Inspection on 23/07/09 for Fairways

This inspection was carried out on 23rd July 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairways 05/11/09

Fairways 05/11/09

Fairways 21/08/07

Fairways 24/08/06

Fairways 14/09/05

Fairways 10/05/05

Fairways 23/08/04

Fairways 23/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Fairways The Fairways Fuller`s Field, Swan Lane Westerfield Ipswich Suffolk IP6 9AX     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Hutton     Date: 2 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Fairways The Fairways Fuller`s Field, Swan Lane Westerfield Ipswich Suffolk IP6 9AX 01473214966 01473214997 manager-fairways@careaspirations.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Care Aspirations Limited care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Fairways Residential Home is situated in a residential area of the village of Westerfield on the outskirts of the town of Ipswich. The home was first registered in April 2004 and offers care and accommodation for up to eight service users who have a learning disability coupled with challenging behaviour. Fairways is owned and administered by Care Aspirations, a specialist independent healthcare provider, established in 1986, who provide residential care and private hospital services for adults within this service user group. During the visit the inspector was informed that the fees for the home range from £1283 to £2607 per week dependent on the care that each resident Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 8 Brief description of the care home required. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which focused on the core standards relating to care homes for Adults (18-65). The inspection was unannounced on 2 weekdays, which lasted 13 hours. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from 4 Have Your Say surveys. Comments from these surveys are used in this report. The Annual Quality Assurance Assessment (AQAA), issued by the Care Quality Commission (CQC) was returned before the inspection and was completed by the deputy manager. This self-assessment gives providers the opportunity to inform the CQC about their service and how well they are performing. We (CQC) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to Care Homes for Adults (18-65 years) Page 6 of 35 people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with and observing people who live in the home and 5 members of staff. Their comments are included in this report. The newly appointed temporary manager and the Assistant Director of Care were present on most of both days. The Chief Operating Officer was present for part of the first day. Feedback was given to all managers who were present at the time. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: During the inspection we gave feedback to the managers present, all of which have given an assurance to develop the key areas that have been highlighted in this report. This service has been without a registered manager since 2006. Since that time there have been approximately 5 different people in charge of the home. The lack of a consistent manager who stays long enough to become registered has been a problem for this service. Staff tell us they want a steady manager to guide them. The lack of safeguarding knowledge directed by a long term manager is affecting the service offered by this home, therefore we would like to see an application for registration made by a new manager. We need to determine that the manager is suitable to be registered and in charge of this service. Since January 2009 we have received 3 notifications of events made under regulation 37 that were safeguarding matters that had not been referred for investigation through local procedures. Therefore on each occasion we have made a referral to Suffolk Social Services. In order to offer a greater degree of protection to residents all staff must receive training on how to safeguard people from abuse. This must include knowledge and understanding of the local Suffolk policy and how to use the procedure to make referrals. Referrals need to be made promptly to protect people effectively. In addition we found some charges for cleaning materials that should not have been made. Managers agreed that this money would be reimbursed and they agreed to look at all Care Homes for Adults (18-65 years) Page 8 of 35 previous charges of such nature for all residents and make reimbursements to individuals if necessary. We were sent the Statement of Purpose and a patient guide. To ensure that people are able to make an informed choice about this service information about this home must be accurate, updated and clearly state the aims, objectives and philosophy of care in line with the regulations 4 and 5. One person using the service was in need of a specialist assessment that had been requested by their Social Worker several months previously and this had still not been actioned. Such requests must be actioned to ensure the service is appropriate and able to meet all residents needs. On the whole we believe care plans are up to date, but are aware of one plan that may not be as effective as it should be. This care plan did raise some concern as it had been written describing behaviour that is unacceptable to allow as it is putting female residents at risk. Staff could interpret this plan as acceptable behaviour and allow this to remain as normal for that individual. Therefore the assessment must be actioned and plans revised promptly to protect all individuals involved. This plan was linked to risk assessments that also described similar behaviour that was putting female residents at risk of potential harm. Since a referral made to safeguarding staff have been closely observing the individual, but the plan and risk assessment should have been revised to give clear guidance to staff on how they should intervene. The emergency health care access and first aid administered to residents in this home needs to be reviewed. Managers agreed to evaluate all previous incidents around health care and first aid interventions and then re train staff accordingly based upon these assessments of risk identified. We found that one resident had not had medication delivered and this had not been followed up by staff in time for them to administer when needed. Residents must receive medication prescribed. We expect the home to access local social and leisure activities, both those that are specifically for people with a learning disability and those in the wider community that are accessible to all. Staff should support residents to become part of and participate in the local community by accessing social and leisure opportunities more often. Staff training was discussed with managers and they agreed that a training plan would be developed and include the required training for staff at Fairways based upon the needs of the residents. This should also include more specialist training such as communication training, epilepsy, autism and the Mental Capacity Act. A discussion was held around the use of dark tints on all windows of the property. The main reason this was installed was to ensure residents privacy, but it also has the effect of darkening each room within the home by not allowing natural light into the property. The lack of natural day light can adversely affect some people moods therefore we asked the owners to review the use of this in all rooms and look to remove the coating where they assess appropriate. Finally, the service may wish to look at ways it can audit its quality assurance systems Care Homes for Adults (18-65 years) Page 9 of 35 and look at ways it could have identified the failings we have found in this report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information about this service is not all together accurate and up to date. People can expect to be able to visit the service and receive an assessment of their needs that forms the basis of fees charged before they move into this home. Ongoing assessments may not be promptly actioned. Evidence: We (The Commission) requested information about this service be sent to us before the inspection so we could understand more about what the service is offering. We were sent the Statement of Purpose and a patient guide. It was good to see the guide for people who use the service had been updated and was using pictures to communicate the information with a colourful lay out. However it was evident this had recently been updated using another services information as it was called a patient guide and the people who use Fairways are residents. Also the details of the previous low secure unit were to be found on page 2 and the details of CQC were that in Nottingham. It would be helpful if the guide had the address of the organisation on it. This guide also said that there was a registered manager and this service has been without a registered manager for 3 years. The Statement of Purpose was last updated Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: in December 2007. We are aware that since this time there have been changes within the organisation and therefore believe that the registered provider details need updating and the overall philosophy may need updating. Therefore both documents need to be updated to meet the regulations set out and thereby provide accurate and up to date information to people. With regard to assessments of people to use this service, no new people have been admitted for some time. The self-assessment had told us that visits to the home are encouraged before people decide to use the service. In the files of 3 residents that we tracked we found some up dated assessments had been carried out since people had been admitted to the service. And therefore the service is aware of some peoples changing needs. However, one person was in need of a specialist assessment that had been requested by their Social Worker several months previously and this had still not been actioned. Therefore without this assessment the service cannot determine whether they can continue to meet the individuals needs. We discussed with the current person in charge about assessments and they were able to describe the current process undertaken in other services within this organisation. We were told that assessments are completed before an individual is offered a place. A clinical based assessment is undertaken that will look at all care and support needs and forms the basis of a care plan. This assessment document is also then used to determine the fees charged. Fees are individualised and based upon support required. We saw that each individual had a contract developed between the organisation and a local authority who placed residents and paid for fees at this establishment. Up to date contracts were not available, but terms and conditions were seen in a more accessible pictorial format. Agreements seen for 2 individuals were signed on behalf of the organisation but no other party had signed these documents. In relation to fees and charges made we have made comment about charges for extras in the management section of this report that we believe is outside of the current agreement. This matter of what fees include and extras must also be clearly documented in information about the service. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place but not all residents can be confident that their individual plan reflects their changing needs. Some risk assessments are in place to support an independent lifestyle, but currently some people are being placed at risk of other peoples behaviour. Evidence: We found that there were care plans in place for the 3 people we tracked. These had been rewritten this year. The information was helpful to staff as it set out the routines that residents liked to follow as part of their day. e.g getting up, personal care and what they liked for their breakfast. All 4 staff spoken with about care plans said they gave them up to date information. One staff member said the plans are right and we follow the number of the care plan. This is because the plans used at this home have specific numbers relating to instructions given to staff. On the whole we believe plans are up to date, but are aware of one plan that may not be as effective as it should be due to the need for a specialist assessment as mentioned in the previous section of this report. This care plan did raise some concern as it had been written describing Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: behaviour that is unacceptable to allow as it is putting female residents at risk. Staff could interpret this plan as acceptable behaviour and allow this to remain as normal for that individual. Therefore the assessment must be actioned and plans revised promptly to protect all individuals involved. This plan was linked to risk assessments that also described similar behaviour that was putting female residents at risk of potential harm. Since a referral made to safeguarding, staff have been closely observing the individual, but the plan and risk assessment should have been revised to give clear guidance to staff on how they should intervene. Risk assessments for other residents were in place and had been reviewed this year and were appropriate for matters such as household safety and related to the use of knives, hand washing and garden tools. Also for traveling and road safety. One individual had a risk assessment recently revised and put in place following an incident with a hot drink that led to them being scalded. The risk assessment clearly states for staff the processes they must follow to prevent a recurrence of the incident. Staff have also been provided with a drinks thermometer. It is unfortunate that this incident did occur and we would expect this type of risk assessment in place and staff to have this knowledge before an incident of this type occurred as this resident had been known to the service for some time. In relation to decision making we were able to observe and speak with staff and they had a good understanding of respect for choice and promotion of this in day to day living. However knowledge and methods of communication were limited. There were few communication aids seen throughout the home in relation to day to day living and as a result residents would have a limited opportunity to express themselves and to be treated as individuals. Staff did not have a working understanding of the Mental Capacity Act (MCA) and how the principals of this legislation should inform how they work. An application had been made for every resident at this service under the MCA in relation to deprivation of liberty. In each case a standard authorisation had not been granted as liberty is not being deprived and it is believed to be in the interests of these residents that their liberty of movement is restricted. Given this service is for people with such a degree of learning disability all staff should have a better understanding of the MCA. This was fed back to managers and they agreed that this would be beneficial and agreed to action this training. The managers also spoke of the use of a local advocacy service and how they were developing their involvement within the home. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fairways choose how they spend their day and have some activities provided, however more access to opportunities in the community would develop a more fulfilling lifestyle. The catering at the home is satisfactory. Evidence: Before we visited the service we read the self assessment and this document talks of a new mini bus at the service, holidays for the residents and art, craft and music sessions, also that aromatherapy was provided on a weekly basis. Whilst at the service we saw that the daily routines for residents were unhurried and allowed time for each individual to get up and have breakfast and personal care at an individual pace. When we spoke with staff about activities staff said that they would assess individuals at the time based upon the behaviour they were presenting as to whether they took them out into the community. We asked what types of activities they did and were told that they generally took people for walks to places of interest and used Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: the local pub where they tended to sit in the garden. Staff spoke of the challenges that they are currently facing when taking people out. The 2 main areas that they were concerned about was the mini bus and staffing levels. Staff had become reluctant to drive the mini bus because recently a staff member was made to pay £150 out of their wages for an accident they had had. This matter was discussed with the managers who agreed to look into the matter and resolve staff reluctance to drive. The issue around staffing levels was that one resident currently was under 1 to 1 close supervision at all times and this staff member had been taken out of existing staffing numbers which meant staff to take people out was more limited. Whilst we were there a resident did go out in the minibus with 2 staff members to meet his family and have a pub meal. Taking into account the 1 to 1 at this time, this would then have left 2 staff members with 6 residents. Staff said it was a challenge to meet all their needs during this time span. We spoke with the managers about how at times like this additional staff could be rostered to support. We were told this should have happened in this instance. Whilst there are several activities taking place within the home setting including a lovely garden with facilities and a snoozlem (soft area with balls and lighting and music) we would also expect the home to access local social and leisure activities, both those that are specifically for people with a learning disability and those in the wider community that are accessible to all. We spoke with the managers and they were aware of some specialist facilities, but were currently not accessing these. These need to be further explored to develop the potential for residents to lead a more fulfilling life. We met and spoke with the cook at the home. She was pleased with the kitchen and the facilities it offered. She said that she was able to provide a variety of meals for the residents and showed us the current menus that she followed. These had been adjusted recently upon the advice of a dietitian. Some residents had become quite over weight and the cook had made adjustments as recommended to help weight reduction and control diabetes. The previous menus were seen and these were more culturally diverse and provided meals that were more in keeping with the cultural backgrounds of the resident group. This was discussed with the managers as to how these could be reintroduced whilst taking on board the dietitians advice. Staff spoken with said that the residents were well fed but that one resident should have their meat ground up as they had no teeth and therefore this was difficult for them to eat. The manager spoken with said she would ensure this happened. The cook used the minibus to go to local supermarkets and buy fresh produce a couple of times a week. The main meal we saw and tasted was a traditional roast dinner that was very nice. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have been put at risk by not receiving immediate medical attention when an accident has occurred. Medication practices were not sufficiently robust to fully protect people. Evidence: We received feed back from 2 relatives who were very positive about the personal care given to their relatives. One relative wrote when asked what the service does well care of her hair and skin - she appears well cared for and physically quite healthy. There are a number of staff employed at the home from similar cultural backgrounds as the residents and we believe this has helped in such matters as hair and skin care. During our visit we saw residents being supported with personal care and this was performed with compassion and with regard to their privacy and dignity. All the residents seen were well cared for in terms of their appearance with clothes and hair. Staff spoken with were aware that all personal care was to be performed behind closed doors and where possible by the same sex carers. Before we visited we were aware of a couple of matters that would have required health care intervention and therefore we explored these whilst visiting. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: The first related to a resident that had been scalded by a hot drink. We saw the first entry for this on an incident form completed by staff. A second incident form was completed the next day about the same incident, but we did not see recording in the daily notes about the incident on those 2 days. There were no recordings about how the incident occurred or what immediate first aid was given upon noticing the injury. There are good notes made 3 days later when the District Nurse visited to treat the injury. We would expect staff to note any injuries and immediately give first aid and seek prompt medical attention. This was lacking in this case. We were also aware that in May 2009 the home had made 2 referrals to the GP for an Occupational Assessment and intervention for one resident. The Occupational Therapist had telephoned the home on 17th, 19th 23rd and 26th June 2009, but staff who answered the telephone did not know anything about the referral and were unable to help. The Occupational Therapy services were concerned about the homes lack of knowledge, passing on messages and wasting time and resources. We explored this issue during our visit. The reason for the referral was due to an individual breaking an ankle the previous year in May 2008 and related to the use of a wheelchair. The home have decided to use their in house OT services and at the time of inspection were still waiting for an initial visit. This delay is not beneficial to the resident concerned. We went on to discuss the initial incident of the broken ankle as we had not received notification about this matter. The home were unable to resolve the notification matter as they are currently having problems with the computer system that relates back to this time. However, from the incident forms completed at the time and speaking to staff we are concerned that on the evening when the resident fell and broke their ankle they did not receive immediate medical attention. But the individual was helped by 2 staff members as the resident could not walk and put to bed. The next day the individual walked on the ankle and later that day medical attention was sought. Both these incidents were discussed with the managers. The emergency health care access and first aid administered to residents in this home needs to be reviewed. Managers agreed to evaluate all previous incidents around health care and first aid interventions and then re train staff accordingly based upon these assessments of risk identified. The current Statement of Purpose in place says there are written procedures in place for accident and incident reporting and there are analysed individually and collectively to prevent similar occurrence. We believe this has not been happening effectively and systems need to be looked at. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: We looked at evidence that related to more routine access to health care and found that residents did see the dentist, chiropodist, psychologist, psychiatrist and had annual health checks. Whilst we were inspecting we looked at issues relating to medication. Staff have access to a medication policy and procedure dated Jan 2007. We observed staff administering medication and saw the process they used. It was satisfactory and in line with their own procedures as two staff administered medication and they used the front sheet with photograph to identify each resident then they returned to the records to sign to say they had administered the medication. Staff were seen to follow their procedure for blood testing for diabetes and the use of sharps bins. We looked at medication administration sheets and found that these were maintained. We saw the use of the code M and asked about this. The manager was able to ascertain that one medication had not been delivered. But the medication was required for that drug round in line with the medication administration chart. The manager looked in the BNF (British National Formulary) and found that the medication related to an individuals diabetes and therefore was an important medication. The manager telephoned the pharmacist to inquire why it was not available and when it would become available. The medication from this supplying chemist was not going to be available until the following day. This delay could have been prevented and processes need to be reviewed to ensure this does not happen again. We were unable to confirm that all staff who administer medication had current up to date training despite looking at training certificates, training records and speaking to staff. Currently 2 or more staff who administer medication do not have up to date medication training. Therefore it is important that a review of staff medication training is completed and those staff who have not received training in the last year are updated. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at this service are being placed at risk of abuse and have suffered abuse. The service is not taking sufficient action to follow up allegations and safeguarding residents. Evidence: This service has a complaints procedure in place and this forms part of their information about the home. The self assessment told us that there is a complaints file within the home and we were able to see this. There had been an issue that had been resolved and that was about trees over growing into neighbours property. The self assessment also spoke of having a pictorial complaints procedure for use by residents. We did not see this on our visit and was not part of the documentation we examined. Staff when spoken with did not refer to having a pictorial guide. Staff did say that they would observe and listen to residents and try to resolve for them any concerns if they were unhappy. Staff said they would also inform the manager on behalf of residents if they had any concerns. The self assessment said that its objective was to continue to have zero complaints. This objective of not wanting to receive complaints is not in keeping with a open culture of listening and taking seriously what people have to say. This objective should be reviewed. On the first day of our visit we (the Commission) found that the service had a policy Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: and procedure of their own relating to protection and abuse. We have requested a copy of this document. The knowledge and understanding of how this related to the local policy and procedure was not evident as Essex Social services was the reference point used when speaking to managers, although the service is based in Suffolk. The Suffolk policy and procedure in place in the office was dated 2004, rather than the current 2008 edition. Staff when asked stated that information about protection was pinned on the notice board and the information found there related to the National POVA (protection of Vulnerable Adults) listings. This information said referral can only be made by the employer and the regulating authority. The current information supplied and known by staff is out of date and misleading, as it relates to Essex safeguarding procedures or the national POVA list and not the local up to date Suffolk policy and procedure. On the second day the person in charge had located Suffolk Social Services website on protection and safeguarding and confirmed they had downloaded a copy of Suffolks latest policy and procedure for reporting suspected abuse and placed this in the office for staff to use. In relation to training on safeguarding and protection the home currently employs 15 staff and 5 of them have received training in June 2009 from a Clinical Nurse Specialist within the company. This was using training material from Regis c.t.v. and related to the companys policy. This did not include the local up to date policy and procedure for reporting suspected abuse. Staff when spoken with did not know of the local reporting procedures but were aware of the term whistle blowing and knew what this meant. However, staff recalled the last time whistle blowing was used and said identity of staff speaking up was not protected so confidence is low in coming forward. Since January 2009 we have received notification of events made under regulation 37 that were safeguarding matters that had not been referred for investigation through local procedures. Therefore on each occasion we have made a referral to Suffolk Social Services. We looked at each issue during our visit at the service with the support and full cooperation of the 2 managers (Assistant Director of Care and a manager from another new project, who was a lead on clinical assessments) present during our inspection. The first of these related to financial matters. We were notified in March 2009 of allegations made in December 2008 of financial abuse. When asked about why a safeguarding referral was not made at that time, the response from the Assistant Director of Care, was that a decision was made within the company not to refer, but Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: for the company to investigate. The internal investigation was concluded in February 2009 which led to a staff members dismissal. An appeal was heard and concluded in March 2009, with the original decision being upheld, hence the notification at that time. Managers within the organisation were keen to point out at this stage that there has been a change in senior management and this in turn has led to changes in procedures on reporting. However 2 further safeguarding matters have not been referred properly to demonstrates this change. We looked at the current recording of finances for 2 people who use the service. We found a process in place whereby individual monies are kept separate in a safe box with individual records kept and receipts in place. This is audited from time to time by a senior manager and then is sent off monthly to the organisation. We examined the records in place and found that the records called for a resident signature, but understand this may not be possible for these residents. The paperwork also asked for a second staff member to sign records as correct and this was not routinely done. We looked at the receipts and found that a large bill for cleaning products such as air fresheners was divided between the residents. This called for £35.50 to be paid by each individual. This is not acceptable as we believe that charges for cleaning would be within the fees charged and not a personal expense. The manager we spoke with agreed to investigate this matter and reimburse the residents. We also asked for all previous financial transactions to be audited and any charge of this nature to be reimbursed. This was agreed with. The second issue which was an allegation of sexual abuse on 30th April 2009 was notified to us on 22nd May 2009. This related to an incident between 2 residents and the notification told us that there was a delay of 22 days in reporting this to safeguarding as a protection issue. We believed that a referral to safeguarding had been made as this is what was reported as action on the notification, but upon contacting Suffolk Social Services, no referral had been received by them and therefore we made a referral. Also it was at this time, 22 days later, that the service implemented a plan of protection by placing the alleged abuser at arms length observation. At our inspection this was still in place. Staff took hourly slots to cover the day time observations and at night a similar process was said to be in place. Thereby offering some protection to the female residents who are currently at risk. We looked at the care planning and risk assessments in place before this incident and found that this had not been an isolated incident, but since January 2009 there had been concerns and 2 other incidents recorded of a similar nature. The care plan and Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: risk assessments written in March 2009 predicted unacceptable sexual behaviour and identified a risk to female residents. The manager at that time sought a review with the placing social worker - the key conclusions of this have yet to be actioned. Therefore we believe that the females at this care home are being placed at risk. The managers present informed us that an investigation into this matter had been conducted. The third issue related to a notification we received on 30th of June 2009. This notified us that on 29th May 2009 a resident had sustained a serious injury. The form also stated medical treatment given within the care home. We noted that medical treatment for the injury was given by a District Nurse 3 days after the incident and were concerned by the delay in treatment. The form also defined the notification as abuse and was neglect by a care worker employed at the home. We made a safeguarding referral on 3rd July 2009. We followed this matter up during inspection and found reference to the injury in notes made on 29th May 2009 but not that 1st aid was given. A clear recording was found on 1st June 2009 noting the District Nurses visit and action taken. The managers told us that an investigation had been completed into the incident and that action to prevent a recurrence had been taken. Equipment for staff had been provided and a risk assessment for the individual was now in place. Care Homes for Adults (18-65 years) Page 24 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fairways benefit from a comfortable environment that is well maintained and clean. Evidence: We undertook a tour of the home and found that all areas were well maintained and clean through out. There were no odours. The lounge provided some comfortable seating for residents and the TV and audio facilities were good. The gardens provide a lovely opportunity for residents to swing on garden furniture and use facilities such as a bicycle. There is also a well designed snoozlem facility that was said to be used regularly by residents. The development of mature shrubs and trees around the property has led to a good degree of privacy for these residents and their neighbours. However a discussion was held around the use of dark tints on all windows of the property. The main reason this was installed was to ensure residents privacy, but it also has the effect of darkening each room within the home by not allowing natural light into the property. The lack of natural day light can adversely affect some people moods therefore we asked the owners to review the use of this in all rooms and look to remove the coating where they assess appropriate. This was agreed with by the managers facilitating the inspection. The laundry room at the home had appropriate equipment and staff were seen to Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: follow good hygiene practices. Some individuals bedrooms were sparse and we were told that this was due to individuals behaviour preventing them from having more furniture. A discussion was held around locks to private bedrooms and how privacy and property can be respected. The managers spoke of a new development that they were researching that was in the form of locks that were activated by a person wearing the correct wrist strap. Therefore individuals could be able to enter their own rooms when they wanted, but for them to be locked to others to ensure privacy and protection of possessions. This development and use of assisted technology is positive and of benefit to the residents as are the plans to extend the communal areas. This is either by change of use of the garage or building a new conservatory. Care Homes for Adults (18-65 years) Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fairways has sufficient staff that are appropriately supervised, recruited and have access to formal qualifications, however there is a lack of up to date training linked to residents needs and therefore not all residents needs are met. Evidence: We met all the staff on duty and interviewed in private 5 staff. We looked at the roster for staff and found that there were regularly 5 care staff on duty. One of which was a senior. In addition there was a cook and a Manager present 5 days a week. At night there were 2 night staff awake. Currently as reported in a previous section one staff member is used to be on a one to one with a resident. Managers agreed that usually when staff go out with residents additional staff are provided. Therefore there are generally enough staff on duty. The self assessment told us that 10 staff had their NVQ in Care and that all staff had training in manual handling and fire. We were also told by managers that the delivery of training for staff was changing and that this would be more in house and that each staff member would get a training profile. The organisation faxed through a training audit that they had been under taking. However this showed that not all staff had received training in fire and that 6 staff needed training on fire safety. We also looked at 3 staff training records and asked staff about training they received. The general Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: view of staff was that they had adequate training and had received training in fire, manual handling, risk assessments, how to deal with challenging behaviour, and some had training in medication, safeguarding from abuse and 1st aid. Records for staff training were not as comprehensive, but we did see that 5 staff had attended safeguarding from abuse training, risk assessment training and accident and incident reporting training. All of which had occurred very recently. The staff training was discussed with managers and they agreed that a training plan would be developed and include the required training for staff at Fairways based upon the needs of the residents. (This should also include: communication training, epilepsy, autism and the Mental Capacity Act) This plan would also include the date training was delivered and the date training is planned to be up dated. This will enable everyone to determine that all staff have the appropriate training to work at Fairways. We looked at the recruitment records for 3 staff and found that all documentation and checks were satisfactory. Staff spoken with said that checks such as references and CRBs were taken up before they started working at the home. And all care staff spoken with said that they received regular formal supervision. We saw records that supported this. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality and consistency of management of this service cannot be assured as the service has been without a registered manger for several years. Systems are in place that generally ensure the health and safety of residents, however these are not currently robust. Evidence: This service has been without a registered manager since 2006. Since that time there has been approximately 5 different people in charge of the home. The lack of consistent manager that stays long enough to become registered has been a problem for this service. Staff tell us they want a steady manager to guide them. The lack of safeguarding knowledge directed by a long term manager is affecting the service offered by this home, therefore we would like to see an application for registration made by a new manager. We need to determine that the manager is suitable to be registered and in charge of this service. The self-assessment was returned before our inspection and completed by the deputy in the service. This gave some good information, but information was randomly placed Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: in the document and did not always relate to the standards in that section. Also some answers needed more explanation and not just a heading. Information about this service sent to us in the form of notifications has not always been prompt and in one case we know (when a leg was broken) we were not notified. We have also explained at length in the protection section the lack of referrals to safeguarding that should have promptly been made and are the responsibility of managers of this home. The service also needs to consider if it should refer staff to the provisional list of the national protection of Vulnerable adults listing. And also give due consideration to refunding the £800 that went missing from a residents finances last year. When looking at residents finances we found that money had been taken from each resident to pay for cleaning materials such as air fresheners. This totaled £35.50 for each resident. The patient guide told us You will only be expected to pay for your own personal items, for example your toiletries, your DVDs and anything you want as extras. Therefore this money taken by the organisation was not agreed. We spoke to the person in charge currently and they agreed that this money would be reimbursed and they agreed to look at all previous charges of such nature for all residents and make reimbursements to individuals if necessary. The self assessment told us that the organisation looks at quality by listening to people through patient forums and through Peloton Customer Surveys. However the service may wish to look at ways it can audit the quality assurance systems in place so the failings we have found in this report can be identified before we pick them up and require action. In relation to health and safety the self assessment told us that all servicing of equipment is up to date. Whilst at the service we saw good practices around infection control. An unplanned fire drill took place whilst we were there. An evacuated took place and staff investigated before it was deemed safe to return, thereby ensuring the safety of all. However we have concerns about health and safety matters such as first aid being available to residents when they need it and whether all staff have received fire training. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 42 23(4)(d) The Registered Persons must 02/04/2007 ensure that all staff employed at the home receive regular training in fire safety. This is a repeat requirement from 24/08/06 Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 Information about this home 30/10/2009 must be accurate, updated and clearly state the aims, objectives and philosophy of care in line with the regulations 4 and 5. This will ensure that people are able to make an informed choice about this service. 2 3 14 The home must keep under review the assessed needs of residents. This will ensure the service is appropriate and able to meet all residents needs. 30/10/2009 3 6 15 All residents care plans must 30/10/2009 reflect how individuals needs are to be met and kept under regular review. This Will ensure residents are appropriately cared for and supported. Care Homes for Adults (18-65 years) Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 19 13 First Aid and health care treatment must be arranged for residents immediately they have an accident. This will ensure their health care needs are met. 30/10/2009 5 20 13 Residents must receive medication prescribed. This will ensure their health and well being is maintained. 30/10/2009 6 23 13 Safeguarding referrals must be made immediately when safeguarding issues are identified and followed up with attendance at safeguarding meetings if invited. This will ensure a plan of protection and investigation is agreed in line with local policy and procedure. 30/10/2009 7 23 13 All staff must receive 25/09/2009 training on how to safeguard people from abuse. This must include knowledge and understanding of the local Suffolk policy and how to use the procedure to make referrals. This will offer a greater degree of protection to residents. Care Homes for Adults (18-65 years) Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 7 Staff should have a good understanding of the Mental Capacity Act and how the principles inform their work. Residents should be facilitated in decision making and choices with individual methods and communication aids through out the home. Staff should support residents to become part of and participate in the local community by accessing social and leisure opportunities more often. All staff who administer medication should have training on the homes policy and procedures in handling medicines, record keeping and be assessed as competent. The premises should have sufficient natural light and the use of a reflective coatings on all windows should be reviewed. A training plan should be developed and include the required training for staff at Fairways based upon the needs of the residents. This should include: communication training, epilepsy, autism and the Mental Capacity Act. 3 13 4 20 5 24 6 35 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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