Care Home: 21 Fairfield Close

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What the care home does well There was a welcoming and friendly atmosphere within the home. The home was clean and comfortable. The service is person centred in its approach and is changing some of its documentation to equip this further. People living at Fairfield have their medical care needs met via the involvement as required of health care professionals. Staff selection procedures are in place to reduce the risk of unsuitable persons gaining employment within the home. What the care home could do better: The area manager agreed that improvement is needed regarding the recording and management of medication. A full audit of training is needed to ensure that people have received the necessary training to enable them to have the skills and knowledge in order to carry out their role and to ensure that records are up to date. Random inspection report Care homes for adults (18-65 years) Name: Address: 21 Fairfield Close 21 Fairfield Close Worcester Worcestershire WR4 9TX three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Andrew Spearing-Brown Date: 1 5 0 6 2 0 1 0 Information about the care home Name of care home: Address: 21 Fairfield Close 21 Fairfield Close Worcester Worcestershire WR4 9TX 01905616527 Telephone number: Fax number: Email address: Provider web address: www.dimensions-uk.org Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Elizabeth Chambers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dimensions (UK) Ltd care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 5 The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5 Date of last inspection Brief description of the care home 21, Fairfield Close is registered to provide residential care for up to five adults who experience a learning disability. The premises is a large, detached bungalow, situated in a residential area on the outskirts of Worcester, with easy access to public transport. The home has access to Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home its own transport. Local amenities include a community resource, medical centre, shops and take aways. The home is owned and run by Dimensions (UK) Ltd., and is part of The New Dimensions Group, which was formed in 2001, and as the parent Company, provides strategic direction and a range of functional support services. The organisation has evolved from the New Era Housing Association, which had been established for over 30 years. The philosophy of Dimensions UK is, `to help people with learning difficulties live the life they want?. The stated purpose of the organisation is, to work with people with learning difficulties, supporting them to make choices and to exercise control over their lives, and the main aim of the home is, to deliver a person-centred response to the needs and aspirations of the people we support. For up to date information regarding fees charged the reader should contact the service directly. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This inspection was unannounced. Therefore nobody within the home knew that we were going to visit. The inspection was carried out by one compliance inspector over the period of one day. The last key inspection at Fairfield Close was carried out during June 2007. The outcome of that inspection was that we rated the service as Excellent. We carried out this inspection to see if the service is still maintaining this level of service. Since our last inspection we have written an Annual Service Review (ASR) about the service. An ASR is a document we produce taking into account information we have received about the service without carrying out a visit to the home. During our visit we looked at some records such as care records, medication records and staffing records. The newly registered manager was on annual leave when we visited. She did however visit the home for a short period of time before having to leave due to other commitments. We had discussions with the area manager, who attended due to our visit, and some of the support workers who were on duty during the day. We had some brief discussions with people who reside at Fairfield in order that we could establish their experiences of the home. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA) from the service. The AQAA is an opportunity for providers of a service to tell us about areas where they are doing well and areas where they believe further development is needed. At the time of this inspection 5 people were living at the home, therefore the service had no vacancies. We were informed that the most recently admitted resident moved into the home over 12 months ago. We were informed that the person concerned was living at another home within the organization and was therefore known to people at Fairfield beforehand. The person concerned visited Fairfield on a few occasions prior to moving in to ensure that it was going to be a suitable placement. Within our previous report we wrote that information about the home is provided for people. This is to help them decide whether the service is suitable and able to meet identified care needs. The AQAA told us that there is a Statement of Purpose available for all to see. We asked the support staff for sight of the Service Users Guide. Although staff were aware of a document a copy of the guide could not be found within peoples bedrooms or elsewhere within the home. As part of this inspection we assessed the management of medication. Medication is stored in lockable cabinets within each individuals own bedroom. The key is held by the support worker in charge of the shift. We saw a copy of the British National Formulary which is a reference book on medicines. The copy we saw was however over 10 years old and therefore its replacement with a more up to date version is recommended. A sheet showing who is able to administer medication was held within each persons file. These sheets were not complete as not all members of staff had signed them to show a Care Homes for Adults (18-65 years) Page 4 of 11 specimen signature. The homes medication policy was held within each persons own file. We looked at some peoples current Medication Administration Record (MAR) sheets and found that overall they were documented with a signature for administration. The time of administration was highlighted on the MAR sheets making the process easier. We also saw a photograph of each resident on file. Usually two members of staff are involved in the administration of medication and generally both sign the MAR sheets. We did however see some gaps where staff had failed to sign for medicines or enter a code to account for why it was not administered. We checked the blister packs and found that the medication had been removed therefore indicating that staff had administered them as prescribed. The home had a small number of boxed medicines. The date of opening was not recorded on these items so we were unable to carry out an audit to confirm that people had received their prescribed medication. The service carries out a stock audit of medication prescribed on an as and when basis. We viewed these and found the vast majority of them to be correct although one was not when we carried out a further audit taking into account medication signed as given on the MAR sheet. Within one cabinet we found a box of medication which, although the correct medicine, it had somebody elses name upon it and the dose to be prescribed did not match with the MAR sheet. We asked about the whereabouts of some medication as we could not locate them in the cabinet, however the audit sheets showed them to be available. We were informed that they were returned to the supplying pharmacy. Unfortunately as the returns book was with the pharmacy we could not check these. We saw that handwritten entries on to the MAR sheets are not double signed to show that people have recored the correct information. On occasions staff had also not recorded other information on MAR sheets such as the date when medication was received into the care home and the quantity. We saw MAR sheets which did not have the month recorded upon them which made auditing more difficult to ensure that peoples medication matched with the written records. Staff had generally recorded when people had seen a GP or another medical person as well as changes to medication. We did see one occasion when a member of staff had recorded a drug with a different name in the daily records to the medication upon the MAR sheet. We saw one drug on a MAR sheet whereby we were unable to establish how the medication was prescribed as no record existed. Information on medication within care records was not up to date in that it did not match the current months MAR sheets. From the records it was evident that the service contacts professionals such as GPs, psychiatrists and chiropodists as needed. People living at Fairfield receive an annual well being check up. We were told that nobody was receiving a service from community nursing services at the time of our visit. The outcome of contact with professionals is recorded and highlighted within a communication book requesting staff to read the relevant up date. This arrangement may not always work as one person was not aware of a request made by a chiropodist. Each person had two files containing care plans. We looked at one persons file in the presence of the resident and found that it contained useful and detailed information regarding the support required in order to meet needs. The plan was person centred in areas such as the use of a hearing aid and the settings required. Risk assessments were in place however these did not cover all areas of known risks or were not updated . For Care Homes for Adults (18-65 years) Page 5 of 11 example we saw staff moving somebody in a wheelchair without footrests in place. However, the risk assessments made no reference to this practice. We saw that the person concerned had bed rails on the bed as well as a pressure relieving mattress. A risk assessment was in place regarding the rails stating that Regular check to be made to ensure rail frame is still correctly in place over bottom of bed. This statement was incorrect and we were not able to establish what checks take place. The risk assessment needs to ensure that entrapment risks are identified. We saw no details regarding the mattress or the risk of developing sores. We discussed the fact that the mattress was placed on top of the bed base without any other mattress in place. We were assured that the community nursing team were consulted and that this was in order, however no risk assessments existed. One person had a detailed My Needs document. This document was completed using pictorial images making it easy to understand. We also saw another document within the other file which was out of date especially in relation to dietary care needs. We were informed that this would be re written using the information within the My Needs document. The staff on duty had a good understanding of peoples needs and the practice we saw during our visit was good. We were told that the service is moving towards a person centred approach. We were told that staff support people to be as independent as possible. For example by residents putting their own tea bag in to a mug prior to staff pouring on the hot water. We saw one resident taken to the laundry in a wheelchair in order for her to place the washing into a basket herself rather than the member of staff just doing it. On the afternoon of our visit residents took part in a group activity within the lounge with the Music Man. We saw residents joining in playing instruments. We were told about holidays either those planned for the future or already taken place to destinations such as the Isle of Wight and Weston. Information was available within the service regarding how to make a complaint. We also saw information in relation to safeguarding vulnerable adults. We were informed that training on safeguarding is planned for the foreseeable future. We, the commission, have not received any concerns or complaints about the service provided. Within the AQAA the manager informed us that the service had received one complaint over the previous 12 months. The area manager was able to tell us about this complaint and how it was resolved to peoples satisfaction. Records regarding this complaint could not be sought within the home. The area manager did offer to obtain records from head office however we were confident that the matter was satisfactorily resolved. We looked at training records and discussed training with the staff on duty. In some cases it appeared that the training records were not up to date as people assured us that they had received an up date. In other cases however it appeared more likely that staff had not received refresher training in line with the expectations of the organization. It was agreed that a full review needs to be undertaken in order to establish any gaps in training and therefore enabling an action plan to be devised. The home has a recruitment process which makes sure that the required checks are Care Homes for Adults (18-65 years) Page 6 of 11 undertaken prior to a new member of staff starting work. The most recently appointed member of staff commenced work at the home over two years ago. We did however see that the service had obtained a CRB (Criminal Records Bureau) disclosure. Having suitable checks in place helps to reduce the risk of someone who is unsuitable gaining employment within the home. We had a look around the home. The front lounge is well furnished and appears very homely. The kitchen / dining room is sufficient in size to sit everybody around a dining table. The back lounge is going to be changed to provide a sensory room. All bedrooms are single and residents are able to personlise their own rooms. The front garden is well maintained. To the rear of the home is a patio area and a raised grassed area. On the patio are some plant pots and a raised flower bed which residents can use. The back garden does however need working upon as the patio had weeds growing between the slabs and the grassed area also had weeds. The AQAA stated that A gardener is now employed on a regular basis to maintain and improve the garden. During our visit we were told that this person works one hour per week. We were however assured that plans are in place to have people carry out work in the back garden. We looked at the homes fire records and found them to be generally up to date. The records did however suggest that the weekly testing of the fire alarm had not happened for three weeks. The area manager checked the diary. The need to remember to activate the alarm was until recently in the diary but was not for the previous two weeks. The other week not recorded was ticked has having taken place within the diary. We saw that until recently the fire alarm was tested in sequential order. However more recently this was not the case. The record regarding the weekly testing of fire doors was also incomplete over recent weeks. Other records such as the servicing of the alarm and fire fighting equipment and the monthly testing of the emergency lighting were in order. Upon the AQAA the manager has recorded that the gas safety certificate was dated March 2009. We therefore requested sight of a more up to date certificate. This could not be found and therefore the service was unable to evidence that the required check had taken place. Other records such as water temperatures, fridge and freezers temperature and night fire records were generally, apart from isolated gaps, in satisfactory order. What the care home does well: There was a welcoming and friendly atmosphere within the home. The home was clean and comfortable. The service is person centred in its approach and is changing some of its documentation to equip this further. People living at Fairfield have their medical care needs met via the involvement as required of health care professionals. Staff selection procedures are in place to reduce the risk of unsuitable persons gaining employment within the home. Care Homes for Adults (18-65 years) Page 7 of 11 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 9 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans and associated risk assessments should be up to date to ensure that individuals health and wellbeing are maintained and to ensure that staff have up to date information in order to meet care needs. A full review of the practice within the home regarding the management and administering of medication should be undertaken to ensure that systems are safe and that people always receive their own medicines as prescribed. A review of training undertaken by staff members should be undertaken in order to establish any shortfalls in training needs. An action plan should be drawn up following the review to ensure any shortfalls are addressed. 2 20 3 32 Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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