Care Home: Fairdene Lodge

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What the care home does well The atmosphere in the home was comfortable, homely,relaxed and very well maintained. Meals continue to be good with alternatives offered at each mealtime and special diets catered for. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has a well maintained and accessible garden to the rear of the property, which is secure and secluded. There is an open-house policy, which welcomes visitors at all reasonable times and complaints are handled well ensuring that residents feel listen to and their views acted upon. There are sufficient staff on duty during the day to meet the needs of residents and the home is well managed ensuring that residents health and welfare is protected. Comments from returned surveys included: * all the girls are lovely - they look after you well. * I enjoy my visits from my daughters. * always nice to be here. * nice staff and good food. Both the inspector and the expert by experience were impressed with staff interactions with residents and it was apparent that care is delivered with kindness and respect for individuals. What has improved since the last inspection? A suitably qualified person has registered with the Commission and there are now procedures in place to ensure the privacy and dignity of residents is promoted and protected. What the care home could do better: Shortfalls were identified in respect of care plans, risk assessments, medication, the environment and night staffing levels. Following the site visit the Registered Manager supplied an action plan within 24 hours outlining the action she will take to address each of the shortfalls. Following the site visit the registered manager confirmed that the statutory requirements in respect of seeking advice from a dietician, identifying residents leisure preferences and risk assessments during the refurbishment have been met in full. Key inspection report Care homes for older people Name: Address: Fairdene Lodge 14 & 16 Walsingham Road Hove East Sussex BN3 4FF     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: Gwyneth Bryant     Date: 2 1 0 9 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 28 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 28 Information about the care home Name of care home: Address: Fairdene Lodge 14 & 16 Walsingham Road Hove East Sussex BN3 4FF 01273735221 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): fairdenelodge@yahoo.co.uk Mrs Maria Holliday-Welch Name of registered manager (if applicable) Mrs Samantha Brown Type of registration: Number of places registered: care home 32 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 to be accommodated is 32 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Fairdene Lodge is a privately owned residential home for up to thirty-two older people who have dementia. The homes provider also owns further registered homes for older people within the East Sussex area. The home is located within level walking distance of Hove seafront, close to local amenities and bus routes into Brighton and Worthing. The home consists of two detached Victorian houses organised into House Care Homes for Older People Page 4 of 28 Over 65 0 32 32 0 Brief description of the care home 14 and 16, which are interlinked by a ground floor corridor. All residents have access to both houses. It is presented on two levels, ground and first floor with access to the first floor via stairs or a stair lift. The second floor is a self-contained flat, which is currently not in use. Residents accommodation consists of twenty-two single and five shared bedrooms, with eleven rooms having their own en-suite facilities. Shared facilities include a large lounge, combined lounge dining room and a conservatory overlooking the rear garden. The is short term pay and display parking both in Walsingham Road and surrounding streets. The homes literature states that their aims are to provide residents with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. The fees vary from £445 for a shared room to £550 depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport , toiletries are additional costs. Care Homes for Older People Page 5 of 28 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: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Fairdene Lodge will be referred to as residents. This was an unannounced inspection which begun at 09:25 and ended at 14:15. There were thirty people in residence on the day of which one was in hospital. The inspector spoke with three residents, the registered manager, one carer and the registered provider. Five staff returned surveys as did nine residents and the responses and comments are included in this report. A range of documentation was viewed including care plans, risk assessments, personnel files and medication records. Fourteen bedrooms were visited in addition to two communal bathrooms, the communal lounges and dining room and three Care Homes for Older People Page 6 of 28 communal toilets. An Expert by Experience accompanied the inspector on the day. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service and their comments and findings are included in this report. The expert by experience spoke to fourteen residents and three care staff, in addition to visiting a random selection of bedrooms. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was completed well and provided when we asked for it and the information included in this report as necessary. The last key inspection was carried out on 29 June 2007 and an Annual Service Review conducted on 25 August 2008. Care Homes for Older People Page 7 of 28 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 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to ensure all parts of the assessment record are completed and that prospective residents are informed in writing that the home can meet their needs prior to admission. Evidence: The pre-admission sheets for the last two people to be admitted were viewed and while they identified most needs, they did not include information as to how the home will meet those needs. In addition some parts of the assessment sheet were left blank. It is important to ensure that all needs are identified to ensure the home is able to meet assessed needs. Currently the home does not inform prospective residents, in writing, that the home can meet their needs and the registered manager agreed to do this for all future admissions therefore no requirement was made. Care Homes for Older People Page 10 of 28 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 care planning systems need to ensure that all health, medical and personal needs of those living in the home are identified and planned for in a consistent and comprehensive manner. Evidence: Three care plans were viewed in depth and a further two looked at briefly for the purpose of cross referencing with other documents such as risk assessments. While the care plan format was comprehensive and generally included good information, some parts were contradictory for example the care plan for one resident said they had good eyesight but the opticians report said the person was very short sighted. Similar contradictions were found in respect of nutritional needs and use of equipment. One plan said the person could be aggressive and had an obsession with food but no other information was available to direct staff in dealing with these issues. These were discussed with the registered manager who agreed work needs to be done to ensure care plans are clearer. The plans included good information on healthcare needs such as dentist, chiropodist Care Homes for Older People Page 11 of 28 Evidence: and opticians. The District Nurse attends to those residents whose mobility has deteriorated resulting in some tissue breakdown. One resident said to the expert by experience they take me to the doctors or hospital if I need to go which was clearly reassuring due to the health condition in question. There is a nutritional screening record in each care plan but one had not been completed and two had not been completed accurately. Despite the inaccuracy of these records, the weight charts indicated that residents were maintaining their weight. One person is on a liquidised diet and good practice suggests that advice is sought from a dietician to ensure supplements or fortified foods are provided if required. Care plans did include information on residents who tend to wake at night that they should be offered refreshments before being encouraged to return to bed. Daily notes were variable with some giving good information as to how the resident spent their days and others more limited with comments such as all care given. Daily records when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. It was good that one person maintains their independence and goes out alone, however a risk assessment had not been carried out in respect of this. Nor had a risk assessment been carried out for those residents who were smokers. It is important for the home to ensure that risk assessments are carried out and are sufficiently detailed to direct staff in the reduction of the risk. One plan indicated that the resident is diabetic and that the condition is controlled by diet. however no additional information in maintaining an appropriate diet was found and this needs to be addressed to ensure all staff are aware of how to control this condition. Following the site visit the registered manager confirmed that risk assessments are now in place for residents who go out alone, are smokers or diet controlled diabetic. The expert by experience felt that staff interactions were a real strength of the home. Without exception, the staff were observed to respond with a great deal of care and respect. It was also obvious that staff were aware of individual likes. She observed that one resident and a member of staff had a lovely dialogue about custard creams and the resident saying to me she knows what I like and I tell them if Im not happy. Also when residents wanted to smoke this need was pre empted and staff noticed the residents routine and behaviour as this being what they wanted at that particular time. The expert by experience reported that all residents she observed were well presented with attention to detail. Many required assistance with personal care tasks. One resident wanted to brush her teeth (despite having already done so) but was Care Homes for Older People Page 12 of 28 Evidence: gently guided to her room to do this again. Medication charts were viewed and there were a number of gaps and some signatures had either been scribbled out or overwritten with a code letter. It is important to ensure that medication records are clear and that staff follow good practice to ensure it is clear whether or not medication has been administered. The minutes of staff meetings demonstrated that the registered manager was aware of the shortfalls and is monitoring the issue, therefore no requirement was made. The home has yet to purchase an appropriate controlled drugs cupboard in line with the latest legislation and this needs to be addressed. Care Homes for Older People Page 13 of 28 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. People in the home have the opportunity to experience a lifestyle that matches their expectations, choice and preferences in respect of leisure activities and meals. Evidence: There is a range of activities provided and the programme indicated that these are mostly provided in the afternoon although the registered manager said that some are provided in the mornings. Activities include crosswords and puzzle books, mobile library, weekly art session, weekly musician, board games and gentle exercises. Regular open days are provided, whereby families and friends are invited to meet each other and spend the day with residents. Care plans and assessments did not always include preferred leisure activities and where they were identified there was little information to show how the home will meet these individual needs. The home has an open house policy with visitors welcome at all times and residents confirmed this with the expert by experience and said that visitors were always made welcome. The expert by experience spent time with residents and noted that one resident thought the tea trolley had been missed but on asking was promptly served with Care Homes for Older People Page 14 of 28 Evidence: another cup of tea. One other resident wanted another blanket albeit already had two, but this need again was addressed in a very kind and caring manner. The expert by experience noted that although one resident felt there was some limits on choices throughout the day, others generally communicated that they were happy with living at Fairdene Lodge and the choices provided. One resident told the expert by experience that it was difficult to cope when some of the other residents were arguing. She added I just keep quiet and keep myself to myself and dont say anything. In observing this resident over the period of time she was there, she questioned whether the discomfort felt during all the bitchiness was causing some withdrawal or whether there was a natural tendency to be more of a loner but she did feel this particular residents dementia was notably not as progressed as most of the others and presented as quite isolated. The expert by experience observed one newly admitted resident wandering a lot, picking things up, exploring them, putting them down again and often asking what to do and where to be. This suggests a little more attention outside of routine tasks should have been provided and more stimulus to someone who was used to being more active. The expert by experience saw one resident pouring the juice at all the tables in preparation for lunch which indicates that residents are encouraged to remain independent. Some residents preferred to eat either in their rooms or in the lounge areas which was fully supported by staff. It was noted that personal care tasks were undertaken with dignity, care and appropriate humour. It was of concern to note that a resident had defecated in another residents room and the registered manager said that the resident was recently admitted and had mistaken the bedroom for a toilet. It is important that the home provides more supervision for newly admitted residents to ensure such incidents do not occur again as it is not only unpleasant but puts residents at risk of cross infection. Comments in surveys included: * its a lovely place to live. * very good service provided. * staff are always very helpful. * it feels like home. The AQAA indicated that there was a five week menu plan and that three cooked meals are provided each day, in addition to regular snacks and drinks. It was good to note that in communal lounges there were plenty of snacks and drinks for residents. The expert by experience joined residents for lunch and found it to be tasty and well Care Homes for Older People Page 15 of 28 Evidence: presented. She also noted that the lunch tables were pleasantly presented with nice touches i.e. napkins, vases, salt, pepper, mustard and that lunch was enjoyed by all. It was presented in an appetising way and it appeared that staff knew what residents preferences were. Care Homes for Older People Page 16 of 28 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. The home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: The AQAA showed that the home had policies and procedures on both complaints and Safeguarding Adults. The complaints log was viewed and it was found that the home has not received any complaints since the last key inspection in 2007. The registered manager confirmed that all staff have received recent training in Safeguarding Adults and the carer spoken with had a very good understanding of what constitutes abuse. She was also very clear on what to do should she need to whistle blow on management. Care Homes for Older People Page 17 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most parts of the home are maintained providing a homely and comfortable environment for people living in the home; improvements need to be made in respect of on-going maintenance. Evidence: Fourteen bedrooms were visited in addition to two communal bathrooms, the communal lounges and dining room and three communal toilets. Generally the environment was well maintained, clean and tidy. On the day there was work in progress to replace the existing kitchen and repaint parts of the communal areas. There was information outlining the responsibilities of the builders in respect of good practice but a lack of risk assessments demonstrating the action staff will take to safeguard residents. It was of concern to note that cupboards containing paint and/or cleaning materials were not locked although there were clear signs indicating that they should be. This was discussed with the registered manager who dealt with the matter on the day. The home needs to ensure all staff are vigilant whilst the refurbishment is in progress. It was good to note that some bedroom doors had locks fitted and a key on a hook inside the room so residents could be offered keys. One resident already has a key to her room and due to an incident now locks her bedroom door. Following the site visit the registered manager confirmed that all bedroom doors now have locks fitted and Care Homes for Older People Page 18 of 28 Evidence: keys placed on a hook near the door. On spending some time in the upstairs bedroom area, the expert by experience found that one resident was becoming quite agitated. The resident had been shouting for help for about 10 minutes. She eventually went in to the bedroom where the resident needed to get up from the bed. The resident was desperately trying to get up off the bed using a Zimmer frame but could not manage to do so. She went to alert a member of staff who promptly went to reassure but as she was assisting someone else to get dressed at the same time had to leave the resident again and it was a further 10 minutes before the resident was attended to during which time again became agitated and began to cry for help. There needs to be a plan to ensure call bells are answered promptly, with other staff assisting if necessary. Another resident she spoke to was still in bed but said to be happy with lying in and that everyone is very kind to me and that her bed was comfy. The expert by experience noted that one bedroom had a kettle on the floor and discussion with the registered manager found that a risk assessment for its use had not been carried out. Following the site visit she informed the commission that a risk assessment had been carried out to ensure the resident was not at risk of scalding. One resident told the expert by experience that another resident never stopped talking quite loudly and said it drives me mad, its constant and I cant get away from it. She noted that area designated as the quiet spot did have the television on with the sound turned up to loud but no one watching it and that trying to have a conversation nearby did prove difficult. There was also another television in the other lounge area which was on with some residents watching it whilst others dozed. The expert by experienced question the need for more memory/ sensory prompts and the need for stimulating individual residents. In addition felt it would be good to provide small group activities which would be beneficial to livelier and quieter residents alike but address their different needs. Following the site visit the registered manager confirmed that usually one lounge has the television left on and the other lounge music is played to provide a quieter environment. Communal bathrooms were clean and tidy and staff noted to work in ways that reduced the risk of cross infection. A number of waste bins used for the disposal of gloves and aprons did not have lids and good practice suggests all such bins are lidded to reduce the risk of cross infection. Care Homes for Older People Page 19 of 28 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. There are sufficient day staff with the skills and competency to meet the needs of people living in the home and recruitment practices are robust ensuring that people using the service are protected. Evidence: Currently there are five care staff on duty for each day shift and two waking staff at night. Given the dependency levels of residents and the layout of the building a review of night staffing needs to be carried out to ensure residents are not at risk at night. In addition to care staff, cooks and domestics are also employed and there is a plan to employ both a laundry and kitchen assistant to free care staff from these duties. The need for such assistants was highlighted in three of the staff surveys. Comments in staff surveys included: * the management are always looking at ways of improving the quality of life for residents. * I enjoy the friendly and family atmosphere the home encourages. * staff are encouraged to get to know and appreciate each resident as an individual. Care Homes for Older People Page 20 of 28 Evidence: * Fairdene strives to provide an outstanding service for all residents. * we pride ourselves with a good workforce who enjoy being part of a team. * the care and welfare of all residents is paramount and we aim to make their live as happy and enjoyable as possible. Recruitment records were viewed and it was found that all staff had provided the required information prior to appointment, including Protection of Vulnerable Adults and Criminal Record Bureau checks, two written references and a full employment history. There is staff training development programme, which includes both mandatory training and additional training such as infection control and dementia care. Of the twelve care staff, eight have achieved National Vocational Qualification level 2 in care therefore this standard is exceeded. There is a staff induction programme and this was confirmed by staff within the staff surveys. In addition, the induction records for two staff were viewed and found to include all aspects of the services provided in the home. The carer spoken with was familiar with the care needs of residents and was clear about approaching the senior staff or management with any concerns. She was aware of the contents of care plans and confirmed that she is expected to contribute to the content. In addition she said that all policies and procedures are held in the staff room and she uses them as a point of reference should she need extra guidance. The expert by experience reported that one member of staff said this was like a second home to them and they had worked here for a few years and enjoyed their work. They felt much supported by the management team. She observed another member of staff reassuring and repeating to another resident and the resident said how lovely she was. She also found that staff were, on the whole, very attentive to requests made to residents and there also felt a calmness in their responses. There was also holding of hands when the resident sought it within the interactions. She overheard a resident say to a group of others Theres some lovely girls here and to show your heart ... well it really makes a difference. Following the site visit the registered manager confirmed that after careful consideration and a review of staffing levels another member of staff at night is not justified. Care Homes for Older People Page 21 of 28 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 service is appropriately managed and all aspects of the welfare, safety and health of people living in the home are protected and promoted. Evidence: The Registered Manager has the skills, qualifications and experience to manage the home and provide clear leadership and direction to staff. Responses in staff surveys indicated that they felt that Fairdene provided residents with a good quality life. Throughout the site visit both staff and residents were comfortable approaching the manager with any concerns. Responses to staff surveys indicated that there was good teamwork and that the manager was supportive. The AQAA indicated that any monies held for residents is held securely and records and receipts maintained for all transactions. Bedrooms visited each had a lockable drawer should residents choose to hold their valuables or money in their rooms. While touring the building it was found that a number of bedroom doors did not fully close which puts residents at risk in the event of fire. Following the site visit the registered manager stated that action had been taken to address this shortfall and that in future doors would be regularly tested Care Homes for Older People Page 22 of 28 Evidence: so no requirement was made. The home carries out regular surveys and the results are collated and action taken to meet any suggestions. The survey carried out in April 2009 found that one person had suggested Scrabble be provided but a set had yet to be purchased, therefore it would be good practice to set a timescale for acting on any suggestions. Following the site visit the registered manager confirmed that a larger Scrabble set is now available in the home. As part of the quality monitoring process both staff and resident meetings are carried out and minutes from the meetings were viewed. These showed that both staff and residents are consulted. Good practice suggests that these meetings are convened more often as currently they appear to be carried out 2-3 times year. The AQAA showed that regular checks are made on all electrical and gas appliances and systems and these records were checked on the day and found to be up to date. In addition checks are carried out on call bells, water delivery temperatures and emergency fire systems. All staff have been trained in fire safety and a fire safety risk assessment has been carried out for all parts of the premises. These systems ensure the safety of people living in the home in the event of fire. Care Homes for Older People Page 23 of 28 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 24 of 28 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 3 14 All parts of the pre admission record needs to be completed. To demonstrate the home can meet care needs. 21/10/2009 2 7 15 That all care plans are fully completed with clear direction to staff in meeting care needs. To ensure all care needs are identified, planned for and met. 21/11/2009 3 8 16 That advice is sought from a 21/10/2009 dietician as required. To ensure service users maintain good nutritional intake. 4 9 13 That a controlled drugs cupboard be installed. To ensure controlled drugs are stored securely. 21/11/2009 Care Homes for Older People Page 25 of 28 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 5 10 12 That a plan is devised to 21/10/2009 protect existing service users until new service users are familiar with the homes layout. To ensure the dignity and privacy of all service users is protected. 6 12 16 That service users leisure preferences are identified and met. To ensure service users have the opportunity to continue with past hobbies. 21/10/2009 7 19 13 That risk assessments are carried out during the refurbishment and are regularly reviewed. To ensure service users are safe at all times. 21/10/2009 8 22 12 That a plan is devised to ensure calls for help from service users are answered promptly. To ensure service users are not at risk. 21/10/2009 9 27 18 That night staffing levels are 21/11/2009 reviewed. To ensure service users are safe at night. Care Homes for Older People Page 26 of 28 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 10 30 8 That staff are trained in the correct use of nutritional screening tools. To ensure they understand the process. 21/11/2009 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 1 2 12 33 That a plan is devised to ensure service users are not disturbed by altercations between others. That timescales are set in respect of addressing suggestions in surveys. Care Homes for Older People Page 27 of 28 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. 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