Inspection on 12/12/05 for Fairwinds

This inspection was carried out on 12th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fairwinds 11/11/08

Fairwinds 07/05/08

Fairwinds 10/05/07

Fairwinds 16/06/05

Fairwinds 03/03/05

Fairwinds 19/10/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOME ADULTS 18-65 Fairwinds Ferham House Kimberworth Road Masbrough Rotherham South Yorkshire S61 1AJ Lead Inspector Rosemary Reid Unannounced Inspection 10 am 12 & 19th December 2005 th Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 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 Fairwinds DS0000059236.V256286.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 Adults 18-65. 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. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fairwinds Address 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) Ferham House Kimberworth Road Masbrough Rotherham South Yorkshire S61 1AJ 01709 565800 01709 565829 lisafairwinds@aol.com Ferham Healthcare Ltd Nazimuddin Abdool-Raheem Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd March 2005 Brief Description of the Service: Fairwinds is a registered home which had been totally refurbished prior to being opened in 2004. The accommodation covers two floors with both bedrooms and communal rooms situated on both levels and designated smoking areas. All the bedrooms are single occupancy there are ample bathing and toileting facilities for the service user group. The home is attached to the main offices of the company and is within walking distance of Rotherham town centre and on a bus route. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 12th December from 10:00am – 4:35pm and on the 19th December from 10:30am – 2:30pm and the 23rd January 2006. Notices were placed in the entrance to the home to inform residents, staff and visitors to the home that an unannounced inspection was taking place. The inspection focussed on the remainder of the standards not assessed at the previous inspection. As part of case tracking four service users files were examined and the staff on duty were spoken with. The inspector attended a residents meeting on the 19th December 2005. Comment cards and prepaid envelopes were left at the home so that service users or their representatives can contact the CSCI with their views about the home, none of which has been received at the time of writing the report. Two of the comment cards had been translated into two other languages. Four residents files were case tracked along with medication, staffing rota, training, and Adult Protection issues. No complaints or comments cards had been received by the Commission from residents, social workers or relatives. The home has a multi culture prospective both in the residents who live at Fairwinds and the staff group. Diversity issues are discussed in both residents and staff meetings What the service does well: Potential new residents have introductory and trial visits at the home to familiarise themselves with the environment, other residents and staff group before they make the decision to come to Fairwinds. On the second day of inspection a potential new service user was visiting the home before making the decision to be admitted to Fairwinds. Each service user has a comprehensive plan of care that they sign in agreement. There is an induction programme and ongoing training for the staff group to ensure that staff members are trained to give an effective delivery of service to all their residents. All Health & Safety certificates were up to date to ensure a safe environment for residents and staff. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 6 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. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 The home has a clear care plan system to ensure that residents changing needs and direction for staff are included within the care plan to support residents in their day-to-day life at Fairwinds EVIDENCE: Each service user has a file and care plan, which addressed service users changing needs and directed staff to care for those residents. Daily working notes were up to date to evidence the care that was provided. Records show that review of each care plan takes place. Three care files were examined and there were risk assessments in place. Accidents are recorded. Full risk assessments had been undertaken. Property list was within each resident’s file. There were many examples of maintaining safety and protecting residents. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 16, 17 The home provides a range of activities both in and out of the home for the stimulation and enjoyment, which benefits residents of the community become part to. The home offers a healthy diet for the physical and mental wellbeing of the residents. EVIDENCE: It is the ethos of the home that any activity of living as part of the resident’s care must have an outcome and how that outcome will be achieved is recorded within the care plan for the resident’s personal development. There are leisure activities in and out of the home. Each Monday there is a meeting for residents and staff. At this meeting residents’ views are encouraged and discussions take place about activates and minutes are taken. In discussions with staff that said that residents went out to the local shops, pubs and shopping trips and this was confirmed by the residents. Residents said that the meals were of a good standard and sometimes they had been involved of cooking a special meal with the help of the staff. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Residents’ physical and emotional health care needs were met by the involvement of the Primary Health Team for example doctors, hospital, and physiotherapists and occupational therapists. Medications were administered as prescribed and the staff at the home work to their medication policies, which promotes the wellbeing of residents. The ethos of the home promotes dignity, respect and independence for residents. Records show that advocacy services had been used, which promote and advance residents’ rights. EVIDENCE: The company’s ethos, induction for staff, the Statement of Purpose, the Service User Guide, along with the policies refers to dignity, respect and independence. Through observations staff were seen to treat residents with respect and dignity. The care records show that there was involvement of the Primary Care Team and appointments kept at hospital/clinics. Medication records were examined which were satisfactory. Four staff were undertaking medication training. The manager is in discussions with the hospital pharmacist. Weights of residents are recorded and action taken for weight gain or loss. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 - 23 The home has policies and procedures to protect residents from abuse. The home has a clear complaints system, which residents and relatives have used to record their grievances and/or concerns EVIDENCE: Evidence in each staff file showed that they had training in Adult Protection procedures and what constitutes abuse. In discussions with staff they confirmed that they knew what to do if they thought any level of abuse took place. The company have a robust complaints policy and all complaints are recorded. Four complaints were recorded and records show that when a complaint is made action is taken by the manager to resolve their grievances. Residents/house meetings take place every Monday morning where residents can make their views known and make complaints through the complaints process. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 The home has appropriate staffing levels that support residents in their day-today needs. Staff have attended induction and training courses, which develops their skill and knowledge base to meet residents’ needs. EVIDENCE: Staffing levels reflect individual care packages to meet assessed residents’ needs. There is one qualified nurse and four support staff on both levels. The home has robust recruitment policies and procedures. There are job descriptions for all levels of staff. Criminal Record Bureau and POVA checks are undertaken on all staff. The parent company has an induction programme for all new staff. There is a training strategy organised by the parent company. Records show that staff had attended training courses. Staff supervision sessions have taken place and are on target to have six sessions per year thereby maintaining a monitoring of staff development. There are comprehensive staff performance reviews, which take place every four- five weeks on all grades of staff to monitor their performance within their roles and responsibilities and to identify any gaps in their knowledge and skills in maintaining their competencies. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 15 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 There are policies and procedure, which promotes the health, safety and welfare of residents. Staff are undertake all necessary health and safety checks, which potentially reduces the possibility of putting residents at risk EVIDENCE: The home has a fire assessment and fire prevention training had been undertaken. Records show that there are service agreements in place and risk assessments have been undertaken. Records show that Health & Safety procedures were undertaken and certificates were up to date. Water temperature are taken and recorded. A member of the parent company do monthly monitoring visits to the home and a report written Staff and residents said they felt supported by the manager. Fairwinds DS0000059236.V256286.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 Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score X X x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Fairwinds Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score X X 3 X X X 3 DS0000059236.V256286.R01.S.doc Version 5.0 Page 17 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations It is recommended that the use of ticks should not be used. Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 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 Fairwinds DS0000059236.V256286.R01.S.doc Version 5.0 Page 19 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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