Inspection on 28/05/08 for Fassaroe

This inspection was carried out on 28th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Fassaroe 31/07/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Fassaroe 5-7 Warwick Road Walmer Deal Kent CT14 7JF Lead Inspector Mary Cochrane Unannounced Inspection 28th May 2008 09:30 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 Fassaroe DS0000068842.V363384.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. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fassaroe Address 5-7 Warwick Road Walmer Deal Kent CT14 7JF 01304 361894 01304 382149 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) Fassaroe Ltd Manager post vacant Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: Fassaroe is a 28-bedded home for older people with dementia care needs. The service came under new ownership in January 2007. The home is situated in a quiet street off the main road leading into the seaside town of Deal. Local shops and amenities are close by and the town is approximately ½ mile away. The home is also close to the beach. There is a reasonable bus service into Deal and Dover. The home itself is situated over two floors, with the main communal spaces being on the ground floor and bedrooms on both floors. There is a garden surrounding the building. The home has the benefit of a good-sized and wellequipped laundry and large kitchen. The current weekly fees for the service at the time of the visit range from £388.00 (KCC rate) to £550.00 (depending on the room size and service users needs). Information on the Home services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This visit to the service was an unannounced “Key Inspection” which took place over one day. All the core standards were looked at during the visit. The registered manager and deputy manager were both available to assist during the site visit. The people living at the home and the staff on duty were helpful and cooperative throughout the visit. To collect evidence for this report we spoke with residents in private and had discussions with the management team and staff. We observed how staff supported residents during social activities and when offering care support. We looked at and discussed residents individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. During this visit, we saw a large part of the home. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also looked at information we have about concerns and complaints and how these have been managed. We also took into account the things that have happened in the service, these are called ‘notifications’ and are a legal requirement. In March 2008 a safeguarding adults alert was raised at the home. The local adult protection team subsequently have undertaken an investigation. The management of the home responded positively to the investigation and are being pro-active in dealing with the issues. At the time of writing the report the alert remained open. Further visits by specialist teams will continue to the home to monitor improvement of the service. This will ensure the residents are being well cared for. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has a new manager who demonstrated that she is committed and determined to improve the service for the people who live at Fassaroe House. At the time of the visit she had been in post one-month. Residents, relatives, staff and visiting professional reported things had started to get a lot better. One relative said, “ The new manager has made a difference. Things have improved greatly over the past few weeks”. Another said ‘I feel much happier about my husband being here now’. An up to date service user’s guide has been developed and is available for the people who wish to use the service. This gives people the information they need to make informed decisions as to whether the home is the right place for them to live. There have been no recent admissions to the home but the new manager has introduced a new assessment format, which will make sure that all prospective residents have been fully assessed before they come to stay at the home. This will ensure the home will only offer a place to someone if they can be sure they can give the support and care the person needs. Updated terms and conditions of residency and contracts are in place. This tells people who live at the home about what fees they pay and what the service offers for the fees. Visiting professionals said the staff contact them if they have any concerns about the welfare of any of the residents. This makes sure people are supported and get the community services they need to promote their health and well-being. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 7 One comment was “the staff have a caring attitude”. Radiator guards are now in place throughout the home to ensure no one sustains any injury from leaning against hot radiators. What they could do better: The AQAA needs to be completed in greater detail so we are able to assess if the home is improving the service it offers to people. Statement of Purpose of the home needs to up-dated so that it reflects the present situation with in the home. The resident’s care/support plans and risk assessments should be further individualised and developed. This will ensure clear guidance is given to staff so needs can be supported and met consistently. This will promote independence and autonomy for residents while keeping them as safe as possible. The medication practises and procedures need to be adhered to make sure that the residents receive their medication safely. Activities and leisure pursuits need to be further developed so as to allow and encourage people to have meaningful and active life’s that suit their preferences and capabilities. Mealtimes arrangements need to be better organised so that residents receive their meals in a more dignified and timely way. The service needs to develop a maintenance and renewal programme to make sure that they have identified the areas within the home that need work. They can then continue improving the environment to ensure it is maintained to a good standard for the people who live there. The home needs to make sure that all residents living at the home can access the garden areas. Staff need to follow procedures for infection control to make sure everyone is protected as much as possible from out-breaks of illness. Competency and appraisal of care staff and updating mandatory training needs to continue. This will ensure staff have the skills and knowledge to look after people in the correct way. The home needs to develop its quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the residents. All safety checks need to be done at the necessary intervals so people live in a safe environment. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 8 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. Fassaroe DS0000068842.V363384.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 Fassaroe DS0000068842.V363384.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): 1,2 and 6 People who use the service experience good quality outcomes in this area. Prospective residents have the information they need to make an informed choice about living in the home; their needs are assessed; and they will only be admitted if the home is confident of meeting these needs. Resident’s places are protected and they know what they are paying for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide. The Statement of Purpose contains a lot of the information needed. It sets out the objectives and philosophy of the service but it does need to be up-dated to reflect the present situation in the home especially with regards to the new management structure. The manager is aware this needs to be done. The Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 11 service users guide has been reviewed and updated and contains information to assist people in making a decision about whether the home is the right place for them to live. The guide is well presented in its present format. The manager needs to develop other formats for the guide so that it will be more accessible and understandable for the people the home caters for. It does include information on how to make a complaint. This standard is no longer a requirement but is now a recommendation. Everyone who uses the service has a terms and conditions/ contract in place. Which explains what the service provides for the money paid. The terms and conditions/contracts need to be kept within the individual file of each person so they are accessible to residents and their families and representatives. They do need to be signed by the person receiving care or their representative and the manager of the home. This requirement has been met. The home has recently reviewed their assessment procedures. The service has developed an assessment format which looks at the person as a whole. It identifies the persons care/support needs and also looks at all aspects of their lifes. It gives a information about their past, their likes and dislikes. Pastimes and religious and cultural preferences. The pre-assassent tool is also supported by assassesments for nutrtion, skin integrity and cognition. These will be used as baseline information to monitor whether people improve or deteriorate after they have come to live at the home. As there have been recent admissions to the home the pre-assessment tool had not yet been tested. The manager plans to use the format to re-assess all the existing residents to make sure that all their needs have been identified. Fassaroe DS0000068842.V363384.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): 7,8,9 and 10 People who use the service experience adequate quality outcomes in this area. Residents cannot be sure that all their needs will be met and that all risks are minimised. They cannot always be sure they will be treated with dignity and respect. The homes medication policies and procedures do not fully protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit the manager and deputy manager home were in the process of transferring the care plans of the residents onto a new format. 2 new plans had been developed and 2 of the old plans were also seen. The new Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 13 plans are more person centred and look at all aspects of support and care needed by the residents. They are easier to follow and focussed on what people could do for themselves. The areas where personal care and support was needed gave clear guidance to staff. However other areas such as social, behavioural and cognition need to be further developed so that staff have the guidance and direction on how to best look after the people in the home. Some plans are not up-dated to reflect the changing needs of the people living at the home. Staff are relying on verbal communication between each other to keep themselves up to date instead of referring to care plans. This will mean that residents are at risk at not having the care they need or receiving care that is not in their best interest. The plans are not yet completed. They did not identify areas of risk and what action is needed to keep risks to a minimum while allowing residents to be as independent and as possible. The manager is working towards making the plans more concise and individualised to ensure that residents and staff use them as daily working tool. This means eventually all the needs of the residents should be met in the way that suits them best. We saw evidence that some important health support needs are not being monitored, so are not being met. An example is nutritional support, - there was not plan to say how to support a person, how to monitor their well-being and what staff should look for to identify and react to complications. We observed staff at a mealtime make assumptions about a persons nutritional needs and not offer additional help. This limited the person’s choice through lack of suitable support. Although residents are weighted each month, there is no clear system for staff to do something about changes noted. A further example was a lack of written plans to monitor the effects of pain relief. This is especially important where people have communication difficulties who are unable to say if the medication has been effective. Staff were able to tell us what they would do, but this needs to be written down so every staff member follows the same, agreed procedure. Daily records are kept but they do not give a clear picture about how residents spent their time and do not relate to the individual care plans. The home does need to develop a more person centred approach to care. Key working needs to be further developed and promoted. Some needs are met in a task orientated way. Plans focussed on what residents could not do instead of promoting independence and self-esteem. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. The home now has regular contact with the Home Treatment Service and district nursing team. Good relationships have developed. The home also has contact with the local older peoples mental health team and consultant Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 14 psychiatrist. This means that people at Fassaroe House are well supported and can easily access the specialist services when they need them. Visiting professional reported that there have been improvements to the standard of care delivered by the home. The residents have regular appointments with opticians, a chiropodist and dentists. Medication procedures were looked at. Some medication is stored in a trolley, which is suitable for purpose however other medication is stored in a locked filing cabinet, which is not in line with the Royal Pharmaceutical Guidelines. The home does have appropriate storage facilities so these needs to be used to ensure all medication is kept securely. A sample of prescription sheets were seen. There was evidence to show that on some occasions staff had not signed the prescription sheets. Records showed medication was not given on the 14th and 15th of May, but no reason was recorded. On the 12th and 13th May medication had been given but not signed for it. There was an absence of instructions for staff to guide their giving out as required. This means that people cannot be sure they will receive their medication when they need it and they cannot be sure they will not be given extra medication. The deputy manager said they had already identified this error and she is going to address it. The home needs to make sure that all staff have competency checks for the administration of medication when they had given the medication. This means that people cannot be sure they have received their medication when they need it and they cannot be sure they will not be given extra medication. The deputy manager had already identified this error and is going to address it. The home needs to make sure that all staff have competency checks for the administration of medication. Some of the people living at the home are prescribed medication (this includes pain relief, topical creams, eye drops) on a ‘when required’ basis. There was an absence of instructions for staff to guide their giving out this as required medicine. There was no monitoring system when pain relief was given to people. As the resident group have varying communication difficulties, staff would be expected to observe and record the effect of such medication by using the guidance that should be in the care plan. As already stated above, the level of detail in the plan was insufficient to guide staff effectively. Through observation and from talking to the residents and staff there was evidence to show privacy and dignity is up-held for the majority of the time. Some staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. Members of staff spoken to confirmed an understanding and commitment to caring for older people. However it was also observed and reported that on some occasions Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 15 staff were not as respectful as they could be. At a meal time staff were observed standing up and leaning over people to feed them. They were also observed feeding 2 people at the same time walking from one to another. Staff were also observed walking past a resident and picking a spoon up and putting food into his mouth without any explanation or warning. A few minutes later they walked back the other way and did the same thing. One member of staff was also seen to enter a bedroom without knocking or letting the person know she was there. This was discussed with the manager at the inspection and she reported she will address the situation. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 16 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): 12,13,14 and 15 People who use the service experience adequate quality outcomes in this area. The home does provide the residents with some opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. But the residents cannot always be sure their diet will be monitored and met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit there was a pleasant and congenial atmosphere in the communal areas of the home. Visiting professionals and relatives reported this was a great improvement. The new manager had developed a programme of activities for the residents. This was yet to be implemented. She has also appointed an existing member of staff to be dedicated to organising activities twice a week. The home also has out-side entertainment on a regular basis. The staff said they want to get people out more within the local area. There Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 17 are some outings to the local park and seafront. There was little evidence to show what activities people had done during the day. There was nothing to say if the person enjoyed an activity or not, whether they fully participated or whether they got fed up. The home does need to incorporate how people spend their time within their care plans. This will show that people are being supported to do what they like and enjoy to help them live a fulfilling life as possible. Relatives said they are made to feel welcome at the home at all reasonable times and no restrictions are imposed. Residents are able to receive their visitors in the privacy of their own rooms or in the communal areas. The people spoken to felt they are able to have some choice in regards to their day-to-day life’s’. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the limited choices they are offered. The home does need to evidence and demonstrate more how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their life’s. All residents and their relatives are invited to attend residents meetings, which are held at regular intervals. The meetings give people the opportunity to express their views and make suggestions regarding their care at Fassaroe and also to make any suggestions on how the service can be improved in any way. The manager told us that suggestions are listened to and acted on. The home employs 2 cooks 2 kitchen assistant who cover the kitchen 7 days a week. The manager has applied for them both to attend the intermediate food hygiene training, which will start in September ’08. Resident’s likes and dislikes are taken into consideration. There is a daily set menu and choices are available. Staff were observed offering choices of drinks to people. The meals are nutritious varied and well presented. It was reported and observed that sometimes residents sit at the tables for a long time before the meal is served. This meant people became agitated and restless. The lounge /dining room was overcrowded. Quite few people were left sitting in armchairs when it would have been more comfortable for them to sit at a table. Some people were left waiting for long period of time before they were served their food. One person refused her meal but staff did not encourage her to eat. They said ‘She only likes puddings’. There was no information in her care plan as to how this need should be addressed. More people could have been encouraged to eat independently and as mentioned earlier not all staff assisted with feeding in a way that was discreet and sensitive. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 18 Plates were removed quickly when residents had finished their meals so it was difficult to see how staff accurately recorded what people had eaten and what they had not. This was discussed with the manager at the inspection. She stated she would be improving meal times for the residents. One lady did say,” the food is quite nice. It’s very pleasant. You get a good variety of vegetables. If you get plenty of vegetables you are OK”. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 19 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): 16 and 18 People who use the service experience adequate quality outcomes in this area The people who use the service are confident complaints will be listened to and dealt with appropriately. They cannot be sure they will be protected from all forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available within the home and some residents and staff are aware of how to make a complaint. Since the new manager was appointed there has been one complaint made to the home. This is being appropriately dealt with by the manager. Residents and relatives feel their complaints are taken seriously and acted on. One relative said “Before the new manager came I spoke to the provider about a concern. He did listen to me and took notice. Things got better for my husband’. The home has all the necessary policies and procedures in place to protect residents from abuse. The manager needs to ensure that all staff have read them. Staff have an awareness of what constitutes the more common forms but they lacked knowledge on the less obvious types of abuse such as Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 20 omissions. They said they would have no problem whistle blowing if the need arose. The lot of the care staff still need to receive safe guarding adults training to assist them in keeping people safe. There has been one safe guarding adult alert raised since the last inspection visit. The local social services have responded to this. Multi –disciplinary meetings have been held in conjunction with the management of the home. The concerns have been investigated and subsequently the home has developed an action plan, which is being implemented. The management of the home has worked pro-actively and improvements have been made. The service is being monitored at regular intervals by specialist services to ensure the improvements continue and people are getting the care and support they need. Specialists who have visited the home generally said that the home is moving in the right direction. They said and standards of care have improved for those who live there. Monitoring will continue and at the time of writing the report the safe guarding adult alert remains open. Further meetings have been planned. Improvements in this area are acknowledged, but the overall rating is adequate as the manager and improvements are so recent. To meet the criteria for good, the home must show a sustained period of compliance. The home does have policy and procedures do protect the resident’s monies and valuables. They have no involvement with resident’s finances. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 21 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): 19 and 26 People who use the service experience adequate quality outcomes in this area The service needs to continue to improve and maintain the environment to provide people with a comfortable homely and safe place to live. On the whole the residents benefit from a clean and homely environment but there is a risk of outbreak of infection due to poor practises. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residential accommodation in the home is set on the ground and first floors of the building. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 22 All external doors have keypad systems and locks to ensure safety of residents from wandering into the street. There is an enclosed garden to the rear. A large lounge/dining room, a small quiet lounge and a conservatory make up the communal space. These are bright and airy rooms in which a range of activities can take place. Many of the bedrooms are well decorated and furnished and have been personalised by residents and their relatives. Some of the rooms need redecoration and up grading. There was a strong odour detected in one of the bedrooms this needs to be dealt with and eliminated Since the last inspection all radiators have been covered to protect residents from the risk of burns. Access to the rear garden could be improved, as there is a potentially difficult step for residents with reduce mobility and could cause a tripping hazard. The rear garden has a large area of shingle flooring, which represents an obstacle for some residents with reduced mobility who use Zimmer frames or wheelchairs. This means that some people are limited to the area of the garden they can use. A partial tour of the building was undertaken. Although the manager is aware of the maintenance required in the home there is currently no formal plan in place for the renewal of the fabric and redecoration. The home needs to develop a plan to address the issue. The kitchen and laundry rooms are suitable for purpose with adequate equipment in place. Residents said that the laundry service was good and they had no complaints. The service needs to ensure that soiled laundry is transported correctly. The manager said she would order alginate bags for transporting and washing of soiled laundry. It was also identified that staff are carry soiled pads in small sacks through the home to the yellow sack in the laundry room. This practise needs to be reviewed and change as it increases the risk of spreading infection. A member of staff was also seen carry a pad in the home without it being in a small sack. This was reported to the manager who will address the issue. All staff need to have up-to date training in infection control. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 23 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): 27,28,29 and 30 People who use the service experience adequate quality outcomes in this area There are adequate numbers of staff on duty but they do not all have the necessary training to undertake their roles effectively and safely. Most staff have a good understanding of the residents and positive relationships have been formed. Residents are protected by the homes recruitment policies and practises. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has undergone a lot of staff changes over the past few months. Residents, relatives and visiting professionals reported these changes have improved the service. There is usually 5-6 staff on duty in the morning 4 in the afternoon and 3 at night. Extra staff are brought in if anyone wants to go any where or if they have an appointment to attend. The manager has recently allocated an extra member of staff to be available 2 days a week for activities. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 24 The home also employs ancillary staff to undertake cooking, cleaning, laundry and maintenance duties. Staff said they could do with extra staff at the busy times of the day especially at meal times and in the morning. From looking at the duty rota, speaking with staff, residents and relatives and from observation there is enough staff on duty to meet the needs of the residents. The home have not yet reached the required level of 50 of care staff trained to NVQ level 2 training is due to start in September. There are gaps in mandatory training. The registered manager is aware of this shortfall and is the process of accessing training for staff over the next few months. The staff also need to receive more specialist training to ensure that they have the skills knowledge and capabilities to care effectively, positively and safely for the residents at the home. The manager has developed a training matrix so gaps can be identified quickly. There was evidence to show that all new members of staff receive an induction into the home and have an induction training programe in place.This has now been expanded and is in line with ‘Skills for Care’. The mangement needs to develop ways to check staff competencies after they have received training. The home does have thorough recruitment practises. The sample of staff files looked at including those of more recently employed staff. They contained all the necessary information and safety checks to ensure that the residents are protected. There was evidence of POVA and CRB checks, two written references and proof of identity. The service needs to make sure they have an update photograph of staff on their files. The manager has audited the files. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 25 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): 31,33,35 and 38 People who use the service experience adequate quality outcomes in this area Residents live in a home that is well managed. Residents cannot be sure the home is run in their best interests. They cannot be sure their health and safety will be promoted and protected at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection the manager of the home had only been in post for one month. She is working hard to bring the home up to an acceptable Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 26 level and to address previous shortfalls and is moving the home in the right direction to meet the National Minimum Standards. The manager is aware of the work that needs to be done to improve the star rating of the service. She has many years of experience working in care and has managed other homes in the past. She is committed to improving the standard of care for the people who live at Fassaroe House. Following her probationary period she needs to apply to the commission to become the registered manager of the home. A staff member commented that, ‘the manager is supportive and I feel that I could go and talk to her.” A relative said, “There has been a lot of improvement in a month “. The service has no involvement with the resident’s finances. All staff have formal supervision on a regular basis. Staff said that they found this beneficial. Regular staff meeting also take place. Staff said that they feel listened to. They said that they could discuss any concerns with the manager or deputy. The home has begun to address quality-monitoring issues but this hasn’t progressed since the last inspection. The provider completes monthly monitoring visits, these still need to be more detailed and provide clear action plans including regular auditing of a range of records including residents plans, staff files, medication and health and safety amongst other things. The manager does have resident/relatives meetings, which is a forum to gain feedback about the service. Questionnaires need to be circulated to residents, relatives and other stakeholders so their opinions and views about the service are sought and considered. All the information needs to be collated and the strengths and weaknesses of the home identified. From this information the home needs to improve the service it provides to the residents. This will ensure that the aims and objectives written in the statement of purpose are being met. During the inspection a number of shortfalls were noted in relation to health and safety issues. This was a requirement at the last inspection. The home has a fire log book, but this has not been completed on a regular basis. In addition a record of fire drills and those taking part needed to be maintained. It is also advised that the current fire risk assessment is reviewed and updated. The manager addressed this short fall as a matter of priority. And evidence was seen within a few days confirming all weekly, monthly and quarterly tests had been carried out and documented appropriately. The requirement has been removed and a recommendation made for the home to continue their monitoring at the necessary intervals. It was also identified that there was no evidence to show water temperatures had been taken. This was also addressed promptly. It was identified the water temperatures are too high. The manager Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 27 was going to address this issue and risk assessments ware going to be implemented until the temperatures are within the required limits. The general thermostat was being turned down and estimates and costing were being sort to install individual thermostats in each area were residents have access to hot water. Accident records are maintained and environmental risk assessments have been completed. The AQAA informed us the Service and maintenance certificates were up to date. The ones seen confirmed this. As previously stated staff are not up –to date with mandatory training. Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 28 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 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 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 X N/A 3 X 2 Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15(1) Requirement The manager needs to develop and agrees with all residents /representative an individual support/care plan, which includes all the health, social and personal care required, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations. The plan needs to be implemented and updated to reflect the changing needs of the residents. Risk assessments need to robust and promote independence. Timescale for action 30/09/08 2 OP8 12(1)(a) 3. OP9 13(2) Daily records need to contain relevant information about the day of the residents and written in conjunction with the care plan. All the health care of the residents need to identified 31/07/08 actioned and monitored closely for improvement or deterioration • All medication 30/09/08 administered needs to be signed for at the time it was given. DS0000068842.V363384.R01.S.doc Version 5.2 Page 30 Fassaroe • • Staff competencies need to be checked regularly. All medication needs to be stored according to the Royal Pharmaceutical Guidelines There needs to be individual guidelines in place for residents prescribed ‘when required’ medication. The effects of pain relief need to be monitored. 31/07/08 31/07/08 • • 4 5 OP10 OP15 12(4)(a) 12 (1) Sch.4 (13) 6. OP26 16(2)(k) Staff at all times need to ensure that the residents are treated with dignity and respect. The manager needs to review how meals times are organised and how food is served how people are assisted to eat and how dietary intake is recorded and monitored. The home needs to make sure there are robust systems in place to prevent the spread of infection. Particularly in relation to the transportation and washing of soiled laundry and the disposal of soiled articles. The home also needs to make sure that all areas are free from offensive odours. Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 30/06/08 7. OP33 24(1)(a) (b),(2)(3) 31/10/08 Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 31 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. 3. 4. Refer to Standard OP1 OP12 OP18 OP19 Good Practice Recommendations The Statement of Purpose needs to be updated and the Service Users Guide needs to available in formats that is more accessible for the people who use the service To make sure residents have a variety of activities available both in-side and out-side the home. All staff need to receive training in safe guarding adults. The provider needs to produce an action plan detailing all works planned and a timescale within which to achieve this work. The plan should pay particular attention to the provision of access to the garden and the redecoration and refurbishment of some of the bedrooms To continue to provide all mandatory training for staff as required and consider implementing in-house competency assessments to underpin knowledge gained. To ensure that all fire safety records are maintained and up to date and that all routine checks are completed. Update the fire safety risk assessment. To ensure the water temperatures are within the required range and are checked at the necessary intervals. 5. OP30 6. OP38 Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Fassaroe DS0000068842.V363384.R01.S.doc Version 5.2 Page 33 - 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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