CARE HOMES FOR OLDER PEOPLE
Fairlawn Nursing Home 87 Higham Road Rushden Northants NN10 6DG Lead Inspector
Mrs Linda Preen Unannounced Inspection 20th October 2005 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 Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V255257.R01.S.doc Version 5.0 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 01933 413187 Mr Tissa Nihal Atapattu Mrs Nelum Vijayanthi Atapattu Clutilda Skinner Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Fairlawn Nursing Home is situated on the main road through Rushden. It is within easy access of the towns of Rushden and Higham Ferrers. A local bus service is easily accessible. The home provides accommodation for 24 residents in single and shared rooms, and caters for elderly residents with dementia related illnesses. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One hour was spent prior to the inspection reviewing previous requirements and recommendations, comments from resident’s relatives and collating information provided by the service. The inspection took place over a period of three 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 rotas and training records were seen. 4 comment cards had been received from relatives, which were very positive concerning the care and attention provided. What the service does well: What has improved since the last inspection?
A programme of activities has been implemented to provide stimulation for the residents. On the morning of the inspection, residents were enjoying a beanbag game and listening to old time music. Work has continued to improve the standard of care plans to ensure that all staff are aware of individual resident’s needs. New carpets have been fitted in all halls and corridors and also in one residents room, and these have greatly improved the appearance of the home.
Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 6 More emphasis has been placed on staff training, and a total of 9 carers currently hold a National Vocational qualification in care with two more working towards this award. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 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 the following standard(s): 2 and 3 Residents may be assured that their needs may be met in the home, and are aware of their terms and conditions of residency. EVIDENCE: Comprehensive assessments of residents needs were available in the care plans monitored. These included both physical and mental health needs as well as lifestyle and personal history in order for staff to provide individualised care. Residents or their advocates have been provided with copies of Terms and Conditions to ensure that they are aware of the services to be provided. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 10 Staff have sufficient guidance to enable them to meet individuals needs. Privacy and dignity is respected within the home. EVIDENCE: Work has been done to provide more comprehensive and individual care plans for the residents. This ensures that staff have clear guidance as to how to meet individual needs. One of the care plans seen had been updated monthly, but omissions in the updating of the other one, meant that problems, which had been resolved, appeared to still be in place. For example: the resident was recorded as having an abscess but this had now healed. A requirement was made in this respect. Residents assessed as being at risk of developing pressure ulcers had the appropriate pressure relieving equipment in place. One lady spoken to stated that the staff looked after her very well. All residents seen appeared well groomed and well cared for. Staff were observed to be treating residents with respect and with due regard to their dignity. Privacy screens were available in shared rooms. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 12, 13 and 14 Individual choice is considered when planning the resident’s day. Contact with family and friends are encouraged. EVIDENCE: Records were available of individual residents preferences for the times of rising and retiring, activities and food. One resident had chosen to have a lie in and was enjoying a late breakfast in his room. Residents were sitting in their own rooms or in one of the lounge areas according to personal choice. A group of residents were enjoying a beanbag game in the front lounge. Activities are provided by an outside company every two weeks as well as by the staff in the home. Records of individual residents participation in activities was available in the files seen. Advice was given that this record should not contain other resident’s names in order to comply with the Data Protection Act. One resident was enjoying a visit from relatives at the time of the inspection and they were very appreciative of a recent barbeque and clothes party, which had been arranged in the home. One gentleman was planning to have a birthday party in the home during the following week. The Registered Manager stated that one lady had been out with her daughter and had thoroughly enjoyed it. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 11 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 the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 19, 20, 23, 24, 25 and 26 Residents live in homely surroundings, which are well maintained and clean. EVIDENCE: A tour of the environment was undertaken. All areas seen were clean and tidy and decorated in a homely manner. A new carpet had been provided for all corridor and stair areas as well as one residents bedroom which had greatly improved the appearance of the home. Resident’s rooms seen showed evidence of personalisation with small items of furniture, pictures and ornaments on display. New radiator covers have been provided since the last inspection to reduce the risk of residents burning themselves, and window restrictors have been fitted to the first floor bedrooms to prevent residents from falling out. Cot sides have been provided with padding to prevent injury to residents and the bath hoist has been refurbished. These were requirements at the last inspection and have now been met.
Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 13 There was an odour of urine in one resident’s room and the Registered Provider stated that he was in the process of ordering alternative floor covering for this resident who had a problem with inappropriate urination. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Recruitment procedures protect residents from potential harm. The home has a commitment to staff training in order to provide residents with the best possible care. EVIDENCE: Duty rotas seen demonstrated that five staff are on duty in the morning, four in the afternoon and three at night, which appears sufficient to meet the needs of the current resident group. Advice was given concerning the provision of staff according to resident dependency and the Residential Forum Guidelines on care staffing is recommended. A selection of staff files was chosen to monitor. These demonstrated that the relevant Criminal Records Bureau and POVA 1st checks are now in place. This was a requirement at the last inspection and has now been met. Several overseas staff are employed in the home, and although they have work permits, these are not always for this employment. The Registered Manager stated that the new permits had been applied for but had not yet been returned. A requirement was made in this respect. The Registered Manager has made great efforts to improve staff training in the home. An induction programme in line with the Training Organisation for Personal Social Services guidelines is in operation. A total of 9 staff now hold a National Vocational Qualification in care with a further two working towards this award. A training matrix was available to demonstrate staff training in statutory subjects. 10 staff have recently completed Food Hygiene training, 4 have done Health and Safety, 3 have done Loss and Bereavement, and all
Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 15 qualified staff as well as 3 carers have completed First Aid training. 11 staff are due to complete fire training on the 31st October with 4 staff booked to do dementia training on the 26th October. This training is reflected in the improved standard of care provided in the home. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38. The Registered Manager ensures that the home is run efficiently, in a way that serves the best interests of the residents. EVIDENCE: The Registered Manager has worked hard to improve the care provided in the home. She has recently completed her Registered Managers Award and is a Registered Nurse with many years experience of caring for this resident group. Systems are in place to audit standards in the home, including resident plans and the environment. A falls audit has been introduced to try to monitor their incidence and find a method of reducing these. Staff meetings are held to update staff on developments in the home and to share ideas and opinions. One of these meetings was scheduled for the afternoon of the inspection. Records of staff supervision were available in the staff files seen.
Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 17 The Ethos of the home has been changed to allow individual resident choice concerning their daily life and not to fit in with staff shift patterns. Residents choosing to stay in their rooms or lie in bed late according to individual preference demonstrated this. As stated earlier, staff have received First Aid training and also Moving and Handling training. Records of the testing of fire alarms and emergency lighting were seen and found to be satisfactory. Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 18 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 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 19 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 2 Standard OP7 OP29 Regulation 15(2)b 19(1) Requirement The resident’s care plan identified must be updated to reflect her current needs. Evidence of valid work permits for all overseas staff must be sent to the Commission for Social Care Inspection Timescale for action 01/11/05 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fairlawn Nursing Home DS0000045316.V255257.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Northamptonshire Area Office 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
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