Inspection on 11/03/06 for WCS - Fairfield

This inspection was carried out on 11th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

WCS - Fairfield 08/11/07

WCS - Fairfield 27/10/06

WCS - Fairfield 10/08/05

WCS - Fairfield 30/11/04

WCS - Fairfield 07/06/04

WCS - Fairfield 11/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE WCS - Fairfield Butler Crescent Exhall Coventry West Midlands CV7 9DA Lead Inspector Patricia Flanaghan Unannounced Inspection 11th March 2006 12:30 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 WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 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. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service WCS - Fairfield Address Butler Crescent Exhall Coventry West Midlands CV7 9DA 02476 311424 02476 490018 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) Warwickshire Care Services Limited Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Fairfield is a former Local Authority, purpose built home for older people. Situated on a large housing estate in Exhall, it lies between the town of Bedworth and the city of Coventry, and is close to local amenities such as shops, pubs and a bus route. The home has good parking and landscaped gardens to the front and rear of the building. The home is on two floors and is organised into five units. The home is staffed over 24 hours by a management team, carers and ancillary staff. Nursing care is not provided, but service users who require the attention of a nurse can access one through the community nursing service, as they would if living in their own homes. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place on a Saturday between 12.30pm and 6.50pm. This was the second visit of this inspection year. Discussions took place with eight residents and three staff members. The inspection focused on the standards relating to medication, health and safety and staffing. Not all documentation was examined as staff on duty at the time of the were unaware of the location of certain pieces of documentary evidence. A service questionnaire was completed by the home and returned to the Commission for Social Care Inspection (CSCI). The manager was asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Four responses from relatives or residents had been received by the CSCI at the time of writing this report. These responses were all positive in their views of the home. What the service does well: The home provides a spacious, pleasant and personalised environment for people to live with a variety of social and recreational activities are provided. The atmosphere in the home was relaxed and peaceful during the inspection. The manager ensures that sufficient staff are on duty at all times to respond to the needs of the residents. Staff have good access to training and this is encouraged and supported by the manager and organisation. The training provides them with the knowledge and skills to deliver the care service that is needed. The residents spoken with were happy with the care provided and felt able to talk to the manager and staff if they had any concerns. Observations during the inspection showed that staff were interacting appropriately with residents. Discussions with staff evidenced that they were aware of resident’s individual needs and their likes and dislikes. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 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 WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 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): 3 All prospective residents are assessed prior to their admission to the home. The assessment completed by the home’s staff would benefit from more detailed information in order to ensure that the individual’s needs are fully met. EVIDENCE: The files of two residents were examined including that of a newly admitted resident. The admissions process includes obtaining a copy of the Assessment and Care Management Team’s (ACM) care plan provided by the social worker (if applicable). Once this documentation has been received an assessment is undertaken by staff from Fairfield. Appropriate pre-assessment documentation was seen on one of the files. Examination of the file of a recently admitted resident identified that information had been obtained from the resident, the resident’s previous care home and from relatives. The community care plans provided by the social worker, as part of the individual needs assessment process, were seen within the file. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 9 Standardised pre-admission assessment documentation is used when visiting potential residents. Relevant information is collected and a decision is made whether the resident’s needs can be met at the home. Staff start to compile care plans once the decision has been made to admit the resident. Information obtained during the initial assessment is used to form care plans. An examination of the pre-assessment documentation completed by staff in Fairfield identified that the sections relating to Nutrition, Falls and Personal Care had not been completed. The lack of information may not adequately provide staff with the information they need to satisfactorily meet individual residents needs. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 10 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 and 9 There has been progress on care planning. The addition of more detailed information will assist staff to have the knowledge to ensure that residents’ social and health care needs are met. Residents are not consistently protected by the home’s policies and procedures for dealing with medicines, which could result in errors being made and risk to resident’s health. EVIDENCE: Two care plans, including that of a recently admitted resident, were examined. The care plan of the resident admitted within the previous month gave details of some of the assessed needs, but needed to contain more information on how these needs are to be met. For example, the care plan documentation was blank, although the pre-assessment information provided by relatives and the ACM team indicated that the resident needed prompting to undertake personal care tasks. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 11 The organisation’s admissions policy and procedure seen stated that ‘in the first week the process of establishing a care plan can be actioned.’ Risk assessments were on file, but again needed more detail of the particular risks applicable to the individual and how these risks are to be minimised. For example, the ACM assessment stated that the resident ‘is not aware of impending seizure’ and a relative provided information stating that the resident had ‘fallen many times in the last year – some seizure, others poor mobility.’ The care plan of the resident who had lived in the home for a longer period of time was seen to set out in detail the action that is required by staff to ensure that all aspects of their care needs are met. The plans had been completed with the involvement of the resident, which gave them the opportunity to agree the level of help they needed from staff. Systems are in place for ordering, storage, administration and disposal of medicines. Medicines are administered by senior care staff who have received appropriate training. The arrangement for the management and administration of medications were observed and discussed with the senior carer on duty. It was observed during the lunch time medication round that a resident was given her medication and left to take it unsupervised although the Medication Administration Records (MAR) had been completed. The signing of the MAR charts is a confirmation that the medication has been taken properly and therefore must be signed after the administration process has been completed. Criteria for ‘as required’ (PRN) administration was not clearly defined and recorded on MARs. When amendments were made, for example a dosage change to Warfarin, to entries on the MAR charts it was noted that the home was not requesting written directions from the hospital to make the required changes. Handwritten instructions had not been countersigned by another appropriately trained member of staff. The integrity of some of the MAR charts could not be guaranteed because there were examples of where medication had not been given yet the MAR charts had been signed to confirm that they had. A number of gaps, where a signature to confirm administration or an abbreviation for non-administration should have been, were observed. Medication, which upon opening had a short shelf life, was found without a date of opening on the containers. One of the medicines involved were two bottles of Calogen energy supplement (use within 14 days of opening). WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 12 Observing the dispensing date on one of the bottles, July 2005, if the bottle had been opened at the time of dispensing then the medication was well past its expiry date. The home was asked to remove this item for disposal and replace with new stock that would be dated upon opening. The number of tablets/capsules in stock at the end of the four-week period are not carried forward to the next cycle, thereby making it difficult to evidence an audit trail. There appeared to be up to six months worth of stock present in some instances. For example, there were 12 boxes of Warfarin 1mg evident for one resident, some dating back to August 2005. This was indicative that the ordering process was wrong in the fact that the home were not checking the prescriptions for accuracy prior to them being dispensed by the Pharmacy. The home was asked to rectify the situation and inform the Pharmacy of any stock that was not required. Tablets were missing from the blister pack for the forthcoming week. For example, Bendroflumethiazide 2.5mg was missing for two mornings on Week 4 of the cycle for one resident and Madopar was missing from the blister pack for the next day (Sunday) for another resident. The home did not have a Controlled Drugs cabinet, instead any controlled medication is kept in the cupboard of the medication cabinet on the top floor. In order for the home to meet this part of the standard the home will need to obtain a metal cabinet, which conforms with the Misuse of Drugs (Safe Custody) Regulations 1973 and install it on to a solid load-bearing wall using expanding rag bolts. There were no controlled drugs in the home at the time of the inspection visit. The Controlled Drugs register could not be found by the senior care staff. The senior carer accompanied the inspector throughout the medication inspection and detailed feedback of the findings was again given at the conclusion of the inspection visit. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents receive suitable meals in pleasant surroundings, which promotes social interaction and wellbeing. EVIDENCE: Meals are served by care staff in the dining area within each separate unit presenting a homely environment, which encourages socialising between residents. Meals can also be served in resident’s own rooms if preferred. Choices are available at mealtimes. Each unit has a kitchenette with a fridge and microwave. Meals are transported from the kitchen in heated trolleys and served to residents by care staff. Meals were seen to be nutritious and well presented and the residents were seen to eat heartily and really enjoy their meals. A brief inspection of the kitchen found it to be clean and in good order with evidence of ample foodstocks. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 14 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): 16 and 18 Systems are in place to ensure any complaints or allegations of abuse received are listened to and referred for investigation as appropriate. The home has systems in place to protect residents from the risk of abuse. EVIDENCE: Standard 16 could not be fully assessed. The complaints procedure was available in public areas. The record/log of any complaints received could not be found by staff on duty, therefore evidence was not available to demonstrate that complaints are taken seriously by the home and are appropriately followed up and investigated. No complaints have been received by the CSCI for this home. A discussion with staff demonstrated that they would respond appropriately to any concerns or complaints raised by residents or their visitors. Residents spoken with said they would speak to the manager or any care staff if they had any concerns. One resident advised that “we have nothing to complain about, nothing is too much trouble for the staff.” This standard will followed up in more detail at the next inspection visit. Comprehensive procedures for the protection of vulnerable adults are in place. Discussions with staff demonstrated a good understanding of recognising the types and signs of abuse. Staff knew how to report any allegations of abuse. A number of staff had attended training on the protection of vulnerable adults the week of the visit and details were seen of a forthcoming training session for the following week. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 15 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): 26 The home is clean, pleasant and hygienic in communal areas. EVIDENCE: At the time of the inspection the home was clean and warm and there were no offensive odours. The laundry is situated on the ground floor. A laundry assistant is employed between the hours of 8am – 12pm on weekdays. Care staff on duty are responsible for laundering clothing outside of these times. A satisfactory system is in place to ensure that cross contamination does not occur between dirty and clean laundry. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 16 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): 29 The procedures for the recruitment of staff require more attention to ensure that all safeguards are accessed to offer protection to residents living in the home. EVIDENCE: Standard 28 could not be assessed. The staff training records seen did not appear to be up to date. It was therefore difficult to evidence that all staff have received training appropriate to the residents needs. The training records were discussed with the senior staff member of duty and the home is advised to put together details of the current records, which will enable them to keep training up to date for all staff. It is important that a consistent system is in place that ensures staff receive all mandatory training and other training that ensures the needs of residents are met. This standard will be assessed at the next inspection visit. The recruitment files of two recently employed staff members were examined. The files were seen to contain evidence to confirm that staff are interviewed and that vetting checks are taken up before staff start work, including evidence of identity and two references. One of the files did not contain evidence of a POVA First / Criminal Record Bureau Checks (CRB) and the other file contained a copy of an email received from the organisation’s Human Resources department stating that an enhanced disclosure had been completed for the staff member, but it did not detail the results of this check. There was no evidence that these outstanding CRB checks had been followed up by the home. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 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 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): 35 and 38 The management of resident’s money provides security and safeguards their interests. Evidence seen at the inspection confirmed that the health, safety and welfare of residents are promoted and protected. EVIDENCE: Monies held at the home on behalf of residents are handled in line with the homes policy of handling resident’s money, ensuring their financial interests are safeguarded. A sample was checked and found to be satisfactory. Secure facilities are provided for the safe keeping of monies. It is recommended that a risk assessment is undertaken on the practice of leaving the key cabinet unlocked while the office is unattended. This could mean that confidential records and residents monies are not always kept securely. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 18 No health and safety hazards were observed during the inspection visit. Records related to maintenance, contracts and servicing could not be examined, as the manager responsible for supporting operations in the home was not available. This standard will be followed up at the next inspection visit to the home. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 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. 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement Timescale for action 30/04/06 2. OP7 15 3 OP9 13(2) The manager must ensure that a comprehensive pre admission assessment is completed for all prospective residents to ensure that their needs can be met. Meaningful care plans must be developed from this initial assessment. 30/04/06 The manager must ensure that each resident has a care plan. Care plans must set out in detail the action needed to be carried out to ensure that all aspects of the health, personal and social care needs of each resident is met. Care plans must be up to date and reflect the current needs of individual residents. These must be reviewed monthly as a minimum. The manager must make 30/04/06 arrangements for the safe handling, storage and recording of medication in accordance with the home’s policy and procedure. A clear audit trail of all medication in the home must be maintained. DS0000004264.V286485.R01.S.doc Version 5.1 WCS - Fairfield Page 21 4 OP9 13(2) Medications that have a short shelf life when opened must be dated upon opening and discarded at the appropriate time. Clear written guideline must be available to staff informing them of the circumstances for when “when required” medication may be administered. 30/04/06 5 OP9 13(2) The stock of medication must be rotated so that the oldest is used first. All medicines administered/non 30/04/06 administered must be recorded immediately after the transaction with either a signature or a defined abbreviation. All gaps on MAR charts must be investigated and appropriate action taken. The manager must ensure that all staff have a Criminal Records Bureau check and that this can be evidenced. 6 OP29 19 30/04/06 WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 22 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 5 Refer to Standard OP9 OP9 OP9 OP28 OP38 Good Practice Recommendations The manager should regularly audit the medication to ensure the integrity of the MAR charts is maintained. It is recommended that the home obtain a Controlled Drugs cabinet, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. A competency-monitoring programme to ensure the correct administration of medication must be developed and completed on a regular basis. The Registered Manager should ensure that at least 50 of care staff have obtained or are working towards an NVQ level 2 in Care. The manager should risk assess the current practice of the key cabinet remaining unlocked when the office is unattended. WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 WCS - Fairfield DS0000004264.V286485.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!