Inspection on 19/09/07 for Fairview House

This inspection was carried out on 19th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 House 28/08/08

Fairview House 04/03/08

Fairview House 30/04/07

Fairview House 08/06/06

Fairview House 10/10/05

Fairview House 24/05/05

Fairview House 16/12/04

Fairview House 30/07/04

Fairview House 14/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Fairview House 14 Fairview Drive Westcliff On Sea Essex SS0 0NY Lead Inspector Michelle Love Unannounced Inspection 19th September 2007 08:00 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 House DS0000015435.V350736.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 House DS0000015435.V350736.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairview House Address 14 Fairview Drive Westcliff On Sea Essex SS0 0NY 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) 01702 437555 01702 432835 Strathmore Care Vacant Post Care Home 55 Category(ies) of Dementia - over 65 years of age (55), Old age, registration, with number not falling within any other category (55) of places Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The number of service users for whom personal care can be provided shall not exceed 55. (Total number not to exceed fifty five). Personal care is to be provided to service users who are over the age of 65. (Total number not to exceed fifty five). Personal care to be provided to no more than 55 service users with dementia over the age of 65. (Total number not to exceed fifty five). The Registered Manager to attend a minimum 5 day registered course in dementia care within 3 months of registration. The Registered Manager to complete NVQ Level 4 in Management and Care by 2005. 30th April 2007 Date of last inspection Brief Description of the Service: Fairview House is a large purpose built home situated in a residential area of Westcliff on Sea. Accommodation is provided on three floors for 55 residents in 49 single bedrooms and 3 shared bedrooms, 28 of which have en suite facilities. A passenger lift provides access to all three floors. Communal facilities are situated throughout the home with the main dining and lounge area being located on the ground floor. Fairview House is within easy reach of local shops and a bus route. There is ample parking space and gardens to the front and rear of the property. The home is registered for older people and older people who have dementia. The home has a Statement of Purpose and Service User Guide and a copy of the last CSCI inspection report in the entrance hall. An Annual Quality Assurance Assessment was received at the Commission for Social Care Inspection on 30th May 2007 and following the last inspection. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken by Michelle Love and Bernadette Little, Regulation Inspectors, over a period of approximately 11.5 hours. This inspection was conducted with the homes newly appointed manager and deputy manager. As part of the process a number of records relating to individual residents and care staff were examined e.g. care plans, risk assessments, healthcare records, staff employment files, staff training records, staff supervision records etc. Additionally the home’s medication systems were observed and records reviewed. A tour of the premises was undertaken throughout various times of the day. During the visit several residents and 6 members of staff were spoken with. Following the inspection relative’s surveys were forwarded to seek peoples’ views. It was positive to note that several were completed and returned to the Commission for Social Care Inspection. Comments from these surveys are documented throughout the main text of the report. Due to the number of requirements identified and the number and areas of judgements identified as poor at the home’s first key inspection, this has necessitated a further key inspection so as to examine progress to meet regulatory requirements and recommendations. Some improvements are noted at this key inspection but these are limited and evidence continues to indicate key areas where the home is not meeting National Minimum Standards or complying with regulations. At this site visit two Immediate Requirement Notices were issued in relation to poor medication practices and poor manual handling procedures. A further serious concern letter was forwarded to the registered provider in relation to poor nutritional records and poor staff recruitment procedures. The provider responded detailing the action to be taken in order to deal with the above issues. What the service does well: Visitors are made to feel welcome and can see their member of family/friend at any reasonable time. In general comments from visitors were observed to be positive and staff working within the home were noted to have a good relationship with relatives etc. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care staff do not appear to understand the concept of person centred care and the importance of delivering care in line with people’s individual care needs and the impact this has if not carried out. Better recording is required in relation to care planning and risk assessing. The management of Fairview House need to be more effective so that residents have sufficient staff to care for them. Continued effort must be given to ensure staff, have the necessary skills, information and supportive leadership to help them to provide better quality and safer care outcomes for individual residents. Staff must be recruited in a way that safeguards and protects those people who live at the care home and further training for staff is required in a number of key areas. Procedures for the safe management of medication must be improved. This refers to poor record keeping and some residents not receiving their prescribed medication. Please contact the provider for advice of actions taken in response to this Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 7 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 House DS0000015435.V350736.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 House DS0000015435.V350736.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): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an appropriate system for assessing the needs of prospective residents prior to admission, however this is not consistently undertaken for all people newly admitted, and this can adversely affect outcomes for residents. EVIDENCE: The home has a comprehensive Statement of Purpose and Service Users Guide which, provides’ details of the services provided at the care home. Consideration should be given by the registered provider to update and review both document’s as some information is out of date. For example the Statement of Purpose makes reference to the previous manager, the experience of the registered provider and existing manager needs to be more detailed and specific information about the range of needs that the care home is intended to meet needs to be further explored e.g. dementia. Two care plans for the newest residents admitted to Fairview House were inspected. It was disappointing to note that no pre admission assessment was Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 10 completed for one person. A letter was on the person’s file and this recorded, “[name of placement officer] will assess [name of resident] once she is in Fairview”. This is not good practice and not in line with regulatory requirements. Although there was an assessment from the resident’s placing authority, this contained limited information. The management of the home must ensure that these assessments are consistently carried out to ensure positive outcomes for new residents. A pre admission assessment was available within the other file examined and this was seen to be detailed and informative identifying their care needs relating to communication, personal care, mobility, dietary requirements, continence and routines of daily living. No information was available to indicate that the registered provider had formally written to the resident and/or their representative, confirming that it could meet the person’s needs. Fairview House DS0000015435.V350736.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans that are in place require further development to improve outcomes for residents and the management of the home need to demonstrate a fuller understanding of this and the concept of person centred care. The home’s medication procedures and record keeping are poor and do not safeguard those people who live at the care home. EVIDENCE: Ten care plans were sampled randomly at this inspection. Three care files were examined in full and the remaining seven for more specifically identified issues, for example pressure sores, diabetes, challenging behaviour, poor nutritional intake. Areas of good practice included a detailed family history and individual’s preferences for night time routines. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 12 Care plans for the newest residents admitted to Fairview House were observed to be limited and did not contain sufficient information detailing their physical, emotional, social or healthcare needs or specifically how care was to be provided by care staff. The pre admission assessment for one resident detailed they required bedrails and the placement officer recorded that an assessment should be completed once the person was admitted to the care home. No assessment was detailed within the care file, no risk assessment was devised and yet from inspection of the person’s room it was clear that this equipment was in situ and being utilised. The pre admission assessment for one person detailed they required a normal diet, needed a lot of encouragement and prompting and were at risk of losing weight rapidly. The care plan made no reference to the above information, yet the nutritional assessment completed on 18.9.07 scored 15/high risk and no risk assessment was devised. A care plan was inspected in relation to someone who had pressure sores. Specialist visits documentation recorded that only two days prior to this inspection a healthcare professional had visited the resident and dressed the resident’s pressure sore. The care plan did not highlight the resident had a pressure area, equipment in place, details of treatment being provided or the frequency of visits by the district nurse team. No risk assessment was devised. The plan of care for another resident detailed they were a tablet controlled diabetic, had a good appetite, good fluid intake, but required a soft diet. The rationale for the reasoning relating to the person requiring a soft food diet was not recorded. The nutritional assessment was last completed in July 07 and recorded a score of 19/very high, no further review was undertaken. On inspection of nutritional/food intake charts, these were inconsistently completed and did not always enable any person inspecting the record to determine what food was actually eaten by the resident. Records also showed that whilst this resident was at nutritional risk, their weight was not being monitored consistently enough to ensure proactive management of the risk. The care file for another resident indicated they presented with challenging/inappropriate behaviours on occasions. It was unclear from the care plan the specific nature of the behaviours manifested, known triggers and there were no clear guidelines for staff to follow as to how to provide appropriate consistent interventions which would safeguard both the resident and staff providing support. Additionally the weight records for this person indicated in January 07 they weighed 57.10KG and each month this had gradually reduced. The record for September 07 recorded 49.03KG. The care plan was observed to detail the resident required prompting with eating and drinking, however there was no evidence to suggest that the persons weight loss was being monitored and that appropriate interventions were being provided. Daily care records confirmed the above, however no records were Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 13 available after 14.9.07. Both the manager and deputy manager were advised and neither person was able to locate further records. The manager and deputy manager were advised that further development of the home’s care planning and risk assessment processes are required to ensure that individual residents needs are fully recorded and depict staff interventions so as to ensure appropriate delivery of care. Particular attention must be given to those residents who have a diagnosis of dementia and the care plan must include details of how this affects their daily living skills. Following the last inspection, an improvement plan was requested from the registered provider. This stated that the “training officer is conducting care planning workshops. The home manager is reviewing care plans”. Little evidence was available to indicate this was happening. During the inspection three poor manual handling procedures were witnessed by inspectors. Information relating to these issues was provided to both the manager and deputy manager. There was evidence to suggest from the homes training plan that not all staff have up to date manual handling training. Relative surveys recorded mixed comments relating to information sharing about individual residents. For example three surveys stated “cannot find any staff who know anything, during visits”, “I have expressed concern re: health issues but had no feedback unless I ask” and “only given information when I visit, not contacted by phone etc” and “left in w/c(not sat in armchair for a sleep). Left at table after meals on their own and isolated. Hair cuts and shaving are poorly carried out” Other surveys were more positive and recorded that the home usually/always keep them involved of important issues affecting their member of family. Comments relating to actual care provided by staff at the care home also varied. Comments from relatives’ surveys included “as far as I know they seem very caring”, “the staff are patient, cheerful and caring”, “basic care is given”, “give a good 24 hour support in looking after my mother. Food choice is good and the staff will feed those that need feeding such as my mum”, “they really seem to care and have worked wonders with [residents name] so far they have settled well and isn’t agitated or stressed like they were”. The homes medication records and medicines round, was observed throughout the day. It was positive to note that medication was administered properly to residents. Some shortfalls were noted and these relate to the omission of staff signatures on Medicine Administration Records (MAR), handwritten prescriptions had not always been double signed/witnessed to indicate that the information recorded is correct and accurate and where the prescription states 1 or 2 tablets to be administered, the actual dose administered was not always recorded. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 14 Where `O` for omission was recorded on the MAR record, the reason for this code was not clearly recorded on the reverse and some residents were prescribed medication on a “when required” basis which is not good practice and should be followed up with the residents prescribing doctor for clear guidance. Additionally, MAR records showed that in one case the prescription was unclear and it was also unclear as to the dose actually being administered by staff or whether they had queried this anomaly with the residents doctor. Another care plan detailed that the resident became aggressive when asked to take their medication. The care plan did not identify staff’s interventions required for when the resident refused medication and no risk assessment was devised. MAR records were examined and indicated consistently that this person refused 7 out of 8 of their prescribed medications. There were no records to indicate that staff, were in consultation with the person’s GP and/or a medication review had been requested. On inspection of the home’s training plan and in conjunction with the list of staff deemed competent to administer medication, one member of staffs training appeared to be out of date (15.6.04), however the Commission recognises that an update is due on 29.11.07 for this person and for the manager, deputy manager and two senior members of care staff there was no information recorded as to when they had last undertaken medication training. The homes improvement plan recorded “all staff responsible for administration of medication have had training”. As a result of the above concerns an Immediate Requirement Notice was issued in relation to medication. Following the inspection the registered provider forwarded a response detailing action to be taken to address the above deficits. This was seen to be appropriate and will be monitored at future inspections to the home for compliance. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The activities programme at the home needs work to ensure that it relates to residents individual needs and provides opportunities for all residents within the home to participate. Residents are happy with the food at the home but further work is required to enable residents to make an informed choice. EVIDENCE: At the time of the inspection an activities co-ordinator had been in post for two weeks. Following discussion with this person, it was positive to note that they had a lot of good ideas for the future and appeared keen and committed to the task ahead. During the inspection the activities co-ordinator demonstrated good communication and an easy manner with individual residents. Residents in return appeared relaxed and responsive to this member of staff. The homes improvement plan recorded “the training for recreation for people with dementia will be organised by the training officer”. We look forward to seeing the improvement plan followed through. No activity plan was available and inspectors were advised this is to be implemented in due course. A sign was displayed on the day of inspection Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 16 advising that an activity (arts and crafts) was planned to be undertaken during the morning, however this did not take place and initially it was unclear as to why this did not occur. However, the activities co-ordinator was observed to assist residents throughout the morning with personal care tasks. Care plans did not always record in sufficient detail individual social care needs based on their previous hobbies, interests and personal preferences. Additionally there was little information recorded identifying how resident’s current needs are to be met/residents supported. The Annual Quality Assurance Assessment recorded that activity questionnaires are in place, however this was not apparent. Activities recorded within care files for individual residents included nail care, hoopla, skittles, singing, dancing, karaoke, cards and colouring. The registered provider and manager must look at activities, which are suitable for those people who have complex needs, dementia and/or behaviour that challenges. Two relatives surveys recorded “employ an entertainment/activities coordinator”, which the management have done and “provide for interests, encourage physical movement, respond better to individuals when requested. Less TV and more mental stimulation”. Interaction provided to residents by some staff members was observed to be poor and in some instances residents were blatantly ignored and their needs/wishes dismissed. Positive interaction was observed between individual residents and one of the home’s decorators. Residents were seen to be relaxed and happy in this person’s company. Lounge areas were not always supervised by a member of staff and residents were regularly left unsupported. Whilst we appreciate that residents are not funded for high levels of intervention, the management need to ensure that they are adequately covered to ensure the safety and wellbeing of residents. This refers specifically to residents observed sitting in the small lounge area adjacent to the main dining area. The home operates an `open visiting` policy whereby visitors are welcome at Fairview House at any reasonable time and this was confirmed by those people spoken with. The home uses a four week rolling menu. The menu for the day was displayed on a blackboard within the dining room. The manager was advised that it could be more appropriate for some residents if written in larger print/simple language and/or pictorial. The menu’s were observed to provide a varied diet to people living within the care home. The menu indicated there were two choices of main course available, beef steak and onion pie, mash potato, carrots and cabbage or jacket potato with Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 17 cheese. For dessert residents had the choice of fruit cocktail and custard or ice cream. Both inspectors observed the lunchtime meal within the main dining room and small lounge area. On a positive note and following the last inspection, the actual delivery of the lunchtime meal to residents was observed to be much improved with residents receiving their meal within a reasonable timeframe. Dining tables were laid with tablecloths and condiments and a choice of drinks were readily available. Staff interaction with residents at lunchtime was observed to be inconsistent, with some staff offering choices of meal/drinks to residents, sitting down to assist individual residents with feeding and providing appropriate encouragement and support. However not all residents were offered a choice of meals and/or drink and three members of staff were observed to stand up while assisting residents to eat their meal. Additionally two members of staff were observed to outpace residents when assisting them to eat their meal. This refers specifically to staff hurrying residents to eat and placing another spoonful of food into their mouth without waiting for them to swallow. These practices are not respectful of residents’ dignity and care needs. Those residents who require a pureed/soft diet were observed to have food items portioned separately on their plate/bowl, however some staff were observed to mix this together prior to assisting the resident to eat. Within the main dining room, jugs of juice were readily available for residents. It was disappointing to note that only one member of staff asked residents if they would like to have a drink outside of set times throughout the inspection. Biscuits offered to residents were rich tea/digestive, however visitors and inspectors were offered a range of luxury chocolate biscuits. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of complaints in general is seen to be good, however training in the area of safeguarding and challenging behaviour is required as this would improve outcomes for residents and staff awareness of individuals assessed needs. EVIDENCE: The home has a clear complaints policy and procedure. Information is also recorded within the homes Service Users Guide. In addition to the recording of complaints, the log-book used, recorded incidents specifically relating to individual residents. Both the manager and deputy manager were advised this does not preserve residents confidentiality and must be reviewed for the future. The home’s complaint records indicate there have been few complaints received since the last inspection. Records detailing the specific nature of the complaint, investigation and action taken to address the issues were available. As stated at the previous inspection to the home, outcomes were not always clearly documented. Surveys from relatives indicated in some cases that not all were aware of the homes complaints procedure. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 19 Training records suggest that the majority of staff working within the home had received training in protecting/safeguarding vulnerable people. Some of the training was noted to have been undertaken 2-3 years ago and for some people this was planned for September/October 07. One member of staff questioned was able to demonstrate an understanding of safeguarding procedures and issues. On inspection of staff files for 4 people, there was no evidence to indicate that they had received the above training. As highlighted previously, no members of staff have received training relating to challenging behaviour, yet it is an identified need for several of the residents at Fairview House. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home environment is satisfactory but some further improvements need to be made to ensure that the home is appropriate and stimulating to meet the needs of those people with dementia. EVIDENCE: As stated previously an extensive programme, of redecoration and refurbishment has been conducted by the registered provider to provide residents with a safe and comfortable home in which to live. The registered provider should consider the use of better colour and signage within the home so as to promote, assist and improve people’s orientation and feelings of comfort and security. This refers specifically to the main corridors being of a single/block colour with no obvious cues available for residents to locate their bedrooms or other areas with ease. Overall, residents spoken with were happy with the facilities in the home. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 21 Of those residents bedrooms inspected, all were seen to be personalised and individualised with many personal items displayed. Some bedrooms were observed to not have call alarm cords available for residents use. The manager and deputy manager were advised at the time of the inspection. In general terms the home was observed to be clean and tidy and there were no unpleasant odours except within one bedroom. One health and safety issue was highlighted at this inspection and this related to hot water above 43° centigrade emitting from one communal wash hand basin on the ground floor and one wash hand basin within a residents bedroom on the second floor. This was reported to both the manager and deputy manager at the time of the inspection and needs to be addressed. Hot water temperatures were checked randomly within other areas of the home and observed to be acceptable. Training records show that only two members of staff have undertaken training relating to infection control, however it is recognised that this training is planned for several members of staff on 15.11.07. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of staffing on occasions restricts the ability of the service to deliver person centred care and to ensure that residents needs, can be met and that they are safe. Both the training provision and staff recruitment procedures need to be reviewed to ensure positive outcomes for those people living at the care home. EVIDENCE: The manager advised the inspector that the homes staffing levels remain at 8 staff between 08.00 a.m. to 14.20 p.m., 7 staff between 14.00 p.m. and 20.20 p.m. and 4 waking night staff between 20.00 p.m. and 08.20 a.m. On inspection of four weeks staff rosters for the period 27.8.07 to 19.9.07 inclusive, it was evident that staffing levels as detailed above had not always been maintained and were having a detrimental affect on individual residents wellbeing and the delivery of person centred care. This refers specifically to lounge areas left unsupervised, residents observed not to be regularly toileted, fluids not actively encouraged throughout the day of inspection and some staff slow to respond to residents requests. This refers specifically to some residents placed within a small lounge at 08.00 a.m. and not being assisted with toileting until 16.00 p.m., residents only being given drinks at routine times during the Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 23 day e.g. mid morning/lunchtime/mid afternoon/teatime and one resident calling out for and requesting a cup of tea for some considerable time and this not being given until inspectors intervened and requested that the resident required a drink. Observations on the day of the site visit indicated that the staffing levels and staff deployment in the home continue not to be adequate to meet resident’s needs. No regulation 37 notifications had been forwarded to the Commission detailing a reduction in staffing levels and measures undertaken by staff to deploy staff to the care home. Two relatives survey commented, “they could do well if they had more staff, for the ratio of clients. Too many clients with dementia. Some of the staff try to do well with what is a difficult job” and “while I appreciate the difficulties, more staff would allow more time to talk to and treat individuals as we would like to be treated”. Additional comments on surveys were noted in relation to staffs ethnicity and these included “ethnicity of staff makes them unaware of most of the clients real needs or wishes”, “employ staff of the correct ethnicity to represent the clients”, “sometimes the care staff do not always speak English clearly. Although this is not a problem for younger people, older people find this difficult” and “have more staff where English is their first language and understand the English culture. This is not a prejudiced comment but 95 of the staff are not English and the older people find this hard to relate to”. The staff rosters did not include the full names of all staff (agency) who had worked at the care home. The staff roster indicates that some staff have been undertaking long days/double shifts (12.20 hours) on occasions and some staff are working between 55.20 and 67.20 hours per week. As stated previously this places both staff and residents at potential risk and is seen as not good practice. It is recommended that this is carefully managed to ensure that staff do not become overtired. Staff recruitment files were sampled for five people. The majority of records had been sought and received however some gaps were noted in relation to no evidence that staff are recruited with a POVA 1st and no Criminal Record Bureau check had been appropriately supervised, a POVA 1st for one person received after they commenced employment, no evidence of experience/qualifications for two people, no written references for one person and inductions not in line with Skills for Care. Profiles were requested for agency staff deployed to Fairview House as recorded within the four weeks staff rosters provided. No profiles were available and there was no evidence they had received an induction to the home. The Annual Quality Assurance Assessment detailed that within the last 12 months the home has improved in its recruitment procedures. A copy of the homes training plan for staff was provided to inspectors. Evidence suggested that less than 50 of staff had received dementia awareness training, not all staff had up to date training relating to manual handling, fire safety awareness, food hygiene, infection control, health and Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 24 safety, COSHH (Control of Substances Hazardous to Health), continence awareness and first aid. Out of 17 members of staff only 4 people had received training relating to care planning. Additional consideration must be given to providing training for those conditions associated with the needs of older people e.g. sensory impairment, diabetes, nutritional needs of the elderly, Parkinson’s disease etc. No evidence of training was available for the deputy manager and one member of care staff. The training plan further evidences no care staff have attained a NVQ qualification but the manager has undertaken NVQ Level 3 in care and NVQ 4 in management. Currently records indicate 7 people are completing a NVQ qualification. The home’s Annual Quality Assurance Assessment dated May 07 recorded 5 members of staff as having NVQ Level 2 or above. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 25 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, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all aspects of the home are effectively managed and require review so as to ensure that there are positive outcomes for residents and positive development of the services provided. EVIDENCE: The manager has been employed at the care home since September 06, initially as the deputy manager and as stated previously has attained NVQ Level 3 in care and NVQ Level 4 in management. In addition to the above there was evidence of other training on the managers file relating to first aid, safeguarding, manual handling, dementia care, medication etc. The homes deputy manager had only been in post for nine days at the time of the site visit. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 26 Both the manager and deputy manager advised inspectors that they are aware of issues highlighted throughout this site visit and are themselves concerned with some members of staff’s attitudes and poor care practices. It is of some concern that the manager and registered provider had not effectively picked up and dealt with the identified areas where the home is not complying with regulation sooner. However the Commission is aware that an external consultant and other support from within Strathmore Care has now been deployed to Fairview House to provide assistance. The manager and deputy manager were advised that staff within the home do not appear to work cohesively as a team and this is having a major impact on the day-to-day running of the home and actual care delivery to individual residents. Monetary records for individual residents were inspected and these were seen to be satisfactory. The administrator was advised to ensure that individual receipts are received from the hairdresser. Regulation 26 reports and residents and relatives meeting minutes were readily available. On inspection of a random sample of staff employment files, it was positive to note staff are receiving regular formal supervision, however this is not in line with the frequency as detailed within the National Minimum Standards for Older People. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 27 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X 3 2 X X Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 and 5 Requirement Timescale for action 01/01/08 2. OP3 14 Ensure that the Statement of Purpose and Service Users Guide is reviewed and updated so that prospective residents and their representatives have the appropriate information. Ensure that pre admission 19/09/07 assessments are completed prior to an individuals admittance and that written confirmation has been forwarded to the resident and/or their representative detailing that the home can meet the individuals needs. Previous timescale of 1.10.06 and 14.7.07 not met. 19/09/07 Ensure that care plans are detailed, comprehensive and include details of the residents care needs and how these are to be met by care staff. Ensure that care plans are regularly reviewed and reflect changes to the residents care needs. Previous timescale of 1.10.06 and 14.7.07 not met. Ensure that risk assessments are DS0000015435.V350736.R01.S.doc 3. OP7 15 4. OP7 13(4) 19/09/07 Page 29 Fairview House Version 5.2 devised for all areas of assessed risk. Previous timescale of 14.7.07 not met. Ensure that suitable and safe arrangements are made for the moving and handling of residents to ensure the safety of residents and staff. The registered person must ensure that prescribed medication is recorded safely and appropriately to ensure the safety and wellbeing of residents. Residents must be given medication in accordance with the prescriber’s instructions to ensure the health, safety and wellbeing of residents. Ensure that residents are treated with dignity. This refers specifically to staff not outpacing residents when assisting them to eat their meal, staff not standing up when assisting residents with their meal and staff not ignoring residents requests. Ensure that all residents receive a regular programme of activities which provide meaningful stimulation. 5. OP8 13(5) 19/09/07 6. OP9 13(2) 19/09/07 7. OP9 12(1) 19/09/07 8. OP10 12(4)(a) 19/09/07 8. OP12 16(2)(m) and (n) 01/12/07 9. OP14 12(2) 10. OP18 13(6) 11. OP19 13(4) Previous timescale of 21.7.07 not met. Ensure that residents are 19/09/07 enabled and empowered to make decisions and choices and that there is clear evidence to depict this. Ensure that all care staff receive 01/02/08 appropriate training relating to challenging behaviour and safeguarding of vulnerable people. The registered person must 19/09/07 ensure that all areas of the home DS0000015435.V350736.R01.S.doc Version 5.2 Page 30 Fairview House 12. OP27 18(1)(a) are free from hazards to individual’s health and safety. This refers specifically to hot water emitting at over 43° centigrade. Ensure at all times that there are 19/09/07 sufficient numbers of staff on duty at all times to meet the needs of residents residing at the care home. This refers specifically to the rosters not being reflective on occasions of sufficient staff on duty and some staff working long days/double shifts. Previous timescale of 1.10.06 and 14.7.07 not met. The registered person must operate thorough recruitment procedures at all times to ensure the safety of residents. Previous timescale of 1.12.06 and 14.7.07 not met Ensure that all staff receive appropriate training related to the specialist needs of older people. Ensure that all staff receive regular supervision in line with regulatory requirements. Previous timescale of 14.7.07 not met. 13. OP29 19 19/09/07 14. OP30 18(1)(c) and (i) 18(2) 01/02/08 15. OP36 01/12/07 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 OP7 Good Practice Recommendations Ensure that daily care records are detailed, informative DS0000015435.V350736.R01.S.doc Version 5.2 Page 31 Fairview House and reflective of how individual residents spend their day. 2. 3. 4. OP12 OP15 OP19 Consider the devising of an activity programme in large print and/or pictorial. Consider devising the menu in larger print and/or pictorial. Consider the use of colour and signage within the home environment to assist residents to orientate within the home environment. Fairview House DS0000015435.V350736.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 House DS0000015435.V350736.R01.S.doc Version 5.2 Page 33 - 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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