CARE HOME ADULTS 18-65
Fairview 33 Bridgend Road Enfield Middlesex EN1 4PD Lead Inspector
Susan Shamash Key Unannounced Inspection 5th May 2006 12:15 Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Fairview Address 33 Bridgend Road Enfield Middlesex EN1 4PD 019 9271 1693 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Avon Lodge UK Ltd Needyanand Raya Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Fairview is a care home registered to provide care for ten adults, aged 18 to 65, who have a learning disability. A private provider owns the home. Fairview is situated in a large purpose built care home, which also houses a care home for older people. The two homes are separated by a fire door. There are eight single bedrooms and one shared room. The shared room is only used for one resident. The home is situated close to a busy road, Bullsmoor Lane in Enfield. The amenities of Enfield Town are a bus ride away. Weekly fees are £1000 - £1400 according to needs as of May 2006. Residents purchase their own toiletries, travel fares, hairdressing etc. and contribute towards holidays. CSCI inspection reports are made available to residents in the dining area and they are informed when a new report has been received. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was a routine visit to the home in order to check on compliance with requirements made at the previous inspection. The visit lasted approximately six hours. The manager was available throughout the inspection, and the inspector also had the opportunity to speak to the area manager, four staff members and a health care professional visiting the home. The inspector had the opportunity to speak with six residents independently, as some residents were out during the day. The partner of one resident also spoke to the inspector as they were visiting the home on that day. A tour of the building was conducted, although some residents’ rooms could not be inspected in their absence, as their permission could not be obtained. Residents’ records, staff files and maintenance records for the home were also inspected. What the service does well:
The home provides a specialised service for residents with learning disabilities who also have mental health problems. Residents feel at home and have good relationships between themselves at the home. They speak positively about the support provided to them by staff. They attend a number of social groups and clubs and are encouraged to form networks outside of the home. A group of residents play football regularly in a nearby park. Residents have the opportunity to go on holiday with others from the home every year. Recruitment procedures, admission and care planning processes are appropriate for the home. Care plans are in place for all residents and their progress in meeting goals set is reviewed regularly. They are encouraged to develop independence skills so that they can move on to more independent living settings. Residents are encouraged to be involved in all aspects of home life and a group of residents take pride in maintaining the home’s garden. The home exceeds the national minimum standard in the number of staff trained to NVQ level 2 or above. The home is inspected at least monthly by a responsible individual on behalf of the provider organisation, and copies of the reports for these visits are sent to the local CSCI area office. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Risk assessments for every resident must be reviewed at least six-monthly and recorded. It is recommended that residents’ health care appointments be recorded separately from other daily notes so that they can be monitored easily. It remains required that all staff undertake training in protecting vulnerable adults from abuse. A timetable must be set for the kitchen cupboards to be replaced and this should be provided to the local CSCI area office. It also remains required that new lampshades, curtains and chairs be provided within residents’ rooms. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 7 Residents must be provided with keys to their individual bedrooms. New dining room furniture must be provided and new curtains must be provided in the lounge. The worn carpet at the entrance to the office needs replacement or repair. A new bed should be provided in the identified resident’s room and it is recommended that a bed or more substantial mattress be provided for staff on sleeping-in duty at the home. Finally procedures must be reviewed for when staff are delayed/do not arrive on shift, potentially leaving one staff member on duty. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. An appropriate system is in place to assess residents’ needs and goals effectively and ensure that these can be met. EVIDENCE: All residents’ files included detailed assessments of their needs. Residents spoken to advised that they were involved in the assessment process and that their needs were being met appropriately. No new residents had been admitted since the previous inspection. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents’ needs and goals are assessed and responded to effectively ensuring that they are met. Risks are recorded appropriately with strategies in place to ensure that residents are protected as far as possible, whilst being encouraged to develop independence skills. However insufficient review of risk assessments may place residents at risk of harm or limitation of their independence. Residents are encouraged to be involved in all aspects of home life. EVIDENCE: Residents told the inspector that they were free to come and go and make their own decisions with support from staff as needed. Regular resident meetings are held, in which they are encouraged to participate. Support provided by the home in assisting residents with their finances, is documented, and residents are encouraged to be involved in the food shopping for the home.
Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 11 Support provided to meet residents goals as well as limitations placed on individual residents, are recorded within care plans, and resident’s signatures evidenced that they had been consulted about the content of their care plans. Those spoken to confirmed that this was the case. Five care plans were inspected and were found to be satisfactory including regular reviews, records of one-to-one sessions with residents and risk assessments clearly detailing control measures. However evidence was not available that risk assessments had been reviewed with the last six-months for each resident. A requirement is made accordingly. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents have varied lifestyles with access to meaningful activities both in the community and in the home and are supported to maintain links with their friends and families. They are encouraged to take responsibility for the running of the home and to develop independent living skills. Dietary needs of residents are catered for with a balanced and varied selection of food available that meets their nutritional needs. EVIDENCE: Staff and residents spoken to confirmed that residents are encouraged to go out and follow their individual interests. Most go out independently, and are involved in activities including various clubs in Enfield, Edmonton and Palmers Green, playing snooker, going to the cinema, shopping and meeting friends. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 13 Staff and residents were playing football in a nearby park on the afternoon of the inspection. Several residents were also involved in planting and tending to vegetables and flowers in the garden and keeping it tidy, and clearly took pride in their work. No residents attend college or employment activities at present. Most residents spoken to indicated that they had active social lives. They are also supported to maintain contact with their relatives and attend places of worship of their choosing if they so wish. Residents spoken to said that the food provision in the home remained good. Residents are able to help themselves to food from kitchen cupboards and support is available from staff in cooking food, thus encouraging greater independence. One resident cooks all meals for themself with support from staff in the home. Stocks of food in the home included fresh fruit, vegetables and snacks reflecting cultural diversity. Residents go on an annual holiday with the home. They went to the coast last August, and also go on occasional day trips. The manager advised that he was looking into the possibility of future trips abroad for residents who are interested. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents receive appropriate physical and emotional support in accordance with their needs and choices. Satisfactory medication procedures ensure that residents’ medication needs are met safely and appropriately. EVIDENCE: Residents advised that their choice of time to go to bed, get up, take meals etc. were respected. The home seeks specialist support from external agencies where needed, to meet residents’ needs. Medication records were satisfactory, with appropriate records of medicines brought into the home and disposed of, and no gaps found in the medication administration records. Staff advised that the records were completed at the time that medication is administered. Although residents confirmed that they attend regular health care appointments including dentist and opticians appointments, these were difficult to track due to their being recording within the daily notes for each resident. It is recommended that residents’ health care appointments be recorded separately from other daily notes so that they can be monitored easily.
Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints procedure to ensure that the concerns of residents are acted upon effectively. Although procedures are in place, staff require adult protection training to ensure the protection of residents from abuse. EVIDENCE: The home had appropriate procedures for investigating complaints and addressing adult protection and whistle blowing. No complaints, disclosures or allegations had been received since the previous inspection. At the previous inspection it was required that all staff undertake training in the protection of vulnerable adults. This had not yet been undertaken, however the manager advised that a training course had been booked for 24 May 2006, for the majority of staff to attend. This requirement is restated. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Although significant improvements have been made, there remains further room for improvement to the environment in which residents live, in order to improve their quality of life. Appropriate toilet and bathroom facilities are available, however further replacement of furniture and fittings is required in specified areas including residents’ bedrooms. There was a sustained improvement in the cleanliness in the kitchen and the home in general and appropriate hand-washing and drying facilities have been provided throughout the home to ensure hygienic procedures for residents. EVIDENCE: Eight single and one shared bedroom are provided in the home, along with five toilets, three bathrooms and adequate communal space. As required at the previous inspection, new sofas and a new carpet had been provided in the lounge, considerably improving the appearance and comfort of the room. The cleanliness within the kitchen remained of a satisfactory standard. The provider is aware that the kitchen cupboards will require replacement, as they are worn and do not close effectively, and a timetable for this to be undertaken
Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 17 is required. As recommended, a full review of the layout of the kitchen was being undertaken including advice sought from an occupational therapist, for which the home is commended. The staff room in the home had been converted into a food storage area including a refrigerator and freezer. Whilst a mattress has been provided in the activities room for staff on sleeping in duty, it is recommended that a bed or thicker mattress be provided for such staff. As required adequate hand washing and drying facilities had been provided in the kitchen, laundry and toilets/bathrooms in the home through fitted papertowel and soap dispensers. It remains required that new chairs, curtains and lamp-shades be provided in residents’ rooms according to their preferences. Dining room furniture also needs to be replaced. The manager and area manager confirmed that plans were in place to address these issues, with most of the items already ordered. As required at the previous inspection the windowsill in room 4, the headboard on the bed in room five, the window handle in room six and the toilet seat in the identified ground floor toilet had been repaired. The public telephone for residents in the home had been replaced and residents confirmed that television reception in residents’ rooms was now improved. It is required that all residents be provided with keys to their individual bedrooms. New curtains must also be provided in the lounge and the worn carpet at the entrance to the office should be replaced/made safe. A new bed should also be provided in the identified resident’s room. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. An adequate recruitment procedure is in place to safeguard residents and staff are supervised effectively. The home is staffed appropriately to meet the needs of residents appropriately, although staff members require further training to ensure that the needs of residents at the home are met, and appropriate procedures to ensure adequate staff cover in the home. EVIDENCE: Staff files for two new staff employed at the home since the previous inspection, were inspected. They were found to include the necessary documentation as required under the Care Homes Regulations 2001 Schedule 4 as appropriate. Four staff members were spoken to, and appeared to be knowledgeable about their role and responsibilities at the home and cultural needs of residents accommodated. They advised that they were receiving sufficient support and supervision from management at the home as appropriate. Records indicated that regular supervision sessions are occurring and this was confirmed by staff members. Residents spoken to advised that staff working in the home were supportive and met their needs appropriately whilst encouraging them to be as independent as possible.
Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 19 The manager advised that over fifty percent of staff are trained to NVQ level 2 or above, which exceeds the national minimum standard. Training provided to staff over the last year included training in autism, disruptive behaviour, fire safety, first aid, health and safety and infection control. It remains required (under Standard 23) that adult protection training be provided to all staff at the home. Following observation of procedures in the home on the day of the inspection, it was recommended that procedures be reviewed for when staff are delayed/unable to arrive on shift potentially leaving one staff member on duty. However following information provided to the home following the inspection, this is now required. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. There is consultation with staff and residents regarding the way in which the home is run, and the Commission is informed of any serious incidents in the home, to ensure that residents are not placed at risk. Regular monitoring visits are undertaken on behalf of the provider organisation. Appropriate health and safety checks and procedures are in place within the home to safeguard residents from harm. EVIDENCE: The registered manager has managed the home over several years, and the inspector is satisfied that the home is managed effectively and competently with the best interest of residents in mind. The inspector was able to speak to a community psychiatric nurse who visits the home on a regular basis. They advised that they were very satisfied with Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 21 the knowledge and experience of the staff team and their communication regarding residents’ needs. Residents spoken to advised that they were consulted with regard to their views about the home at regular meetings. Records of staff meetings also confirmed their consultation about the way the home is run. Monies stored on behalf of two residents for safekeeping was inspected and records were found to be accurate and up to date as appropriate. There was a record of fire extinguisher and fire alarm servicing, fire alarm testing and drills at the home. Up to date insurance, gas and electrical wiring and portable appliances testing safety certificates were available. Up to date risk assessments were available for the home as appropriate including a fire risk assessment. The inspector had been notified in writing of any serious incidents affecting residents since the previous inspection. The inspector also receives regular monitoring visit reports from the responsible individual on behalf of the provider as required. As required at the previous inspection, adequate first aid supplies are available for the home. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13(4) Requirement The registered persons must ensure that risk assessments for every service user are reviewed at least six-monthly and this is recorded. The registered persons must ensure that all staff undertake training in the protection of vulnerable adults. (Previous timescales of 16/09/05 and 03/02/06 not met). The registered persons must ensure that a timetable for the kitchen cupboards to be replaced is provided to the local CSCI area office. The registered persons must ensure that:- service users are provided with keys to their individual bedrooms, and - new dining room furniture is provided - new curtains are provided in the lounge - the worn carpet at the entrance to the office is replaced/made safe. The registered persons must ensure that new chairs, curtains
DS0000062524.V291434.R01.S.doc Timescale for action 30/06/06 2 YA23YA35 13(6) 18(1ci) 30/06/06 3 YA24 16(2j) 23(2c) 30/06/06 4 YA24 12(4a) 23(2bde) 30/06/06 5 YA25 23(2d) 16(2c) 30/06/06 Fairview Version 5.1 Page 24 and lampshades are provided in service users’ rooms according to their preferences (Previous timescale of 24/02/06 not met). A new bed should also be provided in the identified service user’s room. The registered persons must ensure that procedures are reviewed for when staff are delayed/do not arrive on shift, potentially leaving one staff member on duty. 6 YA33 18(1a) 02/06/06 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 YA18 YA24 Good Practice Recommendations It is recommended that service users’ health care appointments be recorded separately from other daily notes so that they can be monitored easily. It is recommended that a bed or more substantial mattress be provided for staff on sleeping-in duty at the home. Fairview DS0000062524.V291434.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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