is in the process of reviewing these. Information was personalised and should help staff have a greater understanding of each resident. One daily routine had identified that a resident particularly gets anxious about the whereabouts of their spouse towards evening time. It is thought that he could be thinking, “it’s getting late, my tea will be ready, my wife will be waiting for me”. By identifying these needs staff are able to recognise the signs and offer reassurance to relieve the residents anxiety. The size and layout of the dining room made it possible for all residents to enjoy the social advantages of dining together. Staff had used their expertise and knowledge of the residents, personalities, preferences and ability to eat independently, when seating them for lunch. In addition to this it was observed that residents can have their meals in their bedrooms if they choose to or if they are unwell. Residents’ surveys suggested that the meals provided were satisfactory, with adequate portions. Residents are able to influence the choices on the menus, which is often discussed at residents meetings. An alternative choice is always available for residents on a daily basis. The 4-week menu rota displayed traditional meals and choice was available at each sitting. The menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. The kitchen was very clean and spacious and stores exhibited a good range of foods. Documentation was provided to show the inspector that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked before serving. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents and relatives can be confident that their concerns will be listened to and that they will be protected from abuse. EVIDENCE: Fairview has a well-established complaints procedure that contains contact numbers and timescales for action. It is included in the residents guide and displayed on the home’s notice board. There has been one complaint received by the home since the last inspection. Documentation about the complaint was examined and details confirmed that policies and procedures were followed correctly and that the complaint was dealt with and resolved effectively and efficiently. One resident felt that complaints or requests were not always acted on as quickly as one would expect. The manager explained that any concerns or requests are dealt with “on the spot” whenever possible and all information is logged in the daily record and cascaded down to staff through handover. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 18 Nine residents surveys said that they knew who to speak to if they were not happy. One resident told the inspector “I would speak to a member of my family if I had to make a complaint” and “I would always speak to Jackie the manager”. Nine residents surveys said that they new how to make a formal complaint, comments stated, “I’ve never had reason to complain” and “I’m quite happy with all that goes on”. There are procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse’ including the Local Authority “No Secrets” document. The staff handbook and induction training provides education on topics for whistle blowing, management of aggression and bullying. The availability of this information should increase staff awareness and understanding of their role in protecting vulnerable adults who live at the home. The inspector was informed by the manager that the organisation actively promotes staff training and education in these areas, all staff are encouraged to attend training in dealing with difficult behaviours and protection of vulnerable adults. Staff training records evidenced this commitment. A number of staff are undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. One relative said in their comment card, “The staff show warmth and affection which is so necessary for the wellbeing of the residents”. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is comfortable, tastefully decorated and furnished. It provides a safe, peaceful and well-maintained environment for the residents. The bedrooms, communal rooms, facilities and equipment are suitable and well presented for their purpose and meet the residents’ needs. Some bedrooms require refurbishment and new flooring. All areas of the home were clean. EVIDENCE: Fairview is situated within the heart of Kingswood and many residents lived within the community before they moved there. It has pretty gardens, which are well maintained and adequate parking is provided for all visitors to the home. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 20 As mentioned at the previous inspection there was a small lip to the front door which caused difficulty for people with limited mobility and when staff were manoeuvring wheelchairs. Action has now been taken to rectify this and a ramp has been provided. Room sizes are adequate for their stated purposes, particularly the lounge and dining room. Residents had been supported to personalise their bedrooms with pictures and ornaments and residents are able to bring items of furniture should they wish. All areas of the home were tastefully decorated, and maintained. Great attention had been given to ensure that all areas were homely. Residents were making full use of these areas and their bedrooms on the day of the inspection. The home has adequate bathing facilities that have been fitted with equipment to encourage the independence and the safety of the residents living in the home. The manager conducts a monthly audit of the premises in order to identify any issues/shortfalls with the environment. An audit had been completed the day before the inspection. The inspector went around the home with the manager and verified that the works that had been identified from her audit must be actioned. This included replacement of some flooring in residents’ rooms, bedroom furniture and vanity units and sinks. Several new beds and bedroom furniture were being delivered to the home on the day of the inspection and the home has a continuing re-decoration programme. The maintenance man was re-tiling one of the bathrooms on the day of the inspection. The manager asked one resident during the tour if there was anything she was unhappy with in her room. The resident felt that her lounge chair was worn and “had seen better days” this was replaced immediately. It was noted that one of the bedrooms sash windows was broken and that a piece of wood was wedged underneath to keep the window open. The resident who used this bedroom had dementia and potentially there was a risk that they could remove the piece of wood and have an accident. The wood was removed and the window locked until repairs could be made to the window. The home was very clean and free from unpleasant odours. The home employs domestic staff on a daily basis. All residents and visitors felt that the home was fresh and clean and one visitor said, “The home is always clean with fresh flowers on the table”. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Adequate staffing levels help to ensure that resident’s needs are met. Residents are supported and protected by the homes recruitment policy. The residents are cared for by skilled staff that are trained and supported by management. EVIDENCE: The staffing levels are well managed by the manager and are indicative of the needs and levels of care required by the residents. If levels of dependence were to increase, then staffing levels would need to be increased. The manager uses her own staff group to cover any staff absences and makes good use of agency staff. This is good practice and provides a consistent care service to the residents. Three residents stated in their surveys that staff are usually available when you need them, and seven felt that staff were always available. One resident commented that it depended on which staff were on duty. Eight residents felt that staff listen to them and act appropriately. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 22 One visitors comment cards said, “ I have always found Fairview a very good home and all the staff are very friendly and happy”. The recruitment process was examined and all staff records examined showed that the home follows a recruitment procedure. Records contained application forms, references, and a CRB (Criminal Records Bureau) disclosure. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, Health and Safety and the Protection of Vulnerable adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. The home continues to support their staff with their NVQ and the enrolling programme continues. The manager and her staff are conscientious in attending training relevant to the care needs of the residents. This year the team are focusing on training in, “Dementia Awareness” and “Infection Control”. All mandatory training was up to date and future dates had been booked for, first aid and basic food hygiene. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents’ needs and best interests are central to the management approach in the home, however the home has failed to meet with previous requirements made at the last inspection. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ personal money. Record keeping needs to be improved in order to meet with requirements of the legislation. The health and safety of residents, staff, and visitors is promoted. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 24 EVIDENCE: Fairview continues to be a well run home. The manager has obtained her NVQ4 and Registered Managers Award. The manager has a dedicated team who work with her to ensure that the highest standards of care are achieved and maintained. Throughout the visit the manager demonstrated a good understanding of the needs of individuals living in the home and visits all residents on a daily basis. During the tour of the premises the manager introduced the inspector to many residents, discussions were open, relaxed and inclusive. It was evident that the philosophy of the home was to provide a good quality service in a homely environment taking into consideration individual preferences. One visitors comment card stated, “There is a wonderful family atmosphere led by Jackie, the staff are always friendly, very understanding and never too busy to spend time talking to and commending residents”. There was a high degree of satisfaction expressed by all residents, relatives and visitors who experience the services provided. Based on the comments received from residents surveys and visitors comment cards and through the inspectors observation it is evident that residents feel the home is run in their best interests to ensure their needs are being met. The policy and procedure for holding residents personal money was examined and four individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. Record keeping remains an area of weakness within the home and this needs to be improved upon in order to clearly evidence that they are meeting with requirements of the legislation. There have been some improvements particularly in relation to induction, staff training records and health and safety checks. However shortfalls still remain around care plans, reviewing and updating information in residents care files. Other lapses identified at the previous inspection were not looked at during this inspection including records of staff supervision and the homes risk assessments. The manager confirmed that health and safety risk assessments had not been reviewed despite a requirement made at the last inspection. In addition there are two further requirements that remain outstanding from the last inspection. Consequently despite evidence of very good practise in other areas the outcome from this group of standards must be poor. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 25 It was not made clear at the previous inspection the reasons why this was happening but in recent discussions with the manager it would seem apparent that record keeping has lapsed in places due to the departure of the deputy manager. Urgent recruitment must be addressed in order to ensure that work practice in this respect is achieved. Some of the Health and safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment, and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas, electrical and lift services. Fire safety training for staff is given on induction and then at the recommended given intervals, as recommended by the Fire Prevention Officer. All night staff have fire drills on a three-monthly basis, and day staff sixmonthly. The Group Manager is completing monthly visits and copies of the reports are being sent to the Commission for Social Care Inspection. Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 3 X 3 X 2 3 Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 27 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. 2. 3. 4. Standard OP1 OP7 OP10 OP19 Regulation 5(1)(f) 15(1)(2) (b)(c) 12(4)(a) 23(2)(b) (d) Requirement Update the service user guide with the correct details about CSCI. Ensure that residents care plans accurately reflect their needs at all times. Stop using residents’ bedrooms for staff interviews and training. Repeated requirement An action plan must be sent to CSCI detailing the timescales and priority areas to; 1. Refurbish and redecorate all bedrooms identified during the environmental audit carried out. 2. Replace carpets in all rooms identified. 3. Repair sash window Review health and safety risk assessments. Repeated requirement Timescale for action 13/10/06 13/10/06 19/09/06 13/10/06 5. OP31 13(4)(a) 13/10/06 Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP37 Good Practice Recommendations Improve record keeping within the home in order to reflect working practice Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Fairview DS0000034844.V305944.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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