CARE HOMES FOR OLDER PEOPLE
Fairways Retirement Home Madeira Road Littlestone New Romney Kent TN28 8QX Lead Inspector
Lois Tozer Unannounced Inspection 17th October 2005 11:25 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 Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 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 Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fairways Retirement Home Address Madeira Road Littlestone New Romney Kent TN28 8QX 01797 362336 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) Mr David James Mrs Alison Jane Yarnley Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (1) of places Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One (1) person under 65 years whose date of birth is 28.11.1942 Date of last inspection 8th August 2005 Brief Description of the Service: Fairways is registered to provide personal care, support and accommodation to a maximum of 28 older people. Situated close to the beach at Littlestone-onSea, and backing onto a busy golf course, this large, late Victorian, detached property is set in its own secluded grounds. A reasonably regular bus route is accessible approximately 10 minutes walk away. The home is owned by Mr David James. It is managed, on a day-to-day basis, by Mrs Alison Yarnley. The property has had several extensions to the original building, and offers 7 bedrooms with en-suite facilities (toilet and hand-wash basin), one of which is a double bedroom. The sharing of bedrooms only takes place by individual consent and as a positive choice. Two of the five communal bathrooms have fitted hoists, and seven communal toilets are well placed throughout the home. Several ground floor bedrooms have patio doors opening onto the garden. Interesting views are available from every window in the home. The offices are on the top floor, and a training room with separate wc is available. A range of in-house activities is provided each week, usually daily, for residents to access if they wish. Residents are encouraged to suggest events and activities though semi-regular meetings. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 17th October 2005 between 11.25am and 2.15pm. The manager, Mrs Alison Yarnley and the staff team willingly assisted the inspection process, with thanks. There were 23 residents living at the home at the time of inspection, three of whom gave some input to the process. Paperwork seen included pre-admissions assessment, individual support plans, risk assessments; medication and administration documents; communication book, duty rota, and residents financial records. A tour of some communal areas took place. Comments received from the residents were, in the main, very positive. Staff are still held in high regard, food is said to be good and activities are frequent. One resident felt that they would benefit from activities being displayed on the notice board, but this was the only improvement suggested. In discussion with the manager, this was implemented, but due to recent staffing difficulties, had been omitted. Assurance that this will be reinstated was given. All but one element of previous requirements were met, the home continues to offer exceptional activities and retain a happy atmosphere. One standard, medication, had requirements made – but in the main, medication is well managed. What the service does well:
Fairways management and staff strive to keep each individuals personal needs under review, and offer the right support when needs change. Staff are kind and considerate, and acknowledge the very human element of supporting residents who are dying. Support and empathy is offered to relatives and the manager supports staff well through difficult times. An activity ‘in house’ is offered most days. Photos and records showed that many residents had enjoyed trips out to places of interest, the cinema and had been given the opportunity to have a horse and carriage ride from the home along the seafront. A wide selection of foodstuffs is offered and enjoyed by residents. Unannounced visitors are welcome at any reasonable time. Many residents like animals, and a well-behaved visiting dog (who was visiting during the inspection), was being fussed and enjoyed. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 6 A positive, friendly and informal atmosphere is maintained by staff. Staff are rapid to respond to residents needs and ensure that people who do not wish to mingle communally have periodic opportunities for company. What has improved since the last inspection? What they could do better: 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. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 7 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 Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 6 A statement of purpose is available upon request that accurately describes the range of services offered by the home. Each prospective service user receives a thorough needs assessment to ensure that the home is able to meet individual requirements. The home is able to meet the needs of the service users it is registered to accommodate. Prospective service users and / or their representatives are invited to visit the home; all residencies are based on a 28-day trial period. The home does not offer intermediate or rehabilitative care. EVIDENCE: The statement of purpose is kept under regular review; a copy is available at the home for general perusal. Prior to moving to the home, a thorough needs assessment is conducted and any special support requirements are explored. All residents are invited to visit the home in advance and benefit from a 28 day trial period. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Care plans describe the personal and social support requirements of each individual. Documented action to support health care needs indicates the home is aware of the support each person needs. Some areas of medication management require improvement, but on the whole, it is well managed. Dignity and sensitive support are well supported by staff. End of life support to residents is very good, as is the support to the families. EVIDENCE: Care plans are written in plain English and improved risk assessment systems highlight support requirements at a glance. Health care needs are vigilantly monitored, with professional support being sought swiftly. Staff are well supported through training and coaching to give the right level of care. Medication management improvements include the need for a suitable controlled drug storage facility and handwritten administration directions to be signed by two people to ensure that the information is a replica of the pharmacy directions. On occasion, the medication storage temperature appears to exceed 25°C; this needs investigation. It is recommended that the door lock be changed to a 5-lever type. Residents feel that they are respected and treated with dignity. Staff were observed to offer support in a considerate and discreet manner. The home
Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 10 work closely with residents and their relatives, wherever feasible, to remain in the home in their final days. Staff acknowledge the effect resident death has on them and the resident group. Support from the manager for staff, residents and relatives are discreet and considerate. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Activities are regular and interesting; many trips out are organised to meet residents interests. EVIDENCE: Records and photos show that a very wide range of external activities, themed around residents interests, take place. Daily activities within the home are also a feature (bingo, crosswords, music etc). A group of residents agreed that the activities were good, but would like to know what was coming up by way of a poster on the notice board. The manager has previously done this, and advised that it would be re-implemented. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected, but both core standards were met at the last inspection. EVIDENCE: Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Significant investment has taken place in the last 3 years to improve the environment. A ‘live’ development plan remains in place to address any areas identified as in need and improve the standards on a priority led basis. The home is safe, secure, and homely. Toilets and bathing facilities are in adequate supply. The home is pleasant, clean, and tidy. Individuals have their rooms as they like them. EVIDENCE: The home is well maintained and reflects a homely atmosphere, is comfortable and enjoyed by the residents. Work to benefit residents has taken place since the last inspection; including individual door locks, improved drain pipes, exterior wood repainted and some more new furniture in the communal areas. There are no unpleasant odours, and a strict infection control policy is in place and is followed by staff. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected, but all core standards were met at the last inspection. EVIDENCE: Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 37 The procedure for handling resident’s finances is robust and protects the individual. All personal and sensitive information is now stored in a locked cabinet. EVIDENCE: The policy and procedures operated by the home offer all residents the opportunity to have their money kept in the homes safe. Records of money received in and paid out are robust. A system of invoicing is in place, to enable residents to use the petty cash and reimburse expenditure in retrospect. Regular audits take place. Sensitive information is now stored securely, but remains accessible to staff who need to gain access. A new handover system is in place, the manager said that this had improved communication and accuracy of recording, lessened writing time and was a success. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 16 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 3 X 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 4 X 3 X Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 17 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 (Previous requirement – 01/9/05) Handwritten directions must be an exact replica of the GP directions and be countersigned as accurate. Appropriate storage facilities for controlled drugs to be implemented. Maximum temperature of medication storage to be explored and reduced as necessary. Timescale for action 01/11/05 2 3 OP9 OP9 13 (2) 13 (2) 01/01/06 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Fit a robust (5 lever) lock to medication storage room. Fairways Retirement Home DS0000023423.V256999.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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