Inspection on 27/06/05 for Fairview

This inspection was carried out on 27th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fairview 10/06/09

Fairview 29/05/07

Fairview 23/11/05

Fairview 05/01/05

Fairview 07/07/04

Similar services:

Elmleigh Convent

Eastfield Farm Residential Home Limited

Cranwell Court Care Home

Cottingham Hall

Cranmer Scheme

Fairburn Mews

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

CARE HOMES FOR OLDER PEOPLE Fairview Brooklands Avenue Leeds West Yorkshire LS14 6NW Lead Inspector Sue Dunn Unannounced 27 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fairview Address Brooklands Avenue, Leeds, LS14 6NW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2738980 Leeds City Council Department of Social Services Mrs Carol Burton Care Home 37 Category(ies) of Dementia - over 65 years of age (37) registration, with number of places Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 05/01/05 Brief Description of the Service: Fairview is a two storey residential home owned and managed by Leeds City Council to provide 24 hour care for older people with a diagnosis of dementia. It is situated in the Seacroft area of Leeds within a short walk of a large supermarket and other local amenities. The main Leeds outer ring road and regular bus services to the city centre are close by.The home accommodates 34 permanent residents and uses the remaining bedrooms for people requiring short term respite care. Access between floors is by passenger lift and each floor has a designated team of staff.Most of the bedrooms are below the minimum size but meet the amended standards for existing homes. All offer single accommodation but none have en suite facilities. The building has compensatory communal space for service users and their relatives to use. There are bathrooms on each floor with assisted baths and a shower room.The building opens onto an enclosed courtyard and has safe surrounding gardens.The organisation is committed to training staff for the NVQ award, which some staff in the home have already achieved. Other relevant staff training is ongoing. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection, carried out by one inspector was unannounced and spanned a period of 4.5 hours. The purpose of the inspection was to ensure the home was operating and being managed in the best interests of the people living in the home and to meet the National Minimum Standards for a Care Home for Older People. Judgements made during the inspection were based on observation of care practices, discussion with the manager, a care officer, three care workers, three visitors, several residents, examination of four care files and a selection of records. This was a good inspection which left the inspector with the impression that residents and their families were confident they would be safe and well cared for What the service does well: The home has a clear information pack which gives people seeking a care home a good indication of what to expect. The home recognises the importance of having some background history about people. This helps staff to care more effectively for people with memory loss. Staff were observed to talk to residents and keep them informed about everyday events. There was a good range of social and recreational activities which both staff and residents seemed to enjoy. Food was of a good standard and staff offered choices in a way which residents could see and understand. Staff were described as pleasant and kind and very good at providing the support people needed. Staff training is ongoing and put into practise The management team are committed to the care of people with dementia and between them provide clear leadership Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 The information pack and completed assessment information inspires confidence that the home has considered what will be required to meet each person’s needs before they are admitted to the home. EVIDENCE: The Statement of Purpose has been updated and includes visual aids. The information makes clear the expectations and responsibilities of the home and the resident. A very good information pack has been produced for the benefit of people seeking respite care. A section in the pack is required to be completed by the residents family or advocate to provide some personal history about the individual. This gives staff some background information to help them care for people who may have difficulty remembering or expressing their feelings. The pre admission assessment has a summary sheet on which identified needs and the resources required to meet the needs is recorded. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The care plans and daily records ensure that health and other care needs are recognised and met. Staff had a good knowledge of the people in their care and were able to adapt their approach to the needs of each individual. Recording skills have improved but more attention should be given by staff to record their own actions and interventions. EVIDENCE: Each of the care files examined included a good ‘life plan’ of each person on which staff could base their care approach. Risk assessments included guidance on diet and guidance on how to work with people with challenging behaviour. However ‘violent incident’ reports did not include a de briefing to identify any triggers to a ‘violent incident’. Some staff were better than others at recording their own actions and following through events from day to day in the daily logs. Records showed GP and regular district nursing visits. Pressure relieving equipment was supplied by the nursing service and the instructions regarding pressure care were clearly recorded in the care files. A member of staff arriving on shift informed a resident she was going with him to a hospital appointment later in the day and explained why. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 10 None of the people in the home manages their own medication. The midday medication process was observed. Where a person refused medication the member of staff returned later. It is acknowledged that some people need more assistance to take medication but staff should avoid handling tablets. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Social activities were creative and varied to provide interest and fulfilment for people living and working in the home. The food was of a good standard and mealtimes a relaxed social occasion. EVIDENCE: It was encouraging to see care plans and life plans based on the person not just the illness. However, information in the life plans did not appear to be being used to tie in and direct activities of interest to specific individuals. For example, one person was said to enjoy music but there was nothing in the activities log to show any provision for him or involvement in this. In another case a person who was recorded as having ‘challenging behaviour’ always participated in any drawing and painting activity though this interest was not recorded in the care plan. A daily log showed all activities and participants and indicated the enjoyment of staff and residents. The range of residents varied from day to day. During June the following activities were recorded:-painting and drawing, sensory therapy, ball games and bean bags, singing , manicures, dominoes, skittles, clay modelling, dancing and story reading. Two people from the church visited to give communion, a regular event which they said has an attendance of 10-15 people. They described the staff as ‘very good’ and said they sit with the frailer residents to assist during the service. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 12 A visitor said staff were always ‘pleasant and kind’ and said her father was always pleased to return to the home after spells in hospital. The choice had been hers to limit personal belongings brought into the home to photographs. The midday meal in the first floor dining rooms was observed and tasted There were two choices of main course and dessert. Dining tables were neatly laid and the food was served from a heated trolley. Staff were calm and unhurried and gave choice to residents by showing them the food and explaining what was on the plates. The food was hot and tasty. Residents indicated that the food was good. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has satisfactory systems in place to ensure people can express their views and concerns and are protected from abuse. EVIDENCE: The homes complaints log shows that the manager is open to complaints and attempts to ensure they are resolved satisfactorily. Three of four complaints since February 04 had been resolved satisfactorily. Some staff have had training on the protection of vulnerable adults and all appear to understand what is regarded as abusive behaviour. Appropriate action has been taken using the adult protection procedures where concerns have been voiced about care practices. An allegation of abuse was being investigated at the time of the inspection. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,23,24,25,26 The home provides a safe comfortable environment. EVIDENCE: The home was comfortable and efforts had been made to make each area domestic in style. Though small, some bedrooms were well equipped with personal items making it easier for people to recognise their bedrooms as their own personal space. Some people were seen to use their bedrooms at mealtimes. The layout of the home, particularly on the ground floor allows freedom of movement inside and outside the building. Restrictions on the first floor were kept to a minimum. Overall odour control was good. There was a slight odour in some lounges and bedrooms and a visitor remarked on some ‘odd smells’ in the home though the carpets were ‘cleaned every day’. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staff showed the benefits of training and on the day of the inspection showed a professional and caring manner whilst treating people as adults. EVIDENCE: The manager stated that staffing levels have improved. The home is 71 hours short on care (applicant have been short listed to be interviewed for these posts) and has employed an agency cook to cover the vacancies which have not been filled in the kitchen. The rota aims for five care staff on the morning shift with an officer and domestic staff. The file of a recently employed member of staff showed a well completed application and a robust selection process with notes made at interview providing evidence of the selection process. Eight staff have completed the NVQ award and several are either registered or doing the award. A member of staff said ‘someone’ had been into the home to give dementia training and the Adult Protection unit had done a course on adult protection. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38 The home has strong leadership and guidance to ensure residents receive consistency of care. The home is managed for the benefit of the residents and in their best interests. The home has systems to ensure the health and safety of staff and residents. EVIDENCE: The manager continues to show commitment and enthusiasm for the job. She has many years experience working with older people and has shown an aptitude for working with people with dementia and their families. She is currently working towards an NVQ4 award in management after which she will look for a suitable course which develops her knowledge of dementia. The officer team work well together and have the respect of the staff team. Staff confirmed that they receive regular formal supervision. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 17 Safety check records were up to date and care files held securely whilst being accessible to staff. Staff have all had training in moving and handling, fire safety and cleaning staff have had infection control training. Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x 3 3 3 3 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 Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 3 3 Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 19 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 OP7 Regulation Requirement Daily logs must record the actions of staff when giving care not just the behaviours of residents Timescale for action 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. Refer to Standard OP7 OP9 Good Practice Recommendations There should be evidence to show that the circumstances leading up to a violent incident are examined and care plans adapted to reduce the likelihood of further incidents Medication should not be handled during administration Fairview 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 20 Commission for Social Care Inspection Aire House Town Street Rodley Leeds, LS13 1HP 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 20050623 Fairview IR Stage 4 J52 V231653 S33206.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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