Care Home: Fairburn Vale

What the care home does well Care records for ten of the people who live at the home were examined in detail. All of the care files seen included care plans which clearly set out the individuals needs and preferences. Comprehensive daily records are maintained for each person and all reflected how the person had spent their time during the day. Many of these records included entries about people having a lie in, staying up late or going for a nap when they wanted one. There was no evidence to show that people were going to bed or getting up early. People spoken with during the inspection confirmed that staff support them to make their own decisions. All of the information included in care charts matched with the care plans and daily records. The operations director said that there had been an incident when a person had beenserved a snack which did not meet with their cultural or preferred diet. Evidence was available to show that this incident had been investigated at length and that the persons family had been kept informed of the incident and the investigation. Care records demonstrated that the needs and preferences of the people who live at the home were set out in care plans and were being met. Several of the people who live at the home have individually designed wheelchairs to meet with their specific needs. All of the ones in use during the visit were being used correctly. Bed rails are in use where this is indicated as required for the safety of the person but other measures are used where possible. For example one persons care plan, for whom bed rails were assessed as being inappropriate, said to have the bed at its lowest level so that if the person rolled out they would roll onto a mat on the floor and not suffer any injury. A pharmacy inspector looked at systems for medication including storage, receipt, administration and disposal of medications. No evidence could be found that care staff any medication other than creams. The pharmacy inspector found evidence that people`s personal preferences about medication are upheld. Some, but not all, people have clear and detailed care plans describing how their medicines should be used. Evidence was available in complaints records to show that whenever a complaint is made to the home it is dealt with in line the home`s robust procedures. All of the staff at the home have received training in protection of vulnerable adults and safeguarding and there is evidence that wherever an issue has arisen it has been referred appropriately under local safeguarding procedures. Records showed that where people have been disciplined, this has been done in accordance with the homes disciplinary procedures. Documentation showed that staff identified by the manager as requiring support and guidance within their work are give this through extra supervision sessions. Nurses spoken said that they would always carry out procedures required to be done by a registered nurse but said that care staff may assist them. This is outlined as part of the duties of the care assistant within the job description. What the care home could do better: The pharmacy inspector said that accurate and timely records of the use of skin medication should be made by the person helping to apply that medication. Hand written MAR chart entries should be sufficiently clear & detailed to be sure that all staff follow the directions & changes correctly. All medicines must be stored securely at temperatures recommended by the manufacturer.Some aspects of medication record keeping should be improved so that all medicines entering the home can be fully accounted for. Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Fairburn Vale Wheldon Complex Wheldon Road Castleford WF10 2PY 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Gillian Walsh Date: 1 3 0 2 2 0 0 9 Information about the care home Name of care home: Address: Fairburn Vale Wheldon Complex Wheldon Road Castleford WF10 2PY 01977521786 01977521787 fairburnvale@exemplarhc.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Fairburn Health Care Ltd care home 20 Number of places (if applicable): Under 65 Over 65 0 0 0 mental disorder, excluding learning disability or dementia physical disability terminally ill Conditions of registration: 10 10 5 Each of the two units within the home will be staffed with a minimum of two carers at all times; and staffing levels will be increased, using the Residential Forum staffing model, in accordance with assessed care needs. Each unit will have a RGN, Level 1, on duty at all times. The home`s full-time manager will be supernumerary to the care and nursing rota. Date of last inspection Brief description of the care home Fairburn Vale is a purpose built facility offering nursing and social care within dedicated units to 10 people between the ages of 18 - 65 with physical disability which may include some mental disorder due to trauma or illness, who require permanent residential care, and 10 people between the ages of 18 - 65 with physical disability Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home which may include some mental disorder due to trauma or illness who have a potential to return to the community. The home shares a site with two other care homes situated on the outskirts of Airedale village and Castleford town centre. There are limited local facilities, although this is partly compensated for by the home having access to a minibus which is used to take residents to nearby shopping and activity centres. Secure garden areas are available and residents have use of patio areas accessed from the home. All bedrooms are single, ensuite and well equipped. Communal areas are spacious and comfortable. The home benefits from the services of a physiotherapist based at the home. Copies of the Service User Guide are placed in each bedroom and are sent to all prospective people wishing to move into the home. Further copies of the Service User Guide and the Statement of Purpose are available in the entrance hallway and on request from the office. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This random inspection was made as a result of an anonymous letter of concern being received by the Commission for Social Care inspection. The visit was undertaken by two regulation inspectors and and pharmacy inspector. The allegations made included poor care practices, care staff carrying out clinical or nursing procedures, care staff being instructed to administer medications they had not been trained to administer, peoples individual needs and preferences not being met and poor and unfair management of complaints and staff disciplinary procedures. The concerns had been referred by the Commission to Wakefield Metropolitan District Councils safeguarding adults policies and procedures who had convened a meeting and a strategy to look into the concerns. The responsible individual for the home was asked by the safeguarding team to conduct an internal investigation into the concerns raised. In order to make sure that this was a fair and open investigation, two senior members of staff were suspended from from duty for the duration of the investigation. This is good practice and is not a reflection of suspicion of poor practice. Time was spent speaking with some people who live at the home, management and some staff. A large number of care records were examined, the homes medication policy & procedures, 19 current medication administration record (MAR) charts and the storage & handling arrangements for all medicines, including controlled drugs. A number of staff files for some people working at the home and for some who have left were also examined The pharmacy inspector found that there are basic procedures for ordering, receiving, administering and disposing of medicines in place. This ensures staff in the home understand what is expected of them when handling and administering medication. The Royal Pharmaceutical Society of Great Britain and CSCI documents on handling medicines in social care should also be available so that staff can refer to current best practice guidance. We found evidence during the visit that people living in the home are able to express a preference about how and when they receive their medicines and that these preferences are upheld. There are some administration gaps on 10 MAR charts, mostly for medicines used on the skin. This means it is not possible to know that people are using all their medication correctly. An accurate and timely record should be made by the carer who has helped the person use their skin medication. Two MAR charts had been amended clearly to include extra instructions to make sure medicines are given correctly but the handwritten entries of medicines on 3 MAR charts are not sufficiently clear and detailed enough to be sure that other staff can follow the changes correctly. There should be an individual plan in place for each person taking medicines prescribed as required. Such plans ensure all staff understand the need to use such Care Homes for Adults (18-65 years) Page 4 of 11 medicines at the right time and for the right reason. Most medicines, including controlled drugs, are stored appropriately in cupboards or in a trolley in a locked store room. Some medicines, including creams and ointments kept in bedrooms are not stored securely. We found some recently delivered medicines which had not been locked away. We also found 8 medicines which should be kept at room temperature stored in the medication fridges. The temperature of the fridges & store rooms are checked and recorded daily. The recorded store room temperatures are higher than the maximum recommended temperatures for storing medicines. All medicines must be stored securely at temperatures recommended by the manufacturer so that staff know they are safe to use when needed. The person in charge of ordering medication sees the regular monthly prescriptions before a supply is made. This is good practice as the checking of prescriptions is an important part of the management of medication in the home. The quantity of medication from one monthly cycle to another is not always recorded on the new MAR chart. This means it is difficult to produce a complete record of medication within the home and to check if medication is being administered correctly. Regulation inspectors found that records showed that where people have been disciplined, this has been done in accordance with the homes disciplinary procedures. Regulation inspectors were unable to find any evidence of poor or inappropriate management practice within the home. Evidence showed that the manager had identified a need for extra support for some staff at the home but this was already ongoing. The majority of the findings relating to care are detailed below in the what the service does well section. Information received through safeguarding procedures since the visit confirmed that the manager had been reinstated but investigations were continuing and any issues would be dealt with. What the care home does well: Care records for ten of the people who live at the home were examined in detail. All of the care files seen included care plans which clearly set out the individuals needs and preferences. Comprehensive daily records are maintained for each person and all reflected how the person had spent their time during the day. Many of these records included entries about people having a lie in, staying up late or going for a nap when they wanted one. There was no evidence to show that people were going to bed or getting up early. People spoken with during the inspection confirmed that staff support them to make their own decisions. All of the information included in care charts matched with the care plans and daily records. The operations director said that there had been an incident when a person had been Care Homes for Adults (18-65 years) Page 5 of 11 served a snack which did not meet with their cultural or preferred diet. Evidence was available to show that this incident had been investigated at length and that the persons family had been kept informed of the incident and the investigation. Care records demonstrated that the needs and preferences of the people who live at the home were set out in care plans and were being met. Several of the people who live at the home have individually designed wheelchairs to meet with their specific needs. All of the ones in use during the visit were being used correctly. Bed rails are in use where this is indicated as required for the safety of the person but other measures are used where possible. For example one persons care plan, for whom bed rails were assessed as being inappropriate, said to have the bed at its lowest level so that if the person rolled out they would roll onto a mat on the floor and not suffer any injury. A pharmacy inspector looked at systems for medication including storage, receipt, administration and disposal of medications. No evidence could be found that care staff any medication other than creams. The pharmacy inspector found evidence that peoples personal preferences about medication are upheld. Some, but not all, people have clear and detailed care plans describing how their medicines should be used. Evidence was available in complaints records to show that whenever a complaint is made to the home it is dealt with in line the homes robust procedures. All of the staff at the home have received training in protection of vulnerable adults and safeguarding and there is evidence that wherever an issue has arisen it has been referred appropriately under local safeguarding procedures. Records showed that where people have been disciplined, this has been done in accordance with the homes disciplinary procedures. Documentation showed that staff identified by the manager as requiring support and guidance within their work are give this through extra supervision sessions. Nurses spoken said that they would always carry out procedures required to be done by a registered nurse but said that care staff may assist them. This is outlined as part of the duties of the care assistant within the job description. What they could do better: The pharmacy inspector said that accurate and timely records of the use of skin medication should be made by the person helping to apply that medication. Hand written MAR chart entries should be sufficiently clear & detailed to be sure that all staff follow the directions & changes correctly. All medicines must be stored securely at temperatures recommended by the manufacturer. Care Homes for Adults (18-65 years) Page 6 of 11 Some aspects of medication record keeping should be improved so that all medicines entering the home can be fully accounted for. 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 7 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 8 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 1 20 13 Arrangements must be made 30/04/2009 to ensure that all medication is stored securely at the temperature recommended by the manufacturer. To make sure that medication is safe to use. 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 20 Professional guidance documents on handling medicines in social care should be available for staff to use in support of the existing medication policy & procedures. Nurses should delegate all associated tasks to suitably trained carers who apply creams and ointments. This includes making their own records on MAR charts so that each individual can take responsibility for and be held accountable for their own actions. Handwritten entries on MAR charts should should be accurately recorded and detailed. This makes sure that the correct information is recorded so that all staff follow the changes correctly. Care Homes for Adults (18-65 years) Page 9 of 11 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 A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. Care plans should contain clear directions for staff to give medicines prescribed as directed or when required (prn) so that these medicines are used safely as intended. Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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