CARE HOMES FOR OLDER PEOPLE
Fairways Retirement Home Madeira Road Littlestone New Romney, Kent TN28 8QX Lead Inspector
Lois Tozer Announced 8 August 2005 9:30 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 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 H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Fairways Retirement Home Address Madeira Road, Littlestone, New Romney, Kent, TN28 8QX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01797 362336 01797 362444 fairwayscontact@aol.com Mr David James Mrs Alison Jane Yarnley Care Home only 28 Category(ies) of Older People x 27; Physical Disability x 1 registration, with number of places Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11th November 2004 Brief Description of the Service: Fairways is registered to provide personal care, support and accomodation 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 room. 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, ususally daily, for residents to access if they wish. Residents are encouraged to suggest events and activities though semi-regular meetings.
Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 8th August 2005 between 9.40am and 6.30pm. The manager, Mrs Alison Yarnley and provider, Mr David James, and the staff team willingly assisted the inspection process throughout the day. There are currently 26 people living at the home, feedback was gathered from 13 residents through discussion (group and 1:1), a brief chat with two visiting relatives. Twenty-five service user and 15 relative comment cards were returned; positive and substantive comments are included below. Paperwork seen included pre-admissions assessment, individual support plans, risk assessments; medication and administration documents; communication book, pre-inspection questionnaire, training details, duty rota, and menu. A tour of all communal areas and a selection of private bedrooms took place. Comments received from residents, both in writing and face to face during the inspection reflect the high regard that they have for the standard of care in the home, these include; ‘I feel very lucky to be here’. ‘Quite happy here. All girls are wonderful’. ‘Found staff very friendly and helpful. Its nice, homely and peaceful’. ‘Very happy, like a hotel, room service good.’ ‘Staff good’. ‘I enjoy my stay here and never want to leave’. ‘Im enjoying the rest and the food is the best’. ‘…cant think of anywhere better to live’. ‘Very nice here, wouldnt want to be anywhere else’. ‘Very happy with everything. I do like it here, other wise stuck in a flat on my own & don’t see anyone, I like being with all the people’. ‘Quite nice, you get used to it and I am happy with what goes on’. ‘I brought my own furniture, have a nice room’. ‘Would I change anything? No’. ‘Every day they ask me what I want for tea, they know I will always have the same thing, but they still ask’. ‘Oh, we have a dog that visits, he is lovely’. ‘The manager always introduces new staff to me personally, and I know just what’s going on in the home, even though I don’t like to join in much’. ‘I can smoke in my room, and this is very important to me’. ‘Make sure you put this down – it’s a happy home here’. Relatives comments included; ‘They are a friendly bunch of staff, the food is good, can’t fault it, they look after mum really well, nothing’s too much trouble’. ‘Overall, I am satisfied with the care that is given to X. I think that they could have a few more staff sometimes it is a job to find someone when needed for the toilet, other than that, it is fine’. The home always seems welcoming & the staff are all caring, treating each resident as an individual, however demanding’. ‘The home also tries to provide a variety of activities open to all & with their own residents association so that they can make decision effecting them’. ‘I am very pleased with the way my aunt is treated’. ‘The home has such a homely feel to it, X is taken out on trips, I could not wish to have her in a better place than this, after viewing many places before this one’. ‘We were thrilled to get my Aunt to Fairways’.
Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 6 Some comments received indicated that there was insufficient communal space for private conversations, however this is not the case, with 4 communal rooms available. One relative noted that an extractor fan in a bathroom doesn’t work, but did not state which room. All comments, made anonymous where names were given, were provided to the manager for follow-up. What the service does well: What has improved since the last inspection?
There was only one requirement at the last inspection; this was to provide the Commission with a monthly report from the registered provider, which was met without delay. The manager and provider seek opinions from relatives, residents, staff, and visiting professionals as they arise, through formal and informal quality assurance processes. There has been an ongoing programme of replacement and refurbishment of fixtures and fittings in the last 12 months; residents gave input regarding type and colour scheme of communal furniture, and like it very much. The provider is attending to improvement on a priority led basis, always ensuring that the health and safety of all are paramount. Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 7 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 H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5, 6 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: Two residents needs assessments were examined, these asked questions that would highlight specific needs and indicated if the home was able to meet these needs. Areas of risk were highlighted for further follow up, and where available, a full care management assessment had been obtained. The assessment formed the basis of the care plan. Prospective residents are invited to visit the home and meet existing residents, staff and see the facilities. All admissions are subject to a 28 day trial period so the prospective resident has the option of ‘test-driving’ the home. Although some respite support is offered, the home does not offer intermediate or rehabilitative care, the aims of the service are to maintain a stable resident group in a homely environment.
Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7, 8, 9, 10 Based on the initial assessment, the service user plan sets out how each individual wishes and needs to be supported. A minor recommendation regarding dental care was made. Health care is well supported; the home is diligent to access professional help and support, as individuals require it. Medication management is generally supported by the home, this suits the current resident group. Generally, good practice was evident, but some minor shortfalls were seen, which form requirements. Residents felt that their privacy was upheld and that they were treated with dignity. EVIDENCE: Each resident benefit from an individual plan that clearly sets out how that individual wishes to be supported and covered almost all aspects of care requirements. A recommendation was made that greater information be included regarding the care of dentures. Records showed that the home supported residents to access health care support speedily, when needed, and documentation showed that advice is followed and outcomes are recorded. A relative commented ‘…health and general condition has improved since being at Fairways’. Medication administration was observed and a safe procedure was being adhered to. Records were in generally good order and the storage of medicines was safe and secure. Some shortfalls were discussed, which the manager felt were able to be addressed quickly, these were; an individuals
Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 11 medication was being secondarily dispensed when the resident went out each day (the pharmacy was consulted during the inspection and a safer arrangement was implemented), some directions to medication were inaccurate or confusing, and had not been signed by the person placing the entry. In discussion with residents during the day, there was a unanimous opinion that staff were respectful of privacy and treated everyone with dignity. Feedback cards indicated a majority of positive responses. Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14, 15 A wide range of regular activities is provided and religious needs are supported. Semi-regular external recreational activities take place. Friends and family are welcome to visit at any reasonable time. Service users are consulted in respect of choice and their wishes are respected. The range of food available is extensive and enjoyed by the vast majority of service users. EVIDENCE: A record book is maintained of activities organised within the home and the attendance / enjoyment. There was a verbal crossword taking place during the inspection, with a large proportion of residents taking part, and seeming to have a good, fun time. A recent garden party was organised (with full resident involvement) as a fundraiser for other, external, activities. A couple of residents are being supported to get passports for a day trip, by local aircraft, to Paris. Visitors are welcome to visit at any time that is suitable to the resident; all 15 comment cards received back agreed that staff were welcoming at any time, and 14 said they were able to visit their relative in private if wished. The home supports individual choice and encourages people to bring in their own personal effects to make the home more their own. Ongoing, environmental, development is in progress to provide safe storage areas in all resident’s rooms. The menu is extensive, and the range of choice offered is wide and varied. Comment cards indicated that 21 of the 25 respondents liked the food, 1 did not and 3 said sometimes. Upon exploration, one resident commented that
Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 13 the variety was possibly too extensive, however, this was clearly appreciated by the vast majority! All main meals are prepared with fresh, local produce and there are unlimited drinks, fruit, and snacks available on request. Cold drinks are constantly available. Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16, 18 Residents and their relatives are aware of the complaints procedure and residents were clear and confident on what they needed to do to raise any concerns. Appropriate support and protection is a key feature of the homes induction procedure; staff demonstrated understanding of the principles of adult protection. EVIDENCE: The complaints procedure is understood by the residents, and they, in conversation, said that they would feel confident raising concerns with any staff member or the manager. No formal complaints have been received in the last 12 months, and any minor problems have been speedily resolved. Feedback cards received indicated that relatives were also clear on the complaints procedure; a copy of this was on display. All residents who conversed with the inspector stated that they felt safe in the home, and the vast majority of comment cards indicated the same. Residents benefit from a staff team of whom the majority have received Adult Protection training. There is a rolling programme in place to supply this essential education to staff. Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 15 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 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 is 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: Communal space is varied and offers all residents the opportunity to have visitors in private without using their rooms, if desired. A passenger lift is available to access the first floor. Three communal areas are available on the ground floor (TV lounge, dining room and conservatory), and in the good weather, a well presented, furnished garden. Lavatories and bathing facilities are well situated; two of the five bathrooms have assistance hoists. The manager and provider have an environmental development plan to maintain current standards and address improvement on a rolling basis. Seven bedrooms have en-suite toilets and hand wash basins. Adaptations are supplied as required by assessment; there is an integral call system in place.
Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 16 Individual rooms are generally spacious and all are well lit with natural ventilation. One resident mentioned a ‘clonking’ radiator, which had not previously been raised with staff; the provider advised that this would be addressed. Planned improvements include individual door locks and locking space within each room. Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staff are supplied in sufficient numbers and skills to meet the existing service users needs. At least 50 of staff are on an NVQ award programme or have achieved this award. Recruitment processes are robust and protect the service users. Service users benefit from a staff team who have received a wide variety of relevant training. EVIDENCE: Staff are supplied to meet the needs of the residents, with the greater number being employed at the busiest times of the day. Residents benefit from dedicated domestic and catering staff, which allows the care support staff to meet individual needs as they arise. Of 15 relatives responding to the questionnaire 13 felt that there were sufficient staff on duty and 14 were satisfied with the overall care provided. Twenty-five residents returned questionnaires, and 24 felt well cared for, 23 felt staff treated them well (1 was blank, 1 said ‘sometimes’). All residents spoken to during the inspection (13) felt staff were ‘the best’ and were professional but friendly when supporting them. NVQ qualifications are well supported, with 10 staff currently on level 2 or 3 and two staff have already achieved an award. The range of training provided meets individual residents needs and a rolling rota of training is in place to keep staff updated. Records are well kept and are under regular review. The home has a very small staff turnover, therefore the recruitment process has not been used regularly. The manager is currently reviewing the procedure against the amended legislation, but the current practices are robust and provide residents with assurance that only suitable persons are employed. Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36, 37, 38 The manager is knowledgeable, competent, and focuses on the best interests of the service users in all aspects of her role. The ethos is clearly understood by staff, who know that the best interests of service users is paramount at all times. The financial procedures of the home are robust and focus on the ongoing development of the service. Staff confirmed that they receive regular, documented, supervisions. The content of records kept by the home is respectful and relevant, but the storage must be improved. Health and safety of all persons living or working in the home is protected by regular, documented, checks and the professional servicing of equipment. EVIDENCE: The manager was pleased to say that the NVQ 4 Registered Managers Award had now been successfully completed and just awaited certification! The evidence collected through this inspection demonstrated that the manager is knowledgeable, competent, and has a clear understanding of the NMS and needs of older people. In conversation with staff, it was apparent that the
Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 19 manager and owner are held in high regard and that their shared ethos of a supportive, enabling, environment for the residents is clearly understood and maintained. An internal quality assurance process is in place which guides the development plans for the future. A certificate of insurance is in place, offering an appropriate level of cover and a live development and business plan exists that prioritises the development of the service. Staff confirmed that they receive regular 1:1 supervision with their manager and that it was easy to access and speak to all levels of management. All safety checks are carried out on a regular basis and are documented. The storage of information pertaining to residents requires improvement, as it is currently easily accessible to all, and does not protect confidentiality. Individual daily notes are required, as currently, information is distributed between two places. The actual content of the information is, however, of a high quality, is written respectfully and has follow up action, where required. Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 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 4 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 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 Standard No 16 17 18 Score 3 x 3 3 3 3 3 x 3 2 3 Fairways Retirement Home H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? 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 In reference to the Royal Pharmacutical Society ; Cease secondary dispensing of medication. Use of short codes must be consistant. Handwritten directions must be an exact replica of the GP directions and be countersigned as accurate. Ambiguity in directions for ointments and as required medication to be clarified. Storage of information to meet with the Data Protection Act and homes policy on confidentiality. Timescale for action 22/08/05 01/09/05 01/09/05 01/09/05 2. OP37 17 01/09/05 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 OP7 Good Practice Recommendations Care plans would benefit from being presented in bold type. Greater information regarding denture care would be beneficial.
H56-H05 S23423 Fairways Retirement Home V226460 080805 Stage 4.doc Version 1.30 Page 22 Fairways Retirement Home Commission for Social Care Inspection 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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