Inspection on 28/08/08 for Fairview House

This inspection was carried out on 28th August 2008.

CSCI found this care home to be providing an Adequate service.

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 04/03/08

Fairview House 19/09/07

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Fairview House 14 Fairview Drive Westcliff On Sea Essex SS0 0NY Lead Inspector Ms Vicky Dutton Unannounced Inspection 28th August 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairview House DS0000015435.V370746.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.V370746.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 fairview14@tiscali.co.uk www.southendcare.com Strathmore Care 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.V370746.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. 4th March 2008 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. On the day of the inspection the cost for accommodation at Fairview House ranged from £388.01 to £538.65 per week. The home has a Statement of Purpose and Service User Guide in place. A copy of the last CSCI inspection report was available in the entrance hall. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced ‘key’ site visit. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of eight hours. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. The home’s Annual Quality Assurance Assessment (AQAA) was sent in to us (CSCI.) The AQAA was received on the due date, was well completed, and outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. Six resident and one visiting professional surveys were returned. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager, and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: People are generally happy with the service offered at Fairview House, and many positive comments were received such as, “I like it here, I have everything I need.” Visitors are always made welcome and staff and management try to work closely with families. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 6 When people are thinking about moving into the home, their needs will be assessed thoroughly to see if the home will be suitable for them. People’s medication is managed well and safely. Staff were kind and caring in their approach, and people said that they got on well with the homes permanent staff. What has improved since the last inspection? What they could do better: Much work has been put into making sure that the care received by people is based on good care planning to meet their individual needs. However care plans and other care records still do not always provide a robust and person centred approach. Staff need to keep up the improvements made in the provision of occupation and ensure that everyone living in the home, including people who have dementia, live in a stimulating environment with opportunities for occupation. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 7 To ensure that people always live in a pleasant home the organisation need to keep up the momentum and build on progress made to date in the updating and refurbishment of the premises. When staff start work at Fairview House they should undergo a good induction programme so they start to develop the skills and gain the knowledge that they need to care for people well. Managers need to ensure that this process happens and is well recorded. Some people felt that staffing at the home was not adequate. So that the organisation can be assured that it is always providing sufficient staff to meet the needs of people living in the home, the method that is used to assess people’s levels of dependency needs to be reviewed. 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 House DS0000015435.V370746.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.V370746.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wanting to move into the home are assured by assessments undertaken that their needs can be met. EVIDENCE: Since the previous inspection the home’s Statement of Purpose and Service Users Guide have been updated and are available. However the manager said that when interest in the service is expressed, people are normally only given copies of a brochure and the latest organisation newsletter. This may not provide people with a detailed level of information about the type of service it is, and what it can provide. For example, one person said that they were very happy at the home, but had been surprised by the number of people having dementia living there. They felt that many were “very severe cases,” and that this reduced their opportunities for companionship. People spoken with and responses on surveys showed that people felt they had received sufficient Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 10 information about the home to help them make a decision about moving in. One person confirmed that they had been to look around the home, but could not remember having any written information. Another said that a relative had visited on their behalf. The Annual Quality assurance Assessment (AQAA) recognised the potential to improve in this area and said it could: “Encourage residents to spend the day at the home before the planned admission. This will give them a better overview of life in a home and a chance to ask questions.” When people have moved in, a ‘Residents Guide’ is available to them in their rooms to provide ongoing information. So that people interested in moving in, and management, know that the home will be suitable to meet people’s needs, the Company employs a placement coordinator. They carry out pre-admission assessments with people interested in moving into any one of the homes owned by the provider. The AQAA completed by the manager said that the organisation have also recently appointed a marketing/PR person who works closely with the placement coordinator and home manager. As well as being involved in the admission this person also follows up the person after the admission to ensure that they have settled in. Questionnaires relating to this were seen in people’s files. The manager confirmed that they had on some occasions been part of the assessment process, but this does not always happen. However the manager felt they had a say about who moved in to ensure a balance of needs. We viewed the pre–admission assessments for two people who had recently moved into the home. They were well completed, and information was also available from the local authority funding the placements. Fairview House DS0000015435.V370746.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service cannot be sure that the care and support they need will be delivered in a well planned and personalised way. They can feel confident that their medicines will be managed well. EVIDENCE: Since the previous inspection a new manager has been working to ensure that people receive better care and support to meet their needs. People spoken with were generally satisfied with the care given. One said, “I am well cared for and happy.” A relative said “I am more than happy with the care given to my [relative].” On surveys received from six people living at the home, four felt that they ‘always’ received the care and support that they needed and two felt that they ‘usually’ did. Care planning to ensure that people receive good and consistent care has been an issue at the home for some time. Following the previous inspection management were required to produce an improvement plan to show how Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 12 they were going to address this situation. The improvement plan said: “All senior staff have been given a number of care plans each to thoroughly review and/or rewrite. We are also planning to put individual residents profiles in each bedroom (discreetly) for staff (especially new) to have relevant information at hand when assisting with personal care. Risk assessments have been rewritten where necessary, and more have been put in place to ensure staff are aware of risks for each individual. The risk assessments will give clear advice on how to manage and/or avoid risks.” The AQAA just completed by the manager recognised that staff could do more to involve people and their families in care planning, with plans being in hand to try and address this. Senior staff complete care plans and have attended recent care planning training. The five care plans we viewed as part of this inspection showed that care plans had been reviewed/renewed since the previous inspection, and risk assessments made more detailed. It was recognised that much time and effort had been put into making care plans comprehensive and effective. However the overall quality of care planning is still quite variable. Some were more person centred and had a reasonable level of detail. Others were quite basic and task orientated in their approach, for example: “Needs assistance of one carer to get [gender] in and out of the bath safely using parker bath hoist to give assistance to do the task safely.” For a person admitted a week prior to the inspection much of the care plan was still blank. Sometimes important potential areas of care needs had not been fully addressed in care planning. For example one person was described as having the potential for mood swings or erratic behaviour. Although management are addressing this situation and getting other professionals involved, the only reference to behaviour in care planning was that, “[Gender] sometimes tends to be argumentative.” This does not provide care staff with sufficient information and guidance to meet the person’s needs. People spoken with and responses on surveys showed that people felt that they received appropriate medical support to meet their needs. One said “I can see a doctor whenever I need to.” Records viewed showed us that people access appropriate healthcare to meet their needs. Referrals are made to other professionals such as community psychiatric services and the falls prevention team as required. On a survey a visiting professional said that there was good communication with them and that staff, “looked after residents well.” Training records showed that some staff have competed relevant training to increase their knowledge and understanding such as diabetes awareness, foot care and Parkinson’s disease. Although people access health services to meet their needs, good and consistent health care may be compromised by care planning, and record keeping not always being robust. One person’s record of professional visits recorded that they had recently seen a doctor and had a urinary tract infection for which antibiotics had been prescribed. There was nothing in daily records or care planning relating to this that would enable staff to carry out appropriate actions, such as encouraging fluids, or to be alert for any other problems. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 13 People being cared for in bed have care/fluid records kept in their rooms. Again these were not always properly maintained, making it appear that people had gone for may hours without proper care or attention. People’s nutritional needs and their potential to develop pressure sores had been assessed using set formats. On one care file viewed these identified a high level of risk, which was not then picked up in care planning to inform staff actions and reduce the level of risk. Good nutrition records are used, but some gaps in recording were noted so that they may not always provide a complete record. The medication systems and records that we viewed during this inspection showed us that this area of care is well managed. Staff that administer medication have received training to ensure that they are competent. Medication audits are undertaken to maintain standards. Since the previous inspection the manager has worked hard to change staff attitudes, and increase their understanding of how to deliver care in a way that shows respect for people’s individuality and needs. ‘Dignity and Respect’ workshops have been held to try and show staff life from a resident’s perspective. A training co-ordinator for the organisation was in the home during the inspection. They said that they had been spending time in the home to observe practice and reinforce these messages. During the inspection staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when carrying out care tasks. It was noted that toilets off the communal lounge area were not fitted with locks to ensure privacy. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People will have some opportunities for a fulfilling lifestyle and, will maintain contact with friends and family. EVIDENCE: Since the previous inspection further efforts have been made to improve the level of activity and occupation so that people have opportunities for stimulation and engagement in their daily lives. The improvement plan sent in following the last inspection highlighted actions taken to improve this area of care. Actions included, a senior member of staff being made responsible for recreation. Undertaking questionnaires to identify people’s hobbies and interests. Making up a reminiscence box to use with people especially those with dementia. Starting a knitting club and a homes shop selling toiletries, sweets, puzzle books etc. Books on various subjects, magazines and puzzles have been bought to leave scattered about in the lounges for staff to sit and look through with people. A first floor lounge has been set up as a film room with the purchase of DVD/video player and an assortment of films. A computer is available for people, but this is not linked to the Internet. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 15 An activities co-ordinator works in the home for two and a half days each week. On the day of inspection forthcoming activities were advertised, and photographs of recent activities were on display. Care staff now undertake activities with people each day, following an activity programme. Records are kept of activities undertaken by people. These demonstrate that although a good improvement has been achieved further work is needed. For example for one person over a two and a half month period, 13 ‘activities’ had been recorded. These included things such as bathing, hairdresser, watching TV and walking round the lounge. Records showed that people have the opportunity attend church services. On surveys people felt that activities were ‘always’ or ‘sometimes’ provided. One person said, “The activities are very well arranged here,” another said, “My [relatives] dementia makes it impossible for them to take part in a lot of activities.” The manager acknowledges that there is more work to do in providing an activity based approach to daily living for people who have dementia. The AQAA said that home’s ‘plans for improvement in the next twelve months’ was to: “Promote staff awareness of different types of activity especially for those with Dementia.” On the day of inspection staff were heard offering people choices about what they wanted to do. Preferred routines such as rising and retiring times were identified in care planning information. Staff deployment had improved so that people were not left unattended in lounges for extended periods of time. Staff have access to individual laminated cards that briefly describe each persons interests, past occupations and any hobbies to help encourage focused interactions. Some people are able to make choices about how they spend their time, and were supported by staff to, for example, go to their rooms when wished. Information on advocacy services was available so that people know where they can go for independent support and advice. A tour of the premises showed that people are able to bring in their own possessions in order to make their rooms homely. Visiting is open, with people made welcome at any time. People spoken with confirmed this. One said, “I always enjoy regular visits from my family.” The manager and staff have worked hard to improve dining arrangements. The AQAA completed by the manager said. “Dining experience has improved by introducing a table plan, table decorations, new dining chairs and soft music playing rather than 3 TV’s on at the same time. Moist hand wipes are offered after each meal, tables are laid in a presentable manner with milk jugs and sugar bowls. Gravy / sauce boats are now used for main meals. Teapots for two tables are used (risk assessed). At breakfast time tea / coffee is served with the meal rather than residents having to wait for the tea trolley to come round after. General etiquette during the mealtime service has improved.” Part of the ‘Dignity in Care’ training undertaken by staff has focused on the importance of mealtimes. During the inspection mealtimes were observed to Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 16 be calm, organised and relaxed. Food was well presented with good portions being offered. People were individually offered the choice of gravy. People spoken with said that they were offered choice. Staff assisted people appropriately. Some comments on the food were: “They will always try their best to find something you will like,” “The meals are always a very good standard. Kitchen staff are very kind and helpful,” and, “Good quality food, and a variety of meals with a choice each day.” On surveys two people said that they ‘always’ liked the meals and four that they ‘usually’ did. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected from abuse by a clear complaints procedure and good practice. EVIDENCE: People have access to a complaints procedure. People spoken with and responses on surveys showed that people are aware of how to raise concerns. Since the previous inspection no concerns have been raised through CSCI, and the home have not recorded any new complaints. Staff training records showed that all staff have received recent training in safeguarding adults. Staff spoken with had an understanding of safeguarding. Up to date Local Authority Safeguarding guidelines were available to staff. The manager had also compiled a separate folder containing the relevant contact details and information so that staff can access this quickly and easily if required. Although the home’s policies and procedures were said to be recently reviewed, the ‘Guidelines for The Prevention of Abuse’ did not appear to give staff the correct information. They said, for example, “If it is a manager who is the perpetrator you must report this to the owner of the home or in the extreme to the Registration and Inspection Unit.” This is out of date. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 18 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, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a home that is suitable to meet their needs. EVIDENCE: People spoken with were happy with the accommodation provided. One person spoken with said, “I am very happy with my room.” Since the previous inspection a number of improvements have taken place in the home to improve the environment for people, and continue to bring the home up to a good standard. New dining chairs and some armchairs have been purchased. Thirteen bedrooms have been redecorated, and nine have new beds in place. Some new bedding has been provided. This work needs to continue so that everyone has good quality furnishings and equipment available to them. Many areas remain in need of redecoration. Many bedrooms still have old style hospital beds in place which are not homely, and many furnishings remain in need of replacement. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 19 On a survey one person felt that although bathing facilities were adequate, the availability of shower facilities would be more beneficial in meeting people’s needs. At the moment there is one old shower area with a wooden seat that does not look pleasant, and is not used by people. Signage has been developed throughout the home to assist people find their way around and identify where facilities are located. A partial tour of the building showed that all areas seen were generally clean and fresh. On surveys people felt that the home was ‘always’ kept fresh and clean. The manager said that there were no schedules in place to ensure regular deep cleaning of all areas, but said that this would be addressed. Since the previous inspection actions have been taken to ensure that equipment used by people such as hoists and wheelchairs are kept in a clean condition. This was observed to be the case during the inspection. Training records showed that staff had received training in infection control. The laundry area was suitable to meet the needs of the home. The member of staff in the laundry had received appropriate training and was knowledgeable about correct procedures. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported by staff who are safely recruited and suitably trained. EVIDENCE: During the inspection people made many positive comments about staff such as, “They are all very nice,” and “I am happy with the way the staff work and care for my [relative]. They are always cheerful and caring under what must be sometimes almost impossible situations. Full marks to them.” However a number of people felt that the staffing levels provided were insufficient to meet people’s needs. One said, “Fairview can on occasion be understaffed in the morning.” One person said that, “ I sometimes find it hard to get staff attention when I want the toilet,” and another, “I can look after myself, but I think they are always short staffed.” Observations during the day showed that staff were busy, but that there were generally staff available to give people assistance. When call bells were tested staff responded promptly. On surveys three people felt that staff were ‘always’ available when they needed them and three that they ‘usually’ were. The improvement plan said that staffing levels had been reviewed using the Residential Forum, which calculates what staffing levels are required. Following this staffing levels have continued to be maintained at eight staff between 08.00 and 14.20. (Includes two senior staff) Seven staff between 14.00 and 20.20, (Includes one or two senior staff.) and four waking night Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 21 staff between 20.00 and 08.20. Rotas viewed showed that these levels were being consistently maintained. The manager said that staff deployment had been looked at, and some adjustments made to start times to improve the service. As at the previous inspection it was noted that the method used for assessing people’s dependency levels and consequently staffing levels does not present an accurate picture. Observations and care files viewed showed that many people living at the home have complex needs. Currently no one at the home is assessed as having high dependency needs. Two people being cared for in bed needing assistance with all tasks, who also have dementia care needs were assessed as ‘low’ dependency. The information used to assess staffing levels is therefore misleading, and the management team risk people not being supported in the way that they need by having the correct number of staff always on duty. At the last inspection it was said that the method of assessing dependency levels was to be reviewed, but this does not seem to have happened. The home has experienced a fairly high turnover of staff. The manager was unclear about the level of vacancies that the home might have, as there seems to be no clear basic establishment hours assigned to the home. Many staff at the home continue to work a number of double shifts each week from 08.00 to 20.20. This is not best practice as staff may become tired. The home is also reliant on the use of agency staff to cover shifts. The AQAA said that in the last three months 207 shifts had been covered by agency staff. This may not provide good consistency and continuity of care for people. One person said that they liked the staff but that, “Agency staff can sometimes be a bit obstreperous.” So that people receive care from a well trained workforce it is recommended that at least 50 of a home’s workforce achieve a National Vocational Qualification (NVQ) in care at level two or above. The AQAA identified that at Fairview House twenty care staff are employed. Of these three have an NVQ. Six further staff are working towards this qualification. The home has not therefore achieved the recommended standard. Staff are recruited centrally by the organisation. Management, staff or people living at Fairview House have no input into the recruitment process. This means that potentially the staff recruited may not meet the needs of the home, or fit in with the existing team. We looked at the files of two staff members who had been recently recruited to ensure that recruitment procedures protect people living in the home. Good records were in place to show that appropriate checks such as taking up references, checking identification and carrying out Criminal Records Bureau (CRB) checks had taken place. In both cases although a POVA first check had been undertaken, CRB checks were dated shortly after the start of their employment. This is not best practice. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 22 The manager said that staff work on a supernumerary basis at the start of their employment for a week, or more, if required. It was also said that staff undergo a twelve week induction with reviews at one, six and twelve weeks, and then move on to a Skills for Care programme. One new member of staff spoken with said that their induction so far had been very good and covered what they needed to know. The record for this induction could not however be found. For the other member of staff, who commenced two weeks before this inspection, the induction record had not been started. The AQAA completed by the manager recognised this as an area for improvement, and under ‘what we could do better’ said, “Ensure all staff receive their induction on time.” Since the previous inspection staff training has been given a high priority. Training records showed that staff have undertaken recent training in many areas such as care planning, Dignity and Respect, Foot care, and Parkinson’s disease. All staff have received training in Dementia Care. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a safe and well managed home. EVIDENCE: Fairview House has been without a registered manager for some time. The home is currently being well managed by a more senior manager in the organisation. This is on a planned temporary basis in order to move the service forward. Over the last six months the manager and senior staff have worked hard to raise standards in the home, and ensure that people receive a better service. The provider has strategies in place to monitor the service. An annual quality audit is normally undertaken by an external company. The audit includes Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 24 seeking peoples’ views via questionnaires. However the audit last took place at Fairview House in May 2007. The manager said that they have been chasing this up. Visits as required by regulation are carried out on a monthly basis. These visits include talking to people about the service provided. Records viewed showed that people also have opportunities to express their views about the service through residents meetings and reviews. Internal quality audits take place such as medication and health and safety audits. Risk assessments are in place to guide staff practice. The AQAA completed by the manager was fully completed, and recognised areas where improvements could be made. The organisation has recently completed a review of its policies and procedures. However as identified under complaints and protection some information may still not be current. Another policy relating to what to do in the case of death, and who to notify did not include the need to notify CSCI, as Regulations require. Individual policies and procedures are not dated, as would be best practice. People know that if they or their families ask the home to help them look after their personal monies that this will be done in a way that safeguards their interests. Good records are maintained, and monies checked during the inspection were correct. People are living in a safe environment and no major health and safety issues were noted at this site visit. A tour of the premises though did reveal that many doors labelled ‘keep locked’ were open, and sluice areas had no means of being locked. As the home is registered to provide dementia care the environment needs to be considered from this perspective. Another issue discussed with the manager was the practice of beds being placed against walls. Where people need help with moving and handling this may compromise staff/resident safety. The manager undertook to review this. The AQAA completed showed that systems and services are regularly maintained. A fire risk assessment was in place, and records showed that regular fire drills take place so that staff are aware of the correct procedures to follow. The fire service visited the home in March this year and found things to be satisfactory. A recent Environmental Health visit identified standards to be ‘Good’ with only minor issues to rectify. These have been addressed. It was surprising to note that for a large home no dishwasher was in place to ensure effective and regular sterilisation of crockery and utensils. This should be considered. Since the previous inspection training in core areas has been ongoing. From training information available staff are up to date in moving and handling, first aid, food hygiene, fire awareness and health and safety. Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement So that people can feel confident that they will receive consistent care that meets their individual assessed needs, care plans and care documentation must continue to be reviewed and developed. Care plans and documentation must provide a person centred and holistic approach that identifies all of peoples care needs and gives staff clear guidance about how to meet these. Previous requirements made in relation to care planning not yet fully met. 2. OP8 12 People must feel confident that their health and welfare is properly managed. Records relating to peoples health and well being such as care/fluid charts and nutrition records must be properly maintained. So that people live in a home that has good facilities to meet their needs, the organisation must continue to invest in DS0000015435.V370746.R01.S.doc Timescale for action 30/10/08 30/10/08 3. OP19 23 01/02/09 Fairview House Version 5.2 Page 27 refurbishing the premises and in the renewal of furnishings and equipment. 4. OP27 18 People must be assured that at all times there are sufficient numbers of staff on duty to meet the needs and provide them with good care. This refers specifically to ensuring that the ratio of staff to the dependency levels of the people living in the home is correct by reviewing the tool used to assess dependency levels. Previous requirement of 30/06/08 not yet met. 5. OP30 18 So that people receive care from staff who have good skills and knowledge from the start of their employment, robust induction procedures must be maintained. 30/10/08 30/10/08 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 OP1 Good Practice Recommendations People should have good information about the home before they make a decision about moving in, a copy of the Service Users Guide should be provided to them. People should be assured of privacy by being able to lock communal toilets. Management should continue to develop an approach to activity and occupation that meets the needs of people who have dementia. DS0000015435.V370746.R01.S.doc Version 5.2 Page 28 2. 3. OP12 OP16 Fairview House 4. OP19 To provide a range of options to better meet peoples individual wishes and, needs the development of shower facilities should be considered. So that people receive care from a skilled workforce 50 of care staff should be trained to NVQ level 2 or above. Staff should have access to accurate and up to date information through regularly and accurately reviewed policies and procedures. 5. 6. OP28 OP37 Fairview House DS0000015435.V370746.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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