Inspection on 23/10/07 for Fairways Residential Home

This inspection was carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fairways Residential Home 24/07/06

Fairways Residential Home 08/12/05

Similar services:

Chirnside House

Emmaus House

East Croft Grange

Craignair

Croston Park Nursing Home

Conifers Nursing Home

Cloisters

Elmsdene Care Home

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

CARE HOMES FOR OLDER PEOPLE Fairways Residential Home 20 Westmoor Grove Heysham Lancashire LA3 2TA Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 23rd October 2007 9.30 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 Fairways Residential Home DS0000065703.V346774.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. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairways Residential Home Address 20 Westmoor Grove Heysham Lancashire LA3 2TA 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) 01524 855222 Mrs Elizabeth Ann Miles Ms Sharon Patricia Beales Care Home 24 Category(ies) of Dementia (24) registration, with number of places Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 24 service users in the category DE (dementia) 24th July 2006 Date of last inspection Brief Description of the Service: Fairways Residential Home is situated in a quiet resident area of Heysham, accessible to local amenities and shops. Other community activities and facilities are accessed either with staff support or via the home’s own mini-bus. The home is a large detached house, built over three floors, with a single storey extension to one side. The home is set within its own ground which residents can access. There are communal areas, including a small conservatory. There are eight single bedrooms and eight shared bedrooms, upstairs bedrooms being accessed by a stair lift. No rooms have ensuite facilities. The home has a no-smoking policy, although for the one person who does smoke the conservatory is the designated area for this. The current weekly fees are £365.00. Further details regarding fees are available from the registered provider or registered manager. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first site visit and was unannounced so the registered provider, registered manager, staff and residents were not aware of the visit. The site visit was carried out by the inspector for the service and forms part of the overall inspection for the home which makes sure people are being cared for properly and to make sure the home is a safe place for people to live in. As well as the site visit, judgements have been made about the service based on information supplied by the registered provider of the home. Comment cards were made available to people who use the service, their relatives and GP surgeries. A limited number of responses were received but all were satisfied with the care provided. Unfortunately, no responses were received from any healthcare professionals, although a visiting district nurse was spoken with during the site visit. The site visit took place over one and a half days and included taking time to sit and speak with people who use the service, speaking with four members of staff and a relative who was visiting the home. A selection of documents were also examined. Feedback was provided to the registered provider and registered manager at the end of the inspection visit. Time was also spent undertaking an observational exercise which provided an opportunity to see first hand the care and interactions between the staff and residents. The home’s registered provider and registered manager made themselves available during the inspection to answer questions and provide additional information. We looked around parts of the home, including communal rooms, a small number of personal rooms, bathrooms and toilets to see first hand if the home was a comfortable, clean and safe for people to live in. Every year the registered person is asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. This information, in part, has been used to focus our inspection activity and is included in this report. The site visits were positive with everyone welcoming, friendly and cooperative during the visit. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 6 What the service does well: Fairways provides a pleasant and homely environment which has a relaxed and friendly atmosphere. The registered provider, registered manager and staff try hard to make sure equal care is given to all residents, considering their individual choices and preferences, and giving equal support to all, irrespective of their race, gender, disability, sexuality, age religion or beliefs. Individual comments about the service were positive and included : – • • • • • • • “personal care is good” “they look after my relative’s wellbeing” “very happy with the service provided and well looked after” “Fairways have given and continue to give more care to my relative than expected or agreed.” (our relative is) “well looked after” Staff are “very supportive” “I feel that Fairways has caring staff, they are always helpful and friendly” The registered provider is at the home on a daily basis and the registered manager works at the home on a full-time basis. This gives an opportunity to talk with the residents and staff and pick up immediately on any concerns or issues. There is equal consideration given to all prospective employees, with both male and female staff being employed. Training and development programmes are offered to all members of staff. At the time of the visit the inspector saw sensitive and kindly exchanges between the staff on duty and the residents who live at the home, with each resident being treated as an individual and given the time and attention needed. Visitors to the home are always made welcome and are able to visit at any time. What has improved since the last inspection? Most of the requirements set at the last inspection have been addressed and have meant improvements to the service. The home now has a formal assessment procedure in place which means that the registered provider and registered manager and staff can be confident they can meet the needs of anyone coming to live at the home. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 7 Care plans have also improved. Care plans are written information about the residents care needs and how the staff at the home are to meet these. Ideas for improving these further were discussed with the registered provider and registered manager and are included in the Recommendations section. Training for staff has continued, with over 70 of staff now trained to National Vocational Qualification Level II, and other staff undertaking NVQ at Level III. Other training has included induction, safe administration of medications, safeguarding adults and dementia awareness. There is an ongoing upgrade programme in place with a number of plans for the future. Since the last inspection, a new stair lift has been purchased, individual rooms and communal rooms have been redecorated and new lounge furniture has been purchased. Residents are also encouraged to bring in treasured personal items to personalise their rooms. All these have added to the homely atmosphere. There are a range of aids and adaptations for use within the home to help maintain residents’ independence and dignity. The staff turnover was discussed and confirmation received that the management team will only employ staff who they feel are able to properly care for the people who live at the home. Staff confirmed that they felt the home took care to make sure they were suitable to work at the home before they started work, and were provided with good support from the outset of their employment. Importantly, the registered provider and registered managers have developed a good professional working relationship which means that the staff team are led and supported appropriately. The findings of this inspection were discussed with the management team who welcomed the feedback as a way of further improving the service. We judged that this service is committed to providing a high quality of care. What they could do better: Four requirements have been made, as follows : A couple of errors were seen in the medication records, including some times when residents have not had medication because the home had run out of their medication. As well as this the home must make sure they keep a record of any medications sent back to the chemist. Information must also be provided to staff so that they are clear about medications that can be given when needed. Having sampled the food and also looked at the written menus, we felt that these did not reflect what the residents were being given to eat. We were concerned that because there was not enough detail, we could not decide if residents were having adequate nutrition. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 8 The registered manager has achieved National Vocational Qualification Level IV in care but needs to now achieve the Registered Managers’ Award. Advice was given to the registered provider over incidents that we must be told about. Further advice was also given over an incident that had happened in the home as we felt the safeguarding adults procedure had not been fully followed. A number of recommendations have also been made. These are considered areas of good practice which the registered provider and registered manager may wish to consider to further improve the service. 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. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 9 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 Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 10 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): Standards 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home obtains good information about the needs of people who may like to live at the home. This means that only people whose needs can be met will be accommodated. EVIDENCE: Whilst Standard 2 was not assessed, advice was given that the home should ensure the information provided in their contracts/terms and conditions of residency should reflect the guidance provided by the Office of Fair Trading. Two care plans for newly admitted service users were examined and found to contain a thorough assessment carried out by the home’s manager and information, as needed, from other healthcare/social professionals. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 11 These files also contained personal and family histories which help staff to “get to know the person”, know about their individual families and previous lifestyles which can all help in making the new resident feel settled. One social history included a description of family pets and their names. This home does not provide intermediate care. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A good level of care is provided to the people which means their health and personal care needs are met and people are treated with dignity and respect. Medication systems need some improvements to ensure residents and staff are fully safeguard. EVIDENCE: Four care files were examined. All were well organised and provided a good range of information. There was evidence of risk assessments (hazard lists). There was evidence of reviews. Discussions with the registered provider and registered manager confirmed that they are intending to review the care plans. As the current information tended to be “healthcare” biased this may be a good opportunity to ensure the care plans are more person centred, reflect a more holistic approach to care and this may be something the individual key workers could contribute to. This is particularly important in the care of people Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 13 with dementia so that staff can better understand support individual residents knowing their backgrounds and social histories. It was also suggested that the care plan could include information on how the individual is personally affected by their dementia – what they are able to do and where support is needed. The care plans should also contain information about how staff are to support individual residents during times of anxiety/stress. For example, the care plans should provide information over known triggers for anxiety, methods to try to defusing situations and any other management strategies that mean staff can be confident in their support and the resident can be appropriately supported. Discussions with care staff confirmed that they had a good understanding of residents’ current needs but were not as familiar with social histories and backgrounds. Relatives who commented were positive about the care provided by the home. Individual comments included – “personal care is good”, “they look after my relative’s wellbeing”, “very happy with the service provided and well looked after” and “Fairways have given and continue to give more care to my relative than expected or agreed.” A visiting relative also confirmed they were happy with the care provided – stating my relative “looks a lot better” since their admission. The medication records and stocks held in the home were examined during the inspection visit. Generally these were accurately maintained, although a couple of anomalies were noted. All but 1 resident has had a medication review recently. There were instances when medication was not given as there were no stocks available. This was something the registered provider confirmed had already been identified as an issue and steps have now been taken to ensure this does not happen in the future. The medication returns book has not been completed since March 2007. Advice was given that this is something that needs to be done and the registered provider is to ensure this is now completed in the future. Staff spoken with confirmed that training in the administration of medications is ongoing for staff, as not all staff have completed this training. The registered provider also confirmed that a further medication administration training course is being held the week following this inspection – night staff will be included in this training so that there is always someone on duty who can administer medication, if needed. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 14 The registered provider and/or registered manager undertake an audit of medications so that any inaccuracies or concerns can be quickly identified and dealt with. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Activities are limited. The home encourages social contacts to be maintained. Menus do not reflect that good nutritional food is being provided. EVIDENCE: Information from the registered provider confirmed that “residents to the home are working at a pace with which they are comfortable, with residents being given choices in whatever they are doing or is being done for them. The registered provider states the home has “happy settled relatives and residents”. Residents care files evidenced that a social and personal history has been obtained. However, discussions with the registered provider confirmed that no records of activities are kept so that it was not possible to directly evidence what activities had been provided and enjoyed by the different residents. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 16 Discussions with staff indicated that activities include –painting, skittles, games, football, playing cards, music and looking at photos. Other activities include music man once a month, soft ball, blow up darts, cards, dominoes, 1 to 1 talking, reading newspapers, TV on after lunch – sport or old films, some people have their own TV and walks to local shops.. It was confirmed that there is one designated person identified to organise activities on a daily basis. 2 hours of the inspection was used to observe how staff responded to residents selected as part of a formal observational exercise. This was carried out in the communal lounge area, although some other observations were made during the lunchtime period. The observations noted that staff were caring and sensitive in their approaches to the residents, with questions being answered and reassurance being given as needed. A number of other very positive interactions were observed and only a couple of interactions could have been handled in a more personcentred way. The observations recorded how staff respond to residents. It was concluded that all the care staff observed during the inspection were seen to respond to the residents needs and were patient and caring in these interactions. The care staff took time to listen to the residents, offering reassurance and encouragement, answering questions, even when these questions were repeated several times. However, interactions generally involved those residents who were the most demanding and were reactive (i.e. answering questions). No planned activities were in evidence. Other residents (who perhaps were sat quietly) had little direct interaction with either staff or each other. One resident was sat reading a newspaper, another resident was sat talking with a member of staff for a short while. Another member of staff took a resident to her room to help put away her laundry. However, a number of residents spent a lot of the observed time asleep. Staff were noted to spend time in the communal lounge and there were missed opportunities to have some interaction/1 to 1 activity with the quieter residents. The registered provider has confirmed that it is her intention to develop the activities further over the next 12 months. The observations of the observation exercise were discussed with the registered provider who agreed that there is a need to develop activities that link in with good times in the day for each of the individual residents and draw on activities the individual residents enjoy. Activities should also look to maintain existing skills and there are a number of external organisations (for example, Dementia Voice, Alzheimer’s’ Society) that can provide further information on activities (like SONAS, reminiscence work, TAI CHI). Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 17 Discussion with a visiting relative confirmed that she feels the home supports her relative to have a good quality of lifestyle, with choices, likes and dislikes being respected. She also confirmed she is able to visit at any time and is made welcome. Observations made at lunchtime confirmed that residents were supported in a positive and caring way, no-one was hurried or rushed to finish and residents who needed support were given this in a sensitive way. The dining room environment is pleasant, with new crockery and glasses in evidence, although some care needs to be taken (tablecloths a little creased, salt cellar top came off, sugar bowl crusty). The new dining tables mean residents can sit in different places and have a social setting. The lunchtime meal provided on the day was sampled and judged to be adequate. This, along with the menus set, were discussed with the registered provider and registered manager and advice given that these do not evidence that a good nutritional balance is being provided and need to be reviewed. There is no evidence that alternatives are provided, or choices are offered to residents. The registered provider confirmed that, following on from this inspection, she intends to review the meals provided also looking at ways of introducing more home cooking. Ideas are also being looked into so that residents can be given, perhaps photographs of meals, so that an informed choice can be made over individual choices at each meal. It was also suggested that the chef may benefit from undergoing training in nutrition. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Concerns can be voiced and residents are safeguarded by staff who are trained. EVIDENCE: The registered manager confirmed that the complaints procedure for the home has not changed and is still on display in the hallway. Confirmation was received via comment cards that relatives know how to complain – but have not felt any need to do so. We have not received, nor has the home received, any complaints, concerns or allegations regarding this service. Information from the home confirms that there are safeguarding adults and the prevention of abuse policies and procedures in place. To date, no referrals to the POVA register or safeguarding issues have been made. The registered provider has confirmed that all staff receive a POVA check and Criminal Record Bureau disclosures on employment and that all staff have now received training in safeguarding adults. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 19 One incident concerning a resident was discussed with the registered provider and further advice was provided to the registered manager that incident may need reporting under the safeguarding adults protocols. The registered manager confirmed that she would be doing so and would also be notifying us of both the incident and outcome in due course. Staff were asked about safeguarding adults and training provided and were able to confirm that they had received this training. Safeguarding had also been covered by those who have done NVQ training. Staff confirmed that the registered provider, whilst not at the home all the time, was on hand and continually monitors the care provided. The registered manager works at the home on a full-time basis and also monitors the care provided. All the staff were able to state what would constitute abuse and were able to confirm who they would go to if concerns were raised. The care plans ask about resuscitation – advice was given that the home needs to access information and training regarding Mental Capacity Act so that the care plans reflect individual last wishes and can demonstrate individual rights under this Act are being maintained. Contact information regarding obtaining information booklets given to provider. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. EVIDENCE: Information provided by the home confirmed that improvements to the home have been made since the last inspection. These include – new furniture and carpets in the lounge areas. A quiet room for residents and their visitors to use, bedrooms are being redecorated according to individual choices and are becoming personalised. The registered provider has developed a new office for the management team to provide a secure and private space for them to use. They are also intending Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 21 to continue with the planned improvements to the home. They are also hoping to make the garden easier to access by the residents of the home. CCTVs are in place on the exits/entrances to the home – registered provider confirmed this is for security purposes only and is not in any of the communal areas of the home. The registered provider confirmed she is aware of the importance of maintaining privacy and not intruding on communal and private areas used by residents. A tour of communal areas and different rooms were seen. There has been a noticeable improvement in areas, particularly in the lounges with the new furniture and the new quiet lounge provides a quiet area for residents and/or their visitors to use. However, the lounge carpet needs cleaning as it is quite stained and dirty in parts – this is something the registered provider is aware of and is addressing. The registered provider indicated she is frustrated that improvements to the home seem to be moving at a slow rate. However, she recognises that this has given her the opportunity to “get to know the building”, the needs of the residents, so that future plans for the service can be better thought out. The registered provider may wish to use information via specialist organisations different websites when planning further environmental changes in this home for people with dementia. The areas of the home seen were clean, warm and odour free. Comments received from a resident confirmed that the home is “always” fresh and clean. One relative commented that the home has a “nice homely environment”. Discussions with the full-time cleaner indicates she takes her responsibilities seriously and is keen to ensure the home is always clean and tidy. Information from the registered provider states that staff are now receiving infection control training, and this is ongoing. There is a policy for preventing and managing infection control in the home. The registered provider is a registered nurse with knowledge and experience of infection control who can direct and guide staff, as needed. Staff spoken with confirmed they have undertaken infection control training and were confident in this area. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 26, 27, 28 and 29 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The calibre of staff is good. People who use the service are safeguarded as their care is provided by a staff team who are vetted, trained and, importantly, care about the residents. EVIDENCE: Information from the home states that “staff are trained or receiving training to NVQ levels minimum of Level 2. Staff receiving other training or completed same. Seniors in charge of shifts. 12 of the current staff team have received training in dementia awareness and further training is being planned for other staff. Staffing levels were confirmed at the site visit and appear to be sufficient to meet the needs of the residents. The inspector spent much of the time observing staff supporting and caring for residents. During the site visit, there was no evidence of institutional or poor care and staff were patient and caring to the residents. When support was needed, this was done sensitively and respecting the resident as an individual. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 23 Discussion took place with the registered provider over staff changes since the last inspection. The registered provider and registered manager confirmed they will only employ staff who they feel are suitable to work with people who have dementia and the 3 month probationary period has been invaluable in allowing them time to identify suitable staff. Relatives commented that care staff usually have the right skills and experience. Individual comments included – “very happy with the service provided….. (our relative is ) well looked after.” Staff are “very supportive., when we know our relative can be very demanding at times” ; “I feel that Fairways has caring staff, they are always helpful and friendly” and “Fairways have given and continue to give more care to our relative than expected or agreed”. Information provided by the home confirmed that 70 of staff already trained to NVQ II; 15 in training to achieve this award and 15 of staff awaiting the next intake to start NVQ training Information provided by the home confirms that all people who have worked in the home in the past 12 months have had satisfactory pre-employment checks. This information also stated that staff are now employed initially on a 3 month contract to ensure that they are right for our clients. The home are also planning to build a bank of carers/nurses of their own. A sample of staff files were examined and found to contain all the required checks, although some files need to have a proof of identity and a recent photograph. The registered provider is to address this. Newer staff were spoken with who confirmed that they followed a thorough recruitment procedure before starting work. On starting work they had worked supernumerary alongside more experienced staff until they felt confident; an induction programme had been carried out over a couple of days and time had been spent watching and learning about care practices, individual care needs and routines. Both confirmed that the registered provider, registered manager and senior staff were very helpful and all they had to do was to ask and they would be given support. Information from the home confirms that staff have received additional training, other than the ongoing NVQ training programme Discussions with staff confirmed that they have received induction training, some have received training in dementia care and infection control. Other training – safeguarding adults, moving and handling and first aid. Staff spoken with welcomed the training and feel this has helped them in their care role. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed and provides a safe environment for the residents and staff. EVIDENCE: Since the last inspection, the registered provider has achieved the registered managers’ award and the registered manager has achieved NVQ Level IV in care. Clarification was given that the registered manager is still required to complete the registered managers’ award as she is in day to day control of the home and this was a requirement set at a previous requirement. The registered provider is on hand during the week, although not working at the Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 25 home on a full-time basis – this function is carried out by the registered manager. Staff spoken with confirmed that the registered manager is on hand on a daily basis and they are happy with the management of the home. Observations during the site visit evidenced that residents appear relaxed and calm within the home and enjoyed good interactions with the registered provider, manager and staff on duty. Relatives confirmed that they are “very happy with the service provided”, “both my husband and myself have the highest regard for Fairways” and “my relative would not be there if I was not so satisfied!” The registered provider has invested into the home, both in terms of the fabric of the home and also in staff recruitment and training and has a number of plans to further improve the service in the future. Whilst the home does not have an external quality assurance system focussing on the service, it does hold an Investors in People Award. In terms of obtaining feedback about the service, the registered provider stated that they ask families, carers, healthcare professionals and the residents themselves. The registered provider is going to put a “suggestions/comments” box in the foyer of the home for relatives and visitors to use. Internal communication systems appear to work well – as well as handovers, there are senior carers meetings and general staff meetings. Minutes of staff meetings were seen. The registered provider confirmed that there are systems in place (daily report notes, day shift and night shift reports) so that staff are made aware and updated on residents regularly, with any concerns being highlighted and addressed. At present, limited work has been done on developing quality assurance systems in the home as general day to day work, redecoration, staff training, etc. have taken priority and this is something for further development. Financial records for charges and payments and also individual monies held were examined and found to be accurately maintained. Financial responsibilities are usually carried out by either relatives or a named advocate (i.e. solicitor), although each resident has their own account. The registered provider was advised that financial records should be one resident per sheet as this protects confidentiality. Staff are undertaking mandatory training and this was confirmed through discussions with staff. Information provided by the home confirms that all the required maintenance and safety checks are being carried out on equipment and facilities in the home – apart from soiled waste contract. The Employers’ Liability Insurance certificate was seen on display, although other certificates requested were with Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 26 the home’s accountant. The registered provider is to forward a photocopy of these in due course. Assessments on hazardous substances not in place – advice given that this should be addressed and also to make sure risk assessments are in place for safe working practices. Some care files have their own risk/hazard list which provides details to staff over areas of concern and, as mentioned previously in this report, advice given that these should include triggers and methods for staff to defuse and should be used to support any administration of “as required” medications. The registered provider and registered manager are notifying us of deaths in the home, as required under the Care Homes Regulations. However, clarification was given over other notifications that we need to be made aware of. Accidents recorded in accordance with Data Protection Act. The registered manager was made aware that one daily record had indicated a fall but no accident form was found for this. The registered manager confirmed she will find out the reason for this. The registered provider confirmed that the home has a fire risk assessment in place. Staff spoken with confirmed that fire drills are held regularly. Staff confirmed that policies and procedures are in place and their location, although some have now been re-written and the registered provider confirmed she is to ensure all staff are aware of the new procedures in future supervisions. Staff spoken with confirmed that any issues or concerns regarding safety or maintenance are dealt with promptly. At the end of the inspection process, a feedback session with the registered provider and registered manager took place. The findings of both the inspection and the observational exercise were discussed with them both and both were welcoming of the findings as a way of improving the service. Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Medication must be administered as prescribed. A record of disposal of medication must be maintained. (Previous timescale of 24/07/06 not fully met) Adequate stocks of medications must be maintained. Care plans must also include guidance for any “as required” medications 2. OP15 17(2) Schedule 4.13 A record must be kept of the food provided in sufficient detail to enable any person inspecting to determine whether the diet is satisfactory in relation to nutrition and otherwise and of any special diets prepared for individual service users. (Previous timescale of 31/07/06 not met). Menus must also be reviewed to ensure that adequate nutrition is being provided The registered manager must achieve the Registered Managers Award by 31 March 2008. (Previous timescale of 31/12/07 not met) DS0000065703.V346774.R01.S.doc Timescale for action 05/11/07 30/11/07 3. OP31 9(2)(i) 31/03/08 Fairways Residential Home Version 5.2 Page 29 4. OP38 37 The home must inform the commission of any incident as outlined in this Regulation. Any safeguarding incidents must be identified and reported as required under the current safeguarding adults procedures 07/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The Service Users Guide could be user friendly and in a format that a person with dementia could better understand Residents’ care plans could be more holistic and reflect current abilities and needs, and could include information on how the individual is personally affected by their dementia. Care plans/risk assessments should also include areas of anxiety, triggers for anxiety and strategies for supporting the resident to cope. The current menus should be reviewed to reflect the preferences of residents The use of a recruitment checklist may help in identifying that the required checks have been obtained The home’s policies and procedures should continue to be reviewed to ensure they reflect the new owner, legislation and current good practices Residents’ last wishes should be recorded on their care files – taking into account the residents rights under the Mental Capacity Act Activities should continue to be developed according to social histories, personal interests. Advice for additional activities could also be sought from specialist organisations/sources The owner should continue with the refurbishment work and ensure the National Minimum Standards for environmental standards are met. National Vocational Qualification training and other DS0000065703.V346774.R01.S.doc Version 5.2 Page 30 3. 4. 5. 6. 7. OP15 OP29 OP38 OP11 OP12 8. 9. OP19 OP30 Fairways Residential Home specialist training should continue 10. OP38 Risk assessments, including COSHH assessments, should be carried out, as needed Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fairways Residential Home DS0000065703.V346774.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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