Inspection on 16/06/05 for Higham House

This inspection was carried out on 16th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Higham House 08/06/09

Higham House 27/08/08

Higham House 06/06/08

Higham House 15/01/08

Higham House 04/07/06

Higham House 20/10/05

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 Northampton NN10 6DG Lead Inspector Linda Preen Unannounced Tuesday, 10th May 2005 at 10:00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairlawn Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Fairlawns Nursing Home Address 87 Higham Road Rushden Northants NN10 6DG 01933 314253 01933 413187 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Tissa Nihal Atapattu Vacant CRH 24 Category(ies) of 24 OP - Old Age over 65 registration, with number 24 DE(E) Dementia - over 65 of places Fairlawn Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th September 2004 Brief Description of the Service: Fairlawn Nursing Home is situated on the main road through Rushden. It is within easy access of the local towns of Rushden and Higham Ferrers. A local bus service is easily accessible. The Home is a converted local building. The home provides accommodation for 24 service users in single and shared rooms and caters for elderly residents with dementia related illness. Fairlawn Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of five hours as part of the statutory inspection programme. Two residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them and also to the staff concerning the care received. In addition to this staff records, Fire records, Complaints and accident records were seen. 2 comment cards had been received from residents, 7 from relatives and information was available from a questionnaire completed by the providers of the service. A tour of the premises was also undertaken. What the service does well: What has improved since the last inspection? What they could do better: Staff recruitment practices are poor and do not protect residents from potential harm. This was made the subject of an immediate requirement. Management of the home is inadequate and little progress has been made in providing adequate guidance for staff in meeting individual resident needs. Resident’s lives are ordered around staff shift patterns and not according to individual choice. Record keeping in the home is poor, with contradictions and inadequate information. Equipment in the home is poorly maintained and safety checks are not up to date, posing potential harm to the residents. Staff training needs have been identified but shortfalls still remain. Requirements were made for all of these areas. Fairlawn Nursing Home Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairlawn Nursing Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fairlawn Nursing Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 Residents are not assured that their needs may be met in the home. EVIDENCE: There was no evidence that residents have been issued with terms and conditions in the files seen. One of the residents had a basic pre-admission assessment completed but this did not contain all of the elements required in Standard 3, to ensure that all aspects of need are identified. The other resident had been in the home for several years and was admitted prior to the current provider and manager taking over. There was no evidence of any assessment of this resident’s needs either at the time of admission or since. This was a requirement following the last inspection and remains outstanding. Fairlawn Nursing Home Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Resident plans are inadequate to form a basis of care to meet all of their needs, however their privacy and dignity are respected. EVIDENCE: Plans of care are written in insufficient detail to guide staff as to how their needs may be met. For example: 1) A resident with an indwelling urinary catheter had no record of when this was inserted, what type or size or when it was due to be changed. 2) A Nutrition care plan stated “ needs assistance for feeding” but does not detail the assistance needed. This resident was recorded to be vegetarian on admission but there was no record of this on her care plan and staff spoken to were unaware of this fact. These areas were made the subject of a Requirement. Fairlawn Nursing Home Version 1.10 Page 10 3) Neither of the residents had care plans for their dementia nor other mental health needs, when this is the prime need for their nursing care. This was made the subject of a Requirement. 4) Records of pressure ulcers are inadequate with no grading of the ulcers. On admission a care plan records that a resident had skin peeled off sacrum and left thigh. Photographs taken of these areas on admission demonstrate that one of these areas had a grade 3 ulcer. There was no evidence that this resident was provided with a pressure-relieving mattress until five weeks after admission to the home in spite of her being identified as having a Waterlow score of 26 before admission and already having these ulcers. This was made the subject of a Requirement. Staff were observed to be treating residents with respect and with due regard to their dignity. Fairlawn Nursing Home Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 No account is taken of individual choices concerning lifestyle, activities or food. Resident’s lives are arranged to meet the staff shift patterns rather than individual needs. The standard of food and the way in which it is served and presented has improved. EVIDENCE: There was no evidence of resident choice in the case files seen. No choice of portion size or content was offered at the lunchtime meal. A member of staff spoken to stated that the routine was to get everyone up for breakfast by 07.30 and that the night staff commenced upstairs at 05.30 in order to achieve this target. Music was playing in one of the lounges but there was no other evidence of activities being provided. The registered manager stated that a lady plays the piano twice a week and that she was planning to commence “Motivational Therapy” for one hour a week shortly. She was unable to provide any details of what was planned for these sessions. Lunch was served in the dining room, in a relaxed manner. The food looked and smelled appetising, and two residents stated that they had enjoyed it. Residents who required assistance to eat were offered this on an individual basis in a sensitive manner. Fairlawn Nursing Home Version 1.10 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints are dealt with in a satisfactory manner. EVIDENCE: A complaints procedure is available for staff guidance. Records demonstrate that complaints are taken seriously. The Commission for Social Care Inspection has received two complaints since the last inspection, concerning resident’s care, and these were investigated satisfactorily by the Registered Provider. Fairlawn Nursing Home Version 1.10 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24 and 26 Some improvements have been made to the décor of the home, to provide a more homely environment, but specialist equipment is unsuitable or poorly maintained. EVIDENCE: New furniture and carpets have been provided in the two lounge areas and obsolete “geriatric chairs “ have been disposed of, creating a more homely atmosphere. Resident’s rooms were bright and airy with evidence of personal possessions on display. Shared rooms were provided with privacy screens to maintain individual dignity. The bath hoist in the downstairs bathroom is rusty and worn posing a risk of injury and infection to the residents. This was taken out of use at the time of the inspection. The bath hoist in the other ground floor bathroom was raised and the bath was discovered to be very dirty underneath it. The Registered Manager stated that this bath was not used very often, and undertook to get it cleaned immediately. Fairlawn Nursing Home Version 1.10 Page 14 Bed rails in the home were all unpadded and posed a risk of entrapment to residents. This was made the subject of a requirement. A member of staff stated that the hoist did not pump up high enough to enable residents to be hoisted into the high divan beds, necessitating staff physically lifting residents with the resultant danger to residents and staff. This was made the subject of a Requirement. Fairlawn Nursing Home Version 1.10 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 and 30 Recruitment procedures do not protect residents from potential harm. The Registered Manager is working to ensure that staff are provided with statutory training. Little progress has been made in providing National Vocational Qualification training for staff as required to meet the 50 target by this year. EVIDENCE: Two staff files were seen. These did not contain the information required by Schedule 2 of the Regulations. The Pre-inspection questionnaire identified that some staff do not have Criminal Records Bureau clearance and have not been checked with Protection of Vulnerable Adults 1st list. The Registered Manager stated that these staff members were not working, but when the duty rota was checked, it was discovered that these staff had worked and were scheduled to work in the home. This was made the subject of an immediate requirement. The pre-inspection questionnaire identified that only 1 member of care staff holds a National Vocational Qualification, but at the inspection, the Registered Manager stated that three staff hold this qualification and that another is waiting to commence the course. There was no evidence that the staff induction programme complies with the Training Organisation for Personal Social Services guidance. Only three staff currently hold a First Aid certificate, which does not comply with the requirement that a member of staff with this training is on duty at all times. A staff training matrix has been devised to Fairlawn Nursing Home Version 1.10 Page 16 enable statutory training and refreshers to be monitored. There was no evidence that staff have received formal supervision as required. Fairlawn Nursing Home Version 1.10 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37 and 38 The standard of management is poor with little progress being made to ensure that residents needs are met in a safe, secure environment giving due regard to their individuality. EVIDENCE: The Registered Manager demonstrated little understanding of requirements to provide a good standard of care to the residents. She has many years experience as a Registered Nurse but little management experience. The Registered Provider is not providing the supervision she requires to run the home. Pre-inspection information sent to the Commission for Social Care Inspection was incomplete and incorrect giving this document no credence despite the Registered Manager signing a declaration that this document was an accurate report of the situation in the home. Fairlawn Nursing Home Version 1.10 Page 18 Records provided in the home were incomplete and did not protect residents or staff. Radiators in the home have all been covered but these covers provide no protection against burning for residents as they consist of a wire mesh fitted tightly to the radiator, which allows direct contact with the hot surface. Windows on the first floor of the home have their opening restricted at the bottom but not at the top and as these windows open outward this poses a risk of falling to residents who may climb out. Records of the testing of fire alarms were seen to be satisfactory but there was no evidence that emergency lighting was being checked at the required monthly intervals. As stated before, there is no evidence of resident’s individual choice in the home, with daily routines being in place to fit in with staff shift patterns not resident needs. There is no evidence that an advocacy service has been provided for those residents with no family or friends to help them. Requirements have been made pertaining to all of the above items. Fairlawn Nursing Home Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 3 COMPLAINTS AND PROTECTION 1 3 1 1 x 3 x 2 STAFFING Standard No Score 27 x 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 1 1 1 x x 1 1 1 Fairlawn Nursing Home Version 1.10 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14(1)(2) Requirement A thorough assessment, in accordance with the standard, must be completed in respect of each resident, contained in the care plan, and reviewed at least six monthly (Timescale of 1/12/04 not met). Evidence must be available that all residents have received a copy of the Terms and Conditions of residency. All residents care plans must be reviewed to ensure that all areas of need are reflected and that there is sufficient detail to ensure that individual needs may be met. All residents assessed as being at risk of developing pressure ulcers must have the correct pressure relieving devises in place before they are admitted to the home or as soon as that risk is assessed for those already in the home. Records of the treatment and progress of pressure ulcers must be reviewed to ensure that they adhere to current research and good practice. Evidence must be available of Version 1.10 Timescale for action 14/6/05 2. 2.1 5 1/7/05 3. 15 7 14/6/05 4. 13 8.3 14/6/05 5. 13 8.3 14/6/05 6. 12 12.1 1/7/05 Page 21 Fairlawn Nursing Home 7. 12 12.2 and 14(1) 8. 16(2)(m) 12.2 9. 10. 22( c) 13(4)(a) 22 22 11. 12. 13(5) 19 Schedule 2 22 29 13. 18( c) 30 14. 19(5)(b) 18(1)(a) individual resident choice in relation to their care and daily life. The practice of getting residents up in order to fit in with staff shift patterns must cease. No resident is to be got up before 7am unless their wish is clearly documented in their assessment. Appropriate, research based and individualised activity and stimulation must be appropriately planned and carried out (Timescale of 1/12/04 not met). The rusty bath hoist in the downstairs bathroom must be replaced. All bedrails must be fitted with appropriate padding to reduce the risk of residents becoming trapped in the rails. A suitable hoist must be provided to enable staff to use it on all beds in the home. All staff must have up to date Criminal Records Bureau or POVA 1st checks in place before working in the home. This was made the subject of an immediate requirement Statutory and specialist training must be provided for all staff in the home oin order to meet resident needs.A copy of the training plan including how the required 50 of staff will hold a National Vocational Qualification by the end of the year will be met, must be sent to the Commission for Social Care Inspection. The local representative for Training Organisation for Personal Social Services must be contacted for information regarding induction and foundation training. This must be Version 1.10 1/6/05 1/7/05 14/6/05 14/6/05 14/6/05 10/05/05 14/7/05 1/7/05 Fairlawn Nursing Home Page 22 15. 16. 13(4)( c) 13(4)(a) 38.2 38 17. 13(4)(a) 38 18. 23(4)( c) 38 put into practice in the home. (Timescale of 1/12/04 not met ). A qualified First Aider must be on duty at all times in the home. All radiators must be covered in a manner that prevents direct contact in order to reduce the risk of a resident burning. Windows above the ground floor must be reviewed to ensure that residents cannot fall or climb out. Emergency lighting in the home must be checked at the required monthly intervals. 1/7/05 1/7/05 14/6/05 1/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 17.2 36.2 Good Practice Recommendations Residents should be referred to an advocacy service where they have no relative or friend to represent their interests in the home. A system of formally supervising staff at the required 6 times a year should be introduced. Fairlawn Nursing Home Version 1.10 Page 23 Commission for Social Care Inspection 1st Floor Newland House Campbell Square Northampton, NN1 3EB 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 Fairlawn Nursing Home Version 1.10 Page 24 - 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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