CARE HOMES FOR OLDER PEOPLE
Fairview Brooklands Avenue Leeds LS14 6NW Lead Inspector
Sue Dunn Unannounced Inspection 29th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairview DS0000033206.V335779.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 DS0000033206.V335779.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Fairview Address Brooklands Avenue Leeds LS14 6NW 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) 0113 2738980 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 DS0000033206.V335779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd November 2005 Brief Description of the Service: Fairview is a two storey care home owned and operated by Leeds City Council to provide care for older people with dementia. It is situated in the Seacroft area of Leeds within easy reach of public transport routes and local amenities. The home has 34 permanent beds, the remainder being available for short term respite care. The first floor has passenger lift access. Bedrooms offer single occupancy but do not have en suite facilities. Communal areas offer sufficient space for residents to meet visitors in private. Restriction of movement within the home is kept to a minimum. Signs and pictures are used around the building to provide prompts which assist people to find their way around the home. The building opens onto an enclosed courtyard and has safe surrounding gardens. Care staff are trained to NVQ standard and receive other training related to their work. The fees at the time of writing are £458.86 per week Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcomes for service users. The inspection report is divided into separate sections with judgements made for each outcome group. The judgements reflect how well the service delivers outcomes to the people using the service. The categories are “excellent”, “good”, “adequate” and “poor”. More detailed information about these changes is available on our website – www.csci.org.uk. The manager completed a pre-inspection questionnaire and this information with information supplied since the last inspection was used as part of the inspection process. One inspector carried out the inspection visit arriving at 10:45 am without prior arrangement and leaving at 3 pm. During the visit, service users, staff, a professional visitor and the manager were spoken with, the care records of three people were examined closely, staff records and other documentation was examined, there was a tour of the building and care practices were observed. Questionnaires were sent to the home after the inspection but none had been returned at the time of writing. What the service does well:
Pre admission assessments include a summary of needs and show the resources the home will provide to meet those needs. A monthly falls monitoring system is linked to an action plan to try to reduce falls or identify where a person needs to be reassessed. A professional visitor said ‘the staff are excellent, they use their initiative, and don’t hesitate to call district nurses or the General Practitioner if they have any concerns. I wish all the homes were as good.’ Overall there was a general feeling of well being despite the limited activities. Some good practice was observed in the way staff diverted a person who was becoming agitated. Staff had a good knowledge of the people they were caring for. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 6 The food was plentiful and nutritious and gave opportunity for choice. The tables were nicely laid with plain dark coloured cloths, which contrasted with the crockery and with teapots, milk and sugar to encourage independence. Staff offered a choice of condiments. The diners appeared to enjoy the meal. When someone was overheard complaining of discomfort a member of staff dealt with this. Over 50 of staff have now achieved the NVQ award. Some staff had completed a 5 unit distance learning training in Dementia care. More staff are to start this course in July. What has improved since the last inspection? What they could do better:
Monthly reviews of care should include information to indicate why care plans can remain the same. ‘No change’ is not sufficient to explain how this decision has been reached. It is recommended that staff receive one to one support to record relevant information in the daily notes which can then inform the care plan. For example, when one person was agitated and upset the member of staff knew what action to take to create a diversion. This was recorded in the daily handover sheet but none of this sort of information was recorded in the daily notes or care plan for other staff to follow. Activities were limited to a small group of five or six people each day and there had been no activities recorded for over a week. The manager acknowledged that the life story book project had been started with enthusiasm but was not progressing as hoped. This could be used to ensure activities are more ‘person centred’. The fragmented layout of the lounges in the home left people on the first floor rather isolated from the downstairs activities, with little of passing interest to observe. The sensory room on this floor was locked because some of the equipment was not working.
Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 7 The lift was locked so that people could only move between floors when accompanied by staff. This was not seen to happen during the visit. The deactivation of the lift and the use of digital locks between areas restricted choice and freedom of movement between some lounges and the two floors. Staff could do more to describe the food being served as several people were overheard to speculate on the ‘lumps’ in the soup. More could be done to develop the idea of signs and landmarks around the home to identify one area from another and for example, direct people from communal areas to the toilets. Doors with digital locks, which restrict access could be made less obvious so that people living in the home do not feel they are encountering barriers which restrict their freedom of movement and choice. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fairview DS0000033206.V335779.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 DS0000033206.V335779.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, (6 N/A) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People have their needs assessed and identified before entering the home to ensure nobody is admitted whose needs cannot be met. A licensing agreement clearly states the rights and responsibilities of all parties. EVIDENCE: The files of one person on respite care and two permanent occupants were examined. Each contained a social workers assessment, which included events leading up to the request for care. The assessment by the home, completed before admission included likes and dislikes in food, recreation and personal dress, the type of dementia diagnosed and significant people in the person’s life.
Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 10 The assessment ended with a summary of the identified needs and the resources required to meet those needs. A License agreement was seen in one of the files explaining the terms and conditions of occupancy and the number of the room to be occupied. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The diverse needs of people living in the home were met by the daily handover meetings and care plans. These could have been improved by including more detail of day to day events. EVIDENCE: The home has a good system of information exchange between every shift so that staff are kept informed of any changes. The care files examined contained Lifestyle plans which had been individually developed for each person and stated how support was to be given with such things as orientation, personal dress, interests and nutrition. A standard risk assessment format was used and adapted to individual circumstances.
Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 12 Where possible pen pictures of peoples past life had been completed with the assistance of the person or a relative. Some of this information was also seen in one of the memory boxes. There were clear records of all contacts with health professionals such as GP’s, chiropodists, dentists etc. A monthly falls monitoring form gives a good overview of any falls and the action taken to reduce the risks or seek a reassessment of need. This could be cross referenced to care files. Where people had refused assistance their choice was respected and it was recorded. Lifestyle plans and risk management plans are reviewed monthly but in the files seen simply stated ‘no change’. Care staff continued to lack confidence in recording information, as the daily progress records were based on practical tasks and did not give a good picture of the care observed. For example when one person was agitated and upset the member of staff knew what action to take to create a diversion. This was recorded in the daily handover sheet but none of this sort of information was recorded in the daily notes or care plan for the individual. The district nurses visit the home twice a week. The view of the district nurse visiting on the day was ‘the staff are excellent, they use their initiative, and don’t hesitate to call us or the GP if they have any concerns. I wish all the homes were as good’. She said there was nobody in the home with a pressure sore but some with skin tears. One person was regarded as ‘at risk’ because the staff had noted some redness of the skin. The nurse said there was no difficulty in providing pressure relieving equipment in such cases. Diabetic blood sugar levels are monitored by the nurses. The medication procedure was observed on both floors. Medication is pre dispensed in blister packs from the pharmacy. Several people had medication in liquid form which made it easier for them to take. During the medication process people were asked if they had any pain and if they wanted painkillers. One of the staff giving medication said that staff had received distance learning training from a local college. Though nervous, she showed a good understanding of the purpose of the medication being given and how different medications needed to be stored. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Activities were limited to a small group of people but overall people were in a state of well being. The meals were nutritious and offered choice. EVIDENCE: The home continues to have an activities file which includes guidance on activities. The activities coordinator however was on sick leave. The activity file recorded what activity had been done with people each day. This was limited to a small group of five or six people each day and there had been no entries for over a week. There did not appear to be a formal approach to person centred care plans for social and recreational needs other than the life story books, which were an activity in themselves. The information gathered from this exercise could have generated a care plan. The manager acknowledged that this project had been started with enthusiasm but was not progressing as hoped. The daily handover records however gave guidance and suggestions to staff on each shift. One
Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 14 person was invited to help clear the dining area after lunch and later went to the pharmacy with a member of staff at the suggestion of the manager. One member of staff started a game of dominoes in the main dining area in the afternoon, several people were walking about and talking to anyone they met, some were doing pseudo work (such as moving ornaments and polishing the TV), and others were sitting listening to the background music or interacting with each other. The manager took a tin of chocolates around after lunch, which met with a good response. The fragmented layout of the lounges in the home left people on the first floor rather isolated from the downstairs activities, with little of passing interest to observe. The sensory room on this floor was locked because some of the equipment was not working. The lift was locked so that people could only move between floors when accompanied by staff. This was not seen to happen during the visit. The deactivation of the lift and the use of digital locks between areas restricted choice and freedom of movement between some lounges and the two floors. Some people were asleep during parts of the day but overall there was a general feeling of well-being. A choice of cooked or cold breakfast is available every day. The lunch was nutritious and people were offered second helpings. Staff could have explained to people what kind of soup was on offer as several people were overheard commenting on the lumps in the soup (which were vegetables and pieces of bread). When people were offered assistance with their food this was done appropriately. The tables were nicely laid with plain dark coloured cloths, which contrasted with the crockery and with teapots, milk and sugar to encourage independence. Staff offered a choice of condiments. The diners appeared to enjoy the meal. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who live in the home are protected by the homes complaints procedure and the training of staff to raise their awareness of adult protection. EVIDENCE: There had been no complaints since the last inspection. One resident was overheard complaining about discomfort due to the tightness of his clothing. A member of staff helped with this, to his satisfaction and relief. The finances of one person whose file was examined closely were managed through the Court of Protection. A copy of the court order was in the file. Past knowledge of the home has shown the manager and staff to understand what constitutes adult abuse and deal appropriately with any allegations. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,25,26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home provides a comfortable and well maintained environment for the people who live there. EVIDENCE: The building was clean and free from any unpleasant odours. Carpets on the first floor and in some of the bedrooms had been replaced with easy to clean hard flooring to assist in the control of odours. Bedrooms were identified by name and number and could be locked as some were. None had en suite facilities but bathrooms were tiled in cheerful colours and there was a shower room on the second floor. Décor around the home was of a good standard.
Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 17 Pressure reliving cushions were seen and plates provided to make it easy for people to eat and keep the food on their plates. There were no bedrails in use but the manager said when these had been used risk assessments had been carried out first. More could be done to develop the idea of signs and landmarks around the home to identify one area from another and for example, direct people from communal areas to the toilets. Doors with digital locks, which restrict access could be made less obvious so that people living in the home do not feel they are encountering barriers which restrict their freedom of movement and choice. A courtyard area provided safe outside space for people on the ground floor but this could only be accessed by people on the first floor with the encouragement and assistance of staff, due to the restrictions around the home. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living in the home are protected by a thorough recruitment and selection process, which follows equal opportunity guidance. Ongoing training gives staff the knowledge and skills to meet the needs of a group of people with diverse needs. EVIDENCE: There were only 5 rather than the usual 6 staff on early shift on the day of the visit as an agency worker had cancelled at short notice. Agency staff have been used to cover vacancies. The manager tries to ensure the same people are used every time. Agency staff work through an induction sheet which gives them enough information about the immediate care needs of each person in the home and an understanding of the fire procedures. They then work with a permanent experienced care worker. The pre inspection questionnaire listed the staff training programme and included moving and handling, use of the hoist, fire safety, adult protection, principles of care, nutrition, dementia, life story books, recording information, risk assessment, and ongoing National Vocational Qualification. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 19 The forthcoming training programme: Death and dying, medication, dementia, fire, person centred care, pressure care, activities, NVQ, data protection recording information, Health and safety. Over 50 of staff have now achieved the NVQ award. Some staff had completed a 5 unit distance learning training in Dementia care. More staff are to start this course in July. The manager had given new staff in house training on the basic principles and practices of care. It was disappointing to find that the life story book programme had been slow to develop. The manager acknowledged that record writing and life story- book training should be repeated to improve the effectiveness of both. The file of a care worker employed since the last inspection visit was examined. The manager keeps a copy of the recruitment and selection information in the home. This showed the home follows a thorough procedure to ensure suitable people are employed in the interests and safety of the people living in the home. The procedures gave candidates equality of opportunity Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33, 36,37,38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The manager is well qualified and experienced and manages the home in the interests of the people who live there. EVIDENCE: The manager has achieved the NVQ 4 Managers’ award and care award. Regulation 26 reports on the conduct of the home are regularly received from the principle unit manager. The Quality assurance audits done by the manager include questionnaires for relatives and other professionals and a specially designed questionnaire for people who live in the home. The information is collated and an action plan
Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 21 developed based on the results. A copy of the monthly outcomes was sent to the CSCI. There was evidence in the staff file examined to show that staff receive 1:1 supervision. The Pre inspection questionnaire completed by the manager showed that health and safety was monitored and checks were carried out. The following Health and Safety records were checked:Landlords Gas Safety Cert for the current year Hairdressing Electrical equipment check The Electrical wiring check was being done over several days during the period of the visit Fire safety checks There were no hazards noted during this visit. Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 4 3 3 3 3 x x 3 3 STAFFING Standard No Score 27 2 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 x x 3 3 3 Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement 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. 3. 4. 5 6 7 Refer to Standard OP7 OP7 OP7 OP12 OP19 OP22 OP15 OP14 OP22 OP19 Good Practice Recommendations Some staff need support to improve the content of information they record about day to day events. The notes of monthly care reviews should include more detail about the progress of the care plans Activities should be more person centred and provide more stimulation for people living on the first floor The equipment in the sensory room should be repaired Staff could do more to describe the food being served More could be done to develop the idea of signs and landmarks around the home to identify one area from another Locked doors which restrict access could be made less obvious so that people living in the home do not feel they are encountering barriers which restrict their freedom of movement and choice.
DS0000033206.V335779.R01.S.doc Version 5.2 Page 24 Fairview Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fairview DS0000033206.V335779.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
