Care Home: Fair Haven

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What the care home does well Staff are committed to providing a friendy, caring home for people. The food is very good and the choices have increased. A cooked breakfast is available every day. Care plans are being written in a more person centred way that means people`s views are more evident. What has improved since the last inspection? Care plans and risk assessments are reviewed and updated so that people`s needs are met. The procedure and recording of money being handled in the home is much better and ensures people`s finances are safe. Care staff are receiving supervision to ensure their practice is maintained. What the care home could do better: Any safeguarding issue must be reported to the local authority safeguarding team to ensure people living in the home are kept safe. Ancillary staff should receive supervision to maintain good practice. The way medication is administered must be according to the training staff have received to ensure the health and wellbeing of people living in the home. Key inspection report Care homes for older people Name: Address: Fair Haven Fair Haven 102 Station Road Soham Ely Cambridgeshire CB7 5DZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Alison Hilton     Date: 1 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Fair Haven Fair Haven 102 Station Road Soham Ely Cambridgeshire CB7 5DZ 01353720916 01353624475 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Kanagasooriam Ravivaruman care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 19 The registered person may provide the following categories 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: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Fairhaven is a service for 19 older people some of whom have a diagnosis of dementia, and is situated in the town of Soham. The cities of Cambridge and Ely are within a reasonable distance of the home. Local resources are accessible for those who are able to go out independently and members of care staff will escort people to the town when possible. Care Homes for Older People Page 4 of 23 Over 65 0 19 19 0 2 0 1 0 2 0 0 8 Brief description of the care home The registered manager has returned from maternity leave. Accommodation at Fairhaven is on two levels, accessible by stairs or passenger lift. The majority of bedrooms are single, but there are some double bedrooms. The home is situated in a quiet road, with adequate parking and an enclosed back garden. On the same site is another residential service for three adults with learning difficulties. There are no shared facilities. Details of the weekly fees can be requested directly from the home. Extras are charged for hairdressing, chiropody and toiletries. The inspection report is available from the office at the home. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Care Quality Commission (CQC) carried out this unannounced key inspection on Monday 19th October 2009 at 07:25hrs, using the Commissions methodology described below. This report makes judgements about the service based on evidence we have gathered. Staff (including night staff), people who live in the home and the manager were spoken to. An Annual Quality Assurance Assessment (AQAA) was completed and returned to the Commission prior to this inspection. This provided us with some facts and figures which we used in the report. A number of records were seen, together with two staff files and three files of people living in the home. There were 18 people resident in the home at the time of the inspection. Care Homes for Older People Page 6 of 23 Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide provide the information needed for people to decide if the home and staff can meet their needs. Evidence: We looked at the Statement of Purpose and Service User Guide and they had the necessary information in them for people to know what the home offers. The manager said people are encouraged to visit where possible. We spoke to people in the home about how they chose Fairhaven. One person said that their family had visited because they had been in hospital, My family visited two or three different places, and another said they chose it because it was near to their former home. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The administration of medication is not undertaken according to the procedures in the home meaning that the health and wellbeing of those in the home cannot be guaranteed. Evidence: Staff were observed giving medication and seen to place pills from the blister pack in their hand before putting them into the pot to be administered to the person. Staff were asked about this and said the pills were difficult to get out of the blister packs. In conversation with the manager it was suggested a different method be used to administer medication to prevent cross infection or reaction to another persons medication. The same staff member also signed the medication as administered before the person had taken it. They were asked whether this was normal practice and admitted it was because they knew the person would not refuse. We discussed what would happen if the person dropped a tablet and how this would be recorded. The staff member was aware of how and where this would be recorded. The manager was told about the issues and said there was training arranged for the 21st October and she would ensure staff attended. Care Homes for Older People Page 11 of 23 Evidence: The controlled drugs register was checked and found to have been completed and the number of medications in tablet and patch form tallied. The temperature in the room where medication is kept is checked and an air conditioner unit used if it is too warm. This means medication is kept at the optimum temperature. Information provided in the single assessment form completed by Cambridgeshire County Council NHS Community services was poor and there were no details as to who had written it, although it was dated. Care plans for three people were seen and one was very detailed and person centred, the others less so. Staff need to make sure they are careful to put the correct information as one persons date of birth was recorded as 10/04/09 and the spelling of their name was different on various paperwork. The care plan was very descriptive and gave information in the first person. For example I am able to say if I would like to use the toilet, but I do have accidents. I am prone to urine infections and carers need to encourage me to drink. I like to listen to the radio in the morning. We saw that the radio was on and being listened to by this person. On another file the person had panic attacks and these were well described and gave staff instructions on how to help the person. Details provided in the AQAA showed that medical needs are addressed promptly via the GP or District Nurse. This was confirmed in the files of people living in the home and when we spoke to them during the inspection. There was information on one file relating to a pressure sore that the District Nurses were dealing with. There was information that other health professionals were involved in peoples care where necessary. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The dietary needs of people living in the home are well catered for with a varied selection of food available to meet peoples tastes and choices. Evidence: People were just getting up when we arrived at the home. Some were dressed and in their rooms and others up in the lounge. Those we spoke to said they were happy to be up. Staff said they got those who had been incontinent up first and it was discussed with the manager that people must have a choice of whether they returned to bed after being changed or went into the lounge. The manager stated she would look into it and ensure staff gave people choice. One person said I read a lot, another goes out for walks. People said they chose what clothes they put on in the morning and when they went to the dining room and lounge. Several said they had family visit them and sometimes take them out as the home did not do this. People said there is a lady who comes in to do different things and work our hands, others were doing puzzles such as wordsearch. The manager said the company does have a vehicle but this had not been used at Fairhaven. Dial-aride do take people out when necessary. Information on the notice board showed that there were a selection of boardgames, chair exercises, massage, quizzes, baking, Care Homes for Older People Page 13 of 23 Evidence: Hama beading, drawing and bingo being provided in the home between 9-12 and 2-4 Monday to Friday. This is an increase in hours since the last inspection. Where time was spent with an individual this included reading to them and writing letters. The manager said there were some trips out and some entertainment bought in, but this was limited. Details in the AQAA showed the manager wants to involve the wider community and also undertake fundraising to finance days out. There was a good choice at breakfast, including a cooked breakfast, which several of those living in the home commented on in a very positive way the food is good; I can have what I want. I have porridge, prunes and toast. Staff were heard to offer choices and when one person was slightly reticent about having a cooked breakfast (because it would be too much trouble) they were assured this was not the case and went on to have a full fried breakfast. People said there was a better choice of food at all mealtimes. Staff said there was now an extra person to cook the breakfasts in the morning and although they were aware of peoples likes and dislikes did encourage them to try different things. Staff in the kitchen were aware of people with special diets and took those into account when creating the menu. Lunch on the day of inspection was meatballs or stuffed chicken, potato, parsnip, cauliflower and green beans with rhubarb crumble and custard or ice cream for dessert. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements and procedures for protecting people in the home must be followed otherwise they will be at risk of harm or abuse. Evidence: Details provided in the AQAA showed that there is an effective complaints procedure and a safeguarding adults policy and procedure in the home and the manager has an open door policy. The manager has not received any complaints and nor has the Commission. There were details of one safeguarding issue that had not been reported to the safeguarding team or the Commission as per the policy and procedure. The manager dealt with the issue immediately. All staff have had Safeguarding of Vulnerable Adults (SoVA) training this year (either February or September) and staff on duty confirmed this. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been no change in decor since the last inspection and some areas are looking worn. Although this does not pose a risk to people living in the home it does not create a pleasing and pleasant environment. Evidence: Details in the AQAA showed that there are plans for the home to be extended and en suite facilities made available. Currently there are some areas in the home that need redecorating and if the extension does not start soon these will need to be looked at, especially in places such as the kitchen where hygiene is key. The AQAA showed that equipment is replaced when necessary and this was confirmed by staff. All cleaning equipment and chemicals were either locked away or on trolleys being used by cleaning staff. There were no malodours anywhere in the home. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff group are relaxed but hardworking ensuring people in the home are well cared for. Evidence: Details in the AQAA showed that there is a robust recruitment process with a 12 week probationary period, which can be extended if necessary. Staff spoken to said they had received the training they needed to enable them to meet the needs of those living in the home. There were details on the notice board that training was available on nutrition (22/10/09) and medication (21/10/09). Some staff said they had completed NVQ Level 2 in Care and intended to undertake Level 3. The manager said that 5 staff currently have NVQ Level 2 and 3 have NVQ Level 3. Two staff files were seen and they contained all the necessary detail. They also showed that staff had not commenced employment until a full and clear criminal record bureau (CRB) check had been received. Staff receive and complete a Common Induction Standard pack and shadow senior staff on shifts until the manager feels they are competent to work independently. The rota given to us during the inspection was not a true reflection of staff duties. The manager stated she had been directly supervising a new member of staff but the rota Care Homes for Older People Page 17 of 23 Evidence: did not show her on duty at the correct time to enable her to do this. The manager stated that the rotas would be up to date with correct hours worked. There are three staff in the morning, two in the afternoon and one waking and one sleeping in at night. The manager stated that there will be two waking nights whenever possible and the home is recruiting at the moment. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has a clear vision for the home and provides clear leadership, which ensures staff provide effective and supportive care. Evidence: The manager is competent and experienced to run the home and is intending to complete the Leadership and Management qualification but does not have a start date. Details in the AQAA showed that the manager ensures staff supervision is done regularly for night and bank staff (as well as regular staff). There was some evidence that care staff receive supervision and those on duty confirmed this; however ancillary staff do not. This was discussed with the manager as the regulations state that all other staff are supervised as part of the normal management process. The manager said they do receive a yearly appraisal. We saw details of a staff meeting held 29/09/09, and information that the manager was holding an open surgery for relatives, residents and next of kin on 04/11/09. Care Homes for Older People Page 19 of 23 Evidence: We saw evidence of numerous safety checks and fire checks in accordance with the regulations. The last fire drill was held on 23/02/09 and the names of those who attended were detailed. There was a special risk assessment for each person living in the home in relation to evacuation from the building, which would provide people with the necessary information when needed. There were details of a quality assurance process where staff, people who live in the home and their relatives completed surveys, however the information collected was not used to formulate a plan that could be assessed and reviewed to improve the service provided currently. There was money on the premises for one person and the transactions were seen and found to be correct. Care Homes for Older People Page 20 of 23 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 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, Care Homes 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 1 9 13 Staff must record, handle, and administer medication safely. This is to ensure the health and wellbeing of people living in the home. 23/10/2009 2 18 13 Staff must report abuse as per the policies and procedures of the home. This is to ensure that people who live in the home are not at risk. 20/10/2009 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 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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