Inspection on 15/01/08 for Higham House

This inspection was carried out on 15th January 2008.

CSCI found this care home to be providing an Poor 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

Higham House 08/06/09

Higham House 27/08/08

Higham House 06/06/08

Higham House 04/07/06

Higham House 20/10/05

Higham House 16/06/05

Higham House 10/05/05

Higham House 09/09/04

Higham House 15/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Fairlawn Nursing Home 87 Higham Road Rushden Northants NN10 6DG Lead Inspector Mrs Carole Burgess Unannounced Inspection 15th January 2008 10:00 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 Fairlawn Nursing Home DS0000045316.V357487.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. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairlawn Nursing Home Address 87 Higham Road Rushden Northants NN10 6DG 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) 01933 314253 F/P 01933 314253 Mr Tissa Nihal Atapattu Mrs Nelum Vijayanthi Atapattu Clutilda Skinner Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Fairlawn nursing home is registered to provide personal care with nursing to male and female service users who fall within the following categories:- Old age, not falling within any other category (OP) 30, Dementia, over 65 years of age (DE(E)) 30. The maximum number of persons to be accommodated at Fairlawn nursing home is 30. 4th July 2006 2. Date of last inspection Brief Description of the Service: Fairlawn Nursing Home is situated on the main road through Rushden. The home is a converted building and provides nursing care for up to 30 frail, elderly residents of both sexes with both physical and dementia related illnesses. Accommodation is in both single and shared rooms over two floors. Some of the newer rooms have en suite facilities and there are sufficient additional toilets and bathrooms with assisted bathing facilities. There are two communal sitting rooms, a dining room, kitchen and laundry, with a garden and patio area to the front and side of the property. It is within easy access of the local towns of Rushden and Higham Ferrers. A local bus service is easily accessible. The Statement of Purpose, Residents’ Guide & Inspection Report are available on request (these provide information on how the home is organised and what services they provide). At the time of the inspection, fees ranged from £435 to £490 per week. Extras include hairdressing, dry cleaning and phone calls made from the foyer. Fairlawn Nursing Home DS0000045316.V357487.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 0 star. This means the people who use this service experience poor quality outcomes. The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. The site visit was unannounced and took place over six and a half hours. The Inspector selected three residents and tracked the care they receive through a review of their records, discussion with them, the care staff, and observation of care practices. The Inspector spoke with staff members regarding training and support. Planning for the inspection included a review of the Annual Quality Assurance Assessment (AQAA), service history and assessing notifications of significant events sent to the CSCI by the home. The Inspector also received eleven replies to surveys sent to residents, relatives and staff. These were generally positive about the care provided, but highlighted some concerns regarding staffing levels, lack of equipment and the poor standard of décor in the home. There have been two complaints received by the CSCI regarding the home since the last inspection. There have been concerns raised by the Northampton County Council (NCC) and the local Primary Care Trust (PCT) regarding the management of, and standard of care, in the home. The provider has employed a consultant to assist in improving standards within the home. The Registered Manager (a person registered with the CSCI) and other staff spoken with were helpful during the inspection. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Requirements and recommendations made following this inspection: Care plans must set out in detail actions that need to be taken by staff to ensure that all aspects of health, personal and social care needs of residents are fully met. Care plans and risk assessments must be reviewed regularly, and, where necessary, professional advice sought in a timely manner, particularly in relation to nutrition and falls. The Registered Persons must ensure that all staff are trained in, and adhere to, safe medication practices, ensuring that residents receive all of their medication as prescribed, and that it has been accurately documented. Repeated omissions and refusals must be discussed with the resident’s GP. Residents must have their social history recorded and be provided with opportunities for appropriate activities, with particular consideration being given to people with dementia and cognitive impairment. Additional professional help and advice must be sought where necessary. Staff must be made fully aware of their responsibilities in safeguarding vulnerable adults and undertake training as necessary. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 7 All parts of the home to which resident have access must be, as far as possible, free from hazards to their safety, specifically burns from hot radiators and scalds from hot water taps. Staff must undertake training in dementia and challenging behaviour to ensure that they can fully understand and meet the needs of their residents. The Registered Manager must ensure that she has the necessary competence and skills to manage the home, and is familiar with the conditions and diseases associated with old age, specifically dementia and challenging behaviours. It is recommended that a copy of the home’s Statement of Purpose, Residents Guide and the last inspection report are kept in the foyer, so as to be accessible to residents, relatives and other interested parties. It is recommended that a more detailed assessment of residents’ social history - work, family and friends, including past hobbies and interests, religious and cultural needs- is obtained so that an individual picture of each resident is formed and an in-depth plan of care can be made. It is recommended that an approved Controlled Drugs Registered, bound and with numbered paged, is used. It is recommended that advice should be obtained from the relevant organisations concerning the provision of activities for residents with a diagnosis of dementia in order that day-to-day activity and stimulation may be provided. It is recommended that information about advocacy services is made available. It is recommended that there are written procedures in place to cover unexpected and long-term sickness and unexpected staff shortages. It is recommended that all staff receive formal, written, recorded supervision at least six times a year to ensure that all their training needs are addressed and standards of care are maintained. It is recommended that the home continues to monitor and service all equipment on a regular basis in line with the manufacturer’s and Health & Safety guidance. 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. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents (or their relatives) are provided with sufficient information about the home, and have their health, welfare and social care needs assessed, so that they can be met once they move into the home. EVIDENCE: The home provides prospective residents and their relatives with a Statement of Purpose and Residents Guide (both give information about the home) to help them decide if the home is the right one for them. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 10 The Registered Manager completes an assessment prior to a resident moving to the home. The three residents’ care plans reviewed contained a pre-admission assessment to show that the home could meet their specific health, welfare, and social care needs. It included personal details, relative and GP contact numbers, a brief medical history, current health care requirements and medications. However, a more in-depth assessment, including a detailed social history, would provide greater insight for care staff when planning care for people with dementia to ensure that all of their care needs are met. Care management assessments, plans and a social history were available in one of the resident’s files seen during the site visit. The home does not provide intermediate care. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 11 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 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although residents’ basic care needs are generally met care planning is poor and not reflective of all of the residents’ health, personal and social care needs. EVIDENCE: Three residents’ care plans were checked. Care plans had recently been reviewed but still did not reflect all of the residents care needs. The care plans in use at the time of inspection were overly complex and difficult to follow. Where a care need or concern had been identified it was not easy to locate an action plan or outcomes. For example: A resident who had diabetes did not have a care plan identifying their specific nutritional or health care needs. Nor Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 12 was their guidance for care staff regarding emergency procedures in the event of the resident having a hypo/hyper glycaemia attack. Residents appeared to have all of the necessary nursing care equipment required within their care plan to meet their specific care needs such as bedrails with ‘bumpers’; air mattresses for residents at risk of pressure ulcers, with a risk assessment in place. Two residents had resolving pressure ulcers and the district nurses were providing additional support to staff to ensure that appropriate treatments were provided. The Registered Manager agreed that the care plans were difficult to follow, especially as many of the nurses/carers have English as a second language. This has led to areas of concern not being identified and addressed in a timely manner by staff; such as a resident with weight loss not being given prescribed supplements, and professional advice not being sought (although this has since been addressed having been noted by visiting healthcare professionals as part of continuing care review process). Medication procedures were checked. The ‘clinic’ where most of the medication is stored was clean and tidy and medicines ordered, stored and disposed of appropriately. Drugs requiring refrigeration were stored at the correct temperature. Controlled Drugs (CD) were stored in an appropriate locked cupboard in an adjacent office. It was recommended that a bound or stapled Controlled Drugs (CD) Register with numbered pages be used to fully comply with current guidance for the safekeeping of controlled medication prescribed for residents. No residents were able to self medicate. Policies and procedures for the safe handling of medication were not seen in the policies and procedures file. Only trained nursing staff administer medication. There was no evidence of recent medication training/updates in staff training files. On checking the prescription sheets it was noted that for one resident two drugs prescribed to be given three times a day at 8am, 1pm and 6pm had been omitted on several occasions throughout a seven-day period because the resident had been sleeping. The Registered Manager said that staff would have offered them again when the resident was awake but they (the resident) probably refused. However this was not recorded nor was medical advice sought thereby putting the resident at risk. Observation during the inspection showed that staff have a good awareness of how to protect residents privacy and dignity. Staff spoke to residents in a respectful, friendly, quiet (unless the resident had hearing difficulties) and supportive way. Most of the residents were very frail with advanced dementia and were unable to give an opinion about the care they receive, but one resident said that he received good care and that staff were very kind. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 13 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 & 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff try to ensure that residents experience a homely life style, but have little time or training in the specific need of very frail residents with dementia to make sure that the residents receive the appropriate level of activity and social engagement which they require. EVIDENCE: On the day of the site visit the television and radio were on but residents did not appear to be listening or watching either. Most residents appeared to be sitting in chairs around the edge of the room, dozing. Some residents were encouraged to exercise to music in the morning and play a game in the afternoon but were not seen to participate in any meaningful way. However, residents appeared to be clean and appropriately dressed. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 14 There was a list of weekly activities displayed on a notice board in the hallway. The hairdresser visits once a week. An outside agency provides ‘physical movement’ on Thursdays; other activities included beauty & grooming, selfcare, games and orientation. There were photographs on the wall of Christmas festivities 2006. Residents showed little interest in their surroundings and most staff have not received specific dementia care training to enable them to construct a programme of activities supported by evidence-based practice. The three care plans seen did not contain sufficient social history – likes, dislike, past interest and hobbies- to enable care staff to produce an activity plan with positive outcomes for each resident. A clearer understanding of the generic and specific needs of persons with dementia would enable a more meaningful programme of activities to be devised for the residents. The home does not receive visits from churches of any denomination but visitors are able to visit at any time. All meals are prepared in the home’s kitchen by the cook. Menus are produced on a four-week rotation and appear to provide a balanced diet. Additional drinks are provided, such as jugs of juice. Residents have a bedtime drink. Special diets such as diabetic and soft diets are catered for, but these were not necessarily identified in the residents care plan, as already described regarding the resident diagnosed with diabetes. Carers were seen to assist residents with their meals in a quiet, discreet and unhurried way. There have been issues regarding monitoring weight loss. It had been noted by visiting health professionals that a resident with a significant weight loss had not been receiving prescribed supplements because s/he did not like them. This has now been addressed. Pro-active nursing interventions are still not being identified and acted upon, or outside professional advice sought in a timely fashion, to ensure that residents receive optimum care (see Health & Personal Care). The Environmental Health Officer (EHO) visited on 27th November 2007. There were a number of actions, one of which was to maintain the food fridges at 5 degrees Celsius, to be completed by January 2008. The Registered Manager said that they had all been completed. Food fridge temperatures were being checked regularly and were satisfactorty. One resident who was able said that he got up and went to bed when he wished, and was able to choose what he wanted for his meals, which s/he said were “brilliant”. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 15 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 & 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints need to be improved and all staff must receive safeguarding vulnerable adults training to ensure satisfactory protection of residents’ rights. EVIDENCE: Since the previous inspection in July 2006 the CSCI has received two anonymous complaints regarding poor care practice in the home. Both were given to the provider to investigate. The second complaint echoed some of the concerns of the first. A reply from the provider is pending but all issues were discussed during this inspection. Areas of concern are highlighted throughout the report. The current policy and procedure requires updating to fully reflect the Local Authority procedures for Safeguarding Vulnerable Adults. Additional information regarding the internal complaints procedure and contact numbers for local Social Services and the CSCI should be included to enable residents and their relatives to access appropriate people if they have concerns about Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 16 the home. Information could be provided in large print or other formats as appropriate. Complaints made directly to the Registered Manager appear to have been dealt with quickly and appropriately. Staff have not received appropriate training in Safeguarding Vulnerable Adults policies and procedures. This must be addressed to make sure that all staff have the necessary knowledge for safeguarding the residents from harm. The Registered Manager said that she had used Age Concern Advocacy service for one resident who required additional outside support but she did not have any written information available. The Registered Manager was advised to display the complaints procedure, along with access to advocacy services, in the foyer to enable residents and/or their relatives to use these, if and when required. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 24, 25 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and tidy, with an extension providing improved en suite accommodation, but much of the décor and furnishings looks ‘tired’ and many areas of the home are in need of refurbishment and redecoration. EVIDENCE: The home was clean and tidy on the day of the site visit. The extension with en suite facilities provides improved accommodation for some residents. Only three of the six rooms were occupied at the time of the inspection. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 18 Although some chairs and carpets have been replaced and some areas repainted, many areas of the home have scuffed paintwork and are still in need of redecoration, particularly in the corridors. There are many notices stuck on walls throughout the ground floor which gives an ‘institutional’ feel and detracts from providing a ‘homely’ environment. The patio garden area to the side and back of the property needs tidying to ensure that it is safe for residents to use, weather permitting. Some residents’ rooms were personalised but some looked bleak with little in the way of personal possession, photos, pictures, memorabilia or soft furnishings that would provide a more ‘homely’ environment. All room are fitted with call bells but one resident spoken with could not reach the bell from his chair so he was unable to ring for assistance should this be required. This was discussed with the Registered Manager, as it was a concern mentioned in the last complaint passed to the provider. She said that this was an oversight, which was not usual practice. Although most radiators have covers a small number have not, for example, the radiator in one of the occupied en suite rooms and in the small room near the hairdressing area. Both were too hot to touch and could easily burn a frail, confused resident. There are sufficient, additional toilets, bathing and assisted bathing facilities. The Registered Manager said washbasins in residents rooms and bathrooms do not have heat control valves on hot water taps, but that hot water temperatures were regularly checked, and found to be satisfactory. However, one washbasin in an en suite room, and in the ground floor bathroom were found to have hot water of 53 degrees Celsius (the recommended temperature is that hot water should be close to 43 degrees Celsius to prevent scalds). It is therefore required that residents’ washbasins should be checked regularly, risk assessments undertaken and steps taken to ensure that residents are not at risk from scalds. The laundry area was satisfactory with industrial machines for washing, sluicing and drying linen and clothes. However, a small chemical store cupboard requires a lock to ensure the safety of resident. A lock has been ordered and was to be fitted within the week. The home’s health and safety arrangements such as regular maintenance had ‘slipped’ and were out of date but servicing for call bells, Portable Appliance Test (PAT) gas appliances, chair scales and the bath hoist have been arranged for and are to be completed during January 2008. The boiler was serviced in December 2007. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 19 Regular fire drills and tests are undertaken and the fire alarm system, installed some 18 months ago, was serviced on the day of inspection to ensure the safety of the residents and staff. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 20 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 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a good recruitment process that safeguards vulnerable people from harm. Staff at the home are caring but have not received the necessary training to enable them to care for very frail residents with dementia, and provide them with the level of individual attention they require. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 21 EVIDENCE: There were twenty residents at the time of the site visit – at least three quarters of those residents were highly dependent, frail and had advanced dementia. Staffing levels, at the point of inspection, were in line with those suggested by the Department of Health Residential Forum Guidelines and should be sufficient to meet the current residents’ needs. The usual staff rota consists of a trained nurse and four carers in the morning, a trained nurse and three carers in the afternoon and a trained nurse and a carer at night. There were only three carers on the morning of inspection, one carer being off sick. There were no official arrangements for emergency cover. The home does not use agency and relies on staff doing extra shifts to ensure that shortages are covered. Staffing may need to be readjusted to cover peak times of activity during the day. The Registered Manager is supernumerary. There is also a cleaner and cook. The current staffing arrangements should allow for the additional time required by staff to engage in a slow and unhurried way with residents, to enable them to make full use of their cognitive abilities. However, staff were seen to tell residents that they were taking them to another room, dining room, bathroom, resident’s room, but did not give the resident time to process the information or understand what was happening. This demonstrates the need for staff to receive dementia care training so they are able to fully appreciate the needs of this specific group of residents. As identified in a requirement made in February 2006 all staff should undertake specific dementia care training to equip them with the necessary skills and knowledge to care for their very frail, vulnerable residents. New staff undertake a recorded, induction programme. Staff had undertaken some training in the last 12 months: Some nurses had completed training days in Controlled Drugs, Infection Control, tissue viability, communication and supervision update for overseas nurses; one nurse had completed a dementia care study day. Some carers had undertaken training in First Aid, diversity, communication, selection team management and NVQ’s. The Registered Manager said that 7 staff have a National Vocational Qualification (NVQ) in Care Level 2 & 3. All staff have just completed a two day course in moving and handling. The trainer, spoken with on the day of inspection, sad that he felt that all the staff were competent in carrying out Moving and Handling procedures and had the necessary equipment to do this safely. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 22 Three staff files were checked and demonstrated a safe recruitment process to ensure that residents were well protected from harm. All had been Protection of Vulnerable Adults (PoVAFirst) and Criminal Records Bureaux (CRB) checked and had the necessary references, work permits etc. Comments received in the ‘Have Your Say About’ CSCI survey from three relatives were positive. One said that staff were ‘always very pleasant and helpful’. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 23 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, 36 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Registered Provider and Registered Manager have allowed standards of care to deteriorate since the last inspection therefore residents are not receiving the quality of care that they deserve. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Nurse, an experienced First Level Nurse who also holds the Registered Manager’s Award, manages the home. The home has an open, friendly atmosphere. She has undertaken a number of study days in the last twelve, including, Supervision for Overseas Nurses and ‘Clostridium Difficile’. Since the last inspection the Registered Manager has had some extended sick leave last year returning in August 2007. During, and since this time, the dayto day management of the home has appeared to become less effective A formal quality assurance programme is in place in which aspects of the service provided are audited. Questionnaires have been sent to relatives. This was last completed in March 2007.The results of the last audit were available for inspection. It is recommended that this should be available with the Statement of Purpose to enable current and prospective residents, and their relatives/representatives to see this information. Staff have not been well supervised during this time. Staff have not receive regular recorded supervision (a regular review of staff’s personal and training needs in relation to their work) and appraisals; training issues have not been identified and addressed, standards of care practice, and the general day to day maintenance of the home have slipped so that residents’ care needs have not been fully met. The Provider (the person who owns the home) has employed a Consultant to assist the Registered Manager to address concerns and improve the standard of care planning for the residents. Health and Safety Policy and Procedures, such as regular, fire drills and fire alarm tests are completed, and areas of concern such as regular servicing of equipment is in the process of being addressed (see ‘Environment’) to ensure the health and safety of the residents and staff. Comments received in the ‘Have Your Say About’ CSCI survey from four residents and three relatives were positive about the care provided in the home. One comment from a relative and one from a member of staff said that more staff, better equipment and general repairs and redecoration were required. Staff indicated that they felt well supported by management. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 3 3 2 2 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 X 2 Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 26 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 13 & 15 Requirement Care plans must set out in detail the actions which need to be taken by staff to ensure that all aspects of the health, personal and social care needs of residents are fully met. Care plans and risk assessments must be reviewed regularly, and professional advice sought in a timely manner, particularly in relation to nutritional and falls. The Registered Persons must ensure that all staff are trained in, and adhere to, safe medication practices, ensuring that residents receive all their medication as prescribed, and has been accurately documented. Repeated omissions and refusals must be discussed with the resident’s GP. Residents must have their social history recorded, be provided with opportunities for appropriate stimulation, with particular consideration being given to people with dementia and cognitive impairment. Additional professional help and DS0000045316.V357487.R01.S.doc Timescale for action 15/02/08 2 OP8 13 & 15 15/02/08 3 OP9 13 (2) 15/02/08 4 OP12 16 (m) & (n) 15/02/08 Fairlawn Nursing Home Version 5.2 Page 27 5 OP18 22 6 OP25 13 7 OP30 19 (5) (b) 8 OP37 10 (3) advice must be sought where necessary. Staff must be made fully aware of their responsibilities in safeguarding vulnerable adults and undertake training as necessary. All parts of the home to which resident have access must be, as far as possible, free from hazards to their safety, specifically burns from hot radiators and scalds from hot water taps. Staff must undertake training in dementia and challenging behaviour to ensure that they can fully understand and meet the needs of their residents. The Registered Manager must ensure that she has the necessary competence and skills to manage the home, and is familiar with the conditions and diseases associated with old age, specifically dementia and challenging behaviours. 15/02/08 15/02/08 15/02/08 15/02/08 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 OP1 Good Practice Recommendations It is recommended that a copy of the home’s Statement of Purpose, Residents Guide and the last inspection report are kept in the foyer and accessible to residents, relatives and other interested parties. It is recommended that a more detailed assessment of a resident’s social history - work, family and friends, including past hobbies and interests, religious and cultural DS0000045316.V357487.R01.S.doc Version 5.2 Page 28 2 OP3 Fairlawn Nursing Home 3 4 OP9 OP12 5 6 7 OP17 OP27 OP36 8 OP38 needs- be obtained so that an individual picture of each resident is formed and an in-depth plan of care can be made. It is recommended that an approved Controlled Drugs Registered, bound and with numbered paged, is used. It is recommended that advice should be obtained from the relevant organisations concerning the provision of activities for residents with a diagnosis of dementia in order that day-to-day activity and stimulation may be provided. It is recommended that information about advocacy services is made available. It is recommended that there are written procedures in place to cover unexpected and long-term sickness and unexpected staff shortages. It is recommended that all staff receive formal, written, recorded supervision at least six times a year to ensure that all training need are addressed and standards of care are maintained. It is recommended that the home continue to monitor and service all equipment on a regular basis in line with the manufacturer’s and Health & Safety guidance. Fairlawn Nursing Home DS0000045316.V357487.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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