Care Home: Fairfield House

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What the care home does well New people are supported to visit and try out the service before moving in. People are supported to have their health needs met and their physical care needs met in the way they prefer. They can spend time doing things they like at home. People are supported to use communication aids to help them understand things and make choices. They are supported to stay in touch with their families. Their home is comfortable, homely and safe and they have single bedrooms with their own things in them. What has improved since the last inspection? People now have information about the home that is more accessible. The people in the home are a good mix and are comfortable living together. The training room is being used more to give people the chance to learn new skills. Their medicines are managed more safely. The house has been changed to meet one person`s needs. People are growing more things in their garden. People are being supported by a staff team that is working well together. The staff are well trained and most are qualified. What the care home could do better: Support people to choose their own goals and ambitions. Make sure people`s support needs are in their care plans. Ensure every person is offered a good range of activities and quality time with staff. Ensure people are not stopped from doing things without a good reason. Support each person to have their own health action plan that they can take with them if they leave. Carry out better checks on new staff to make people in the home safer. CARE HOME ADULTS 18-65 Fairfield House Bleathwood Nr Ludlow Shropshire SY8 4LF Lead Inspector Jean Littler Key Unannounced Inspection 27th February 2008 12:00 Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfield House Address Bleathwood Nr Ludlow Shropshire SY8 4LF 01584 711878 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Winslow Court Limited Amanda Jane Mellings Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th December 2007 Brief Description of the Service: Fairfield House is registered to accommodate six people with learning disabilities who need support with complex behaviours that can be challenging. The Home is situated on the outskirts of the village of Bleathwood in a very rural location on the border between Herefordshire and Shropshire. There is a spacious garden with attractive views. Each person in the Home has a single bedroom with en-suite facilities and they share a lounge and dining room. In the grounds is a detached wooden building that provides additional space for activities and meetings. The Home was opened and registered in August 2005. It is owned by Winslow Court Ltd. a company that comes under the umbrella of an organisation called the SENAD Group. The Home retains close links with Winslow Court, which is a larger Care Home in the area. The company training, health and safety, and human resources departments are based there. Information about the Home is available on request from the Home or from Winslow Court. In 2006 the fees ranged between £1600 and £2000 a week depending on people’s assessed needs. Current fees are not included in the Service User’s Guide. People have to pay for their own personal items or services e.g. hairdressing or chiropody, toiletries and clothes. A contribution is expected towards holidays and vehicle hire for the holiday if the cost exceeds £500. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out over 6 hours on February 27th. The manager was on duty and helped with the process. We spoke with one member of staff and looked around the house. Two people showed us their bedrooms. Some of the relatives of people who live in the Home and some professionals filled out surveys to give us their views. We looked at some records such as care plans and medication. The manager sent information about the Home to us before the visit. What the service does well: What has improved since the last inspection? Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 6 People now have information about the home that is more accessible. The people in the home are a good mix and are comfortable living together. The training room is being used more to give people the chance to learn new skills. Their medicines are managed more safely. The house has been changed to meet one person’s needs. People are growing more things in their garden. People are being supported by a staff team that is working well together. The staff are well trained and most are qualified. What they could do better: Support people to choose their own goals and ambitions. Make sure people’s support needs are in their care plans. Ensure every person is offered a good range of activities and quality time with staff. Ensure people are not stopped from doing things without a good reason. Support each person to have their own health action plan that they can take with them if they leave. Carry out better checks on new staff to make people in the home safer. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with information in a format that will help them make a choice about where to live. Their needs are being assessed, however this process can be improved. Prospective service users are well supported to visit and trial the Home before moving in permanently. EVIDENCE: A Statement of Purpose and Service User’s Guide are in place and both have been kept up to date. In the AQAA (the Annual Quality Assurance Assessment that registered people have to send to us, the commission) Miss Mellings reported that she sends these documents and the most recent inspection report to any interested parties. A version of the Guide was given to each person as they moved in. This had Widget symbols with the text. Recently the speech and language therapist has developed the Guide into a more accessible format with pictures, symbols and photographs. Since the last inspection one person has moved back to Winslow Court as they needed a higher level of support with their behaviours. Another person has moved on to a supported living service where she has her own flat. One of these vacancies was filled by a person who moved in from Winslow Court. This assessment and transition process happened before Miss Mellings became manager. The person seems settles and compatible with the group. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 10 There is currently a vacancy and Miss Mellings has begun the assessment process for a young man. He has been to visit and staff said he seemed very suitable. Miss Mellings said she has reassured him that he can bring his own furniture as this was important to him. Assessment information has been provided by the funding authority. Miss Mellings has also completed the company assessment form. She was made aware that this does not cover all the areas of a person’s needs. She should clearly demonstrate how all of his needs will be met before a placement is offered. It is positive that new people who move in from outside the organisation are enabled to move in on a trial three month basis. Their relatives are involved in the transition arrangements and invited to all review meetings. It is not viable to keep a bed unoccupied at Winslow Court for three months when someone has transferred but in the past they have been given a two week trial. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs and development goals are included in their care plans. Some areas for improvement where identified. People are being supported to make decisions about their own lives where possible. People are being supported to take reasonable risks but some unnecessary restrictions may be in place. EVIDENCE: One person’s care records were sampled. He had a care plan and an intervention plan included in his file. Risk assessment information is being kept centrally, which may not support keyworkers in keeping information up to date. The care plan contained information about the person’s support needs and areas for development. The professionals based at Winslow Court assist the team to develop the intervention plans and help them monitor the outcomes. The majority of the information was valid and useful. Some needs to be reviewed as it needs more explanation or contradicts what is elsewhere. For example one section says the person seems to enjoy all activities and another that being expected to take part in activities causes him anxiety. His activity records showed he spends much of his time in his room listening to Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 12 music. Staff are not recording if they have offered him an alternative activity or not. Another section said he liked touch but he is not being offered any activities related to this such as aromatherapy massage. Miss Mellings reported in the AQAA that everyone has had their care plan reviewed at least every six months. This plan had been reviewed three times in 2006 then in February 07. She was not sure why there were no recent review dates. Review meetings are being held every six months and the families and social workers are invited to these. Keyworkers write a summary report beforehand. Risk assessments on the whole seem appropriately balanced between enabling people to enjoy a good quality of life by partaking in activities and being supported to stay safe. For example people go horse riding and go on holidays. Some need to be expanded to explain how decisions have been made in light of the Mental Capacity Act 2005. One seen said the person cannot selfmedicate but gave no explanation as to why or how decisions about medication are going to be made on his behalf. Some restrictions are in place that do not seen justified e.g. no one is being enabled to keep their money in the bedrooms, one man is being stopped from sitting on his bed during the day by the bed rails, that he no longer needs for health reasons, being raised when he gets up. This is to stop him laying on his bed all day, which staff feel would be bad for him. He has a comfortable armchair but a review of this and any other restrictive practices is recommended. Restrictions should be proportional to the risks involved and should take account of people’s rights as adults. The way the daily recording is being managed has been improved. All records and charts are together in a monthly pack and this information is then summarised at the back at the end of each month. One summary gave positive information about a person’s progress towards their goal of learning to dress independently. Information about activities was quite vague and did not make it clear if they had attended all their planned activities and if it was felt they were still benefiting from them. The two incidents that had occurred that month were not mentioned. Headings may help keyworkers include all the information that should be monitored. Person Centred Planning PCP could be further developed. Currently the plans are not in a format that would help people understand them. People do have memory books in their bedrooms and staff are using digital photography to help people keep these updated. On person showed us her book that included photos of her learning to blow-dry her hair. Other development goals seen were getting new shoes, taking part in regular activities and making a cup of tea. The PCP process could be used to develop other types of personal goals that may be personal ambitions such as going on a flight, moving into their own flat. The Circle of Friends approach can help develop ideas when people are not able to make suggestions themselves. People are being supported to communicate their wishes and choices e.g. some use the PECS symbol system, by signing or by pointing. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in the outcome area is good. This judgement has been made using available information and a visit to this service. People are being offered opportunities to take part in appropriate activities both outside and inside the Home. Some people may be having better outcomes in this area than others. Generally people’s rights are being respected but some restrictions on them may be unnecessary. People are being well supported to maintain personal relationships with friends and family and they have a choice over their meals. EVIDENCE: There was a relaxed and homely atmosphere in the house and staff organised things calmly such as food shopping and outings. The daily routine seemed quiet flexible and can take account of people’s choices on the day. Each person has a personalised activity plan that has been developed around what they like to do and what activities are assessed as being of benefit to them. Miss Mellings reported in the AQAA that people are supported to develop their life skills e.g. by doing their own laundry. An activities coordinator helps to develop new ideas for activities. The training room is being put to better use and Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 14 people are doing more cooking sessions. Some people horse ride, attend a farm project, pottery, snoozalem and music sessions. Several staff drive the vehicle to facilitate outings but Miss Mellings is hoping a car will also be provided. Community facilities are being accessed including local shopping, walks, pubs and cafes. Day trips of interest and holidays are also arranged. A variety of in-house activities are available including personal CDs, TV and DVDs in bedrooms, communal entertainment equipment, football nets and a pool table. Feedback in the surveys was positive about activities and people’s overall quality of life. During the inspection some people went on planned activities. Of the people at home one person was seen to be engaged with more than one staff to plan a shopping list and play cards. A man was in the communal areas with a ball. One worker played catch with him for a few minutes now and then. Another man spent time in his room listening to music and staff checked on him periodically. Staff were not observed to offer either man any other activity or engage with them for long. As mentioned in the care plan section one of these men’s records showed he spends a lot of time in his room and he sometimes does not go out for 2-3 days in a row. Activity plans should be reviewed to ensure they are balanced and consideration should be given to staff being delegated responsibility for specific people in the shift plan to ensure their attention is distributed equally. People continue to be well supported to stay in touch with their families. Some visit and the training room is used for people to spend time in private. The kitchenette facilities are used when families want to have a meal together. Miss Mellings said relations with neighbours are positive but she hopes to improve links by having a summer garden party. People return to Winslow Court for certain activities and this allows them to see people they have known in some cases for many years. Communication aides are being used daily including symbol systems, signing and specific verbal prompts. Speech therapy input is provided to support this work. Miss Mellings has ordered a picturebased communication programme that will enable staff to work with people directly rather then waiting for information to be designed by the therapist. The meals are arranged in a flexible manner depending on what activities are planned. A record of meals eaten is made in each person’s daily records. Those seen showed a reasonably varied and balanced diet. Lunch options could be reviewed as a lot are toast based and some people also have toast for breakfast. Miss Mellings said in the AQAA that people are involved in choosing meals when possible and if a meal is refused an alternative is offered. There was no record of an alternative being offered to one person who quite often refuses meals so recording of this should be improved. A member of staff said people are encouraged to choose a meal each during the week and those who cannot speak point at menu cards. It is positive that people are being involved in growing their own fruit and vegetables in the garden. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are having their personal care and health needs met in a sensitive and proactive manner. People do not self-medicate but safe arrangements are in place. EVIDENCE: Care records showed that people are bathing or showering daily and their other personal care needs are being met. Appropriate gender care is being given whenever possible for the men and always for the only woman. When they are able to people are supported to hold a key to their bedroom doors. All have locks that allow people to lock themselves in bedrooms and bathrooms for privacy but these can be overridden in an emergency. Staff were observed to respect people’s privacy e.g. only showing us people’s bedroom’s with their consent. The carer spoken with said they felt people were treated with respect by all staff. Feedback in the surveys was also positive in relation to personal and health care. Miss Mellings reported in the AQAA that links with local health professionals are in place and people are all registered with a GP, dentist and optician. All staff receive epilepsy training as three people in the home have epilepsy and it is Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 16 important for staff to know how to respond to a seizure effectivley. Staff also receive First Aid Appointed persons training so are able to respond to an emergency in a calm and efficient manner. Since the last inspection she has reviewed the first aid arrangements and the night staff are going to undertake the four day qualification which she also holds. A sample of records seen showed that people were having regular health checks and any health concerns are being recorded. Health needs such as epilepsy are included in the care plan. One person’s plan said if he refuses a meal he should be offered a supplement drink. Daily notes gave no mention of this happening. His weight is being monitored but is recorded in a separate book. This should be included in his care plan to aid monitoring. He had a goal to increase his fine motor skills but there was no mention of how this will be achieved or if an occupational therapy assessment has been requested. Each person has a Health Action plan but these are still being completed. The nurses at Winslow Court offer support with health matters and they are sent copies of the epilepsy charts. Mrs Mellings needs to ensure that written evidence is provided demonstrating that the GP has delegated responsibility to the site nurses if they provide any direct nursing care as the Home is not registered as a nursing home. The staff are supported to meet people’s needs by a team of professionals who give advice. These include the two nurses, a speech and language therapist and psychologist and their assistants. These professionals contribute to the staff training programme e.g. the nurse trains staff in epilepsy and diabetes. A recent review of the way the psychology team develop behaviour intervention strategies highlighted the need to modernise their methods. Psychiatry support is accessed through the health service. The organisation is taking positive action to address the findings. Incidents are being more closely monitored and strategies are being changed to reduce trigger points. Only one person is being physically restrained and the frequency of this is reducing. The medication is being stored securely in an appropriate cabinet. Each person has a medication profile and photos are in place to help avoid errors. Miss Mellings has reviewed the system since taking over and feels the arrangements have been greatly improved. The records seen were very clear and showed a clear audit trail. A system is in place where a second worker signs a separate record to show they witnessed the medication being administered. Some people are prescribed medication to be only given under certain circumstances. Protocols are now in place to ensure staff know when to administer a dose. One of these is a schedule 3 controlled drug (CD). It would be safer if this was stored in a CD cabinet and the balance recorded in a CD register. A medication policy is in place and staff do not administer medication until they have shadowed a colleague several times and been deemed competent. Miss Mellings said she carries out competency checks on all staff every few months to keep standards high. It is positive that staff are now being provided with Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 17 accredited training and the supplying pharmacist now carries out audits of the system. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s views are listened to and acted on. Arrangements are in place to help protect people from abuse and self-harm. Staff recruitment checks can be further improved. EVIDENCE: Policies and procedures are in place for the management of complaints and any adult protection concerns. All the people have keyworkers and family members or representatives who can raise concerns on their behalf. The complaints procedure is included in the Service User’s Guide and has been given to everyone in the Home and their representatives. Feedback from surveys indicated that people feel able to raise concerns and have confidence that they will be listened to. Miss Mellings had records of four complaints since taking up her position. One was from a mother who was concerned about three staff being on duty instead of four. Miss Mellings responded to this by engaging agency staff when rota gaps could not be filled at short notice. Another mother raised concerns about a worker chatting to her about her child in a public place. A worker raised the point that people’s razor blades were being used too quickly, so a chart was set up. The fourth was made by someone living in the home who made an allegation about a worker’s conduct. This was appropriately reported and investigated under the local multi-agency procedures. It was concluded that there was no evidence so the worker was allowed to return to work. An incident occurred in February 07 when a worker behaved inappropriately. Her colleagues rightly reported the incident and the worker was suspended. Local procedures were followed and the worker resigned. Miss Mellings Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 19 reported concerns in July 07 when bruises where seen following an incident when physical intervention was used. This was investigated under local procedures. It was concluded that the bruises had been caused prior to the restraint and were therefore were not connected. This person had not been restrained before so the incident did highlight some training issues. One worker was not aware of the physical intervention risk assessment in place for this man. Both workers attended the organisation’s adult protection training again. All staff attend this during their induction. Miss Mellings has improved the recording of incidents and they are also now logged onto a database so that patterns can be monitored. It is positive that the organisation rechecks staffs’ CRB’s every three years. Some shortfalls were again found in recruitment practices. The providers and manager need to raise standards to provide the best possible protection to the people who use the service. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have a comfortable and clean home that is suitably equipped and well maintained. They have access to a pleasant garden and communal facilities, and their en-suite single bedrooms have been nicely personalised. EVIDENCE: The house is detached and has a large attractive garden. It is situated in a very rural location, which is beneficial to people in terms of the quietness. The location does not easily facilitate them becoming part of a local community or give them the option of using public transport for outings. The exterior of the home is in good condition and the interior has been well maintained following its initial refurbishment. The gravel has been removed from the drive as one person had thrown stones at people and property. Miss Mellings has raised repair needs as they have arisen e.g. one man is due to have his shower replaced. The organisation has a repairs and maintenance department, however a slow response time has been noted over some work in the providers monthly visit reports. Staff have been developing the gardens to Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 21 provide activities for people. Some people have enjoyed growing vegetables in the poly-tunnel and there are plans to grow potatoes and strawberries this year. There are six bedrooms with en-suite facilities, some with baths and showers. Those who only have a toilet and sink have a communal bathrooms close by. These rooms more homely since the last inspection. The bedrooms seen were comfortable and had been nicely personalised. The newest person had brought his own furniture from Winslow Court and he has a wide screen television with freeview digital TV as he enjoys the music channels. To better meet one person’s needs the ground floor office was converted into a bedroom with ensuite and the office is now upstairs. The conversion has been done very well and the person was involved and supported to choose the decoration. There is a family style kitchen that is well equipped. The laundry is in an outbuilding that is well laid out. Some people are supported to do their own washing. The lounge and dining room/conservatory are attractive and appropriately furnished. These rooms are close together and all relatively small to accommodate ten or eleven people (including the staff). Fortunately some people choose to spend time in their bedrooms and during the day some are usually on outings. Additional communal space is available in a large wooden building in the grounds. This has been fitted out with a lounge, dining/activity area and kitchenette. It is used for meetings, staff training and for people to spend time in private with their visitors. Miss Mellings is improving the facilities so they will be used more. Computers have been installed and more kitchen equipment added. Some steps are being put in place to safeguard equipment and fixtures to prevent continual damage e.g. pictures are being screwed to the walls, televisions are behind perspex screens. Some people have possessions locked away in their rooms. Miss Mellings must ensure this is only done on the basis of a risk assessment that balances their rights against the risk of damage to the possessions. Where restrictions are needed a programme should be considered to help them learn to look after their belongings. Currently everyone is mobile and so no aides or adaptations for physical disabilities are needed at present. The care staff do a good job keeping the house clean. A few of the more hidden areas seemed to have been missed so the cleaning schedules may need to be expanded to cover these. Staff try to engage people in domestic tasks e.g. tidying their bedrooms. Infection control arrangements are in place. A company comes to test the water each month and there is a pest control contract too. Protective clothing is provided for staff and laundry management systems are followed. Kitchen checks are in place through the company systems. Miss Mellings agreed to speak to Environmental Health about their Safer Food Better Business management pack, as this may be useful. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are being supported by a competent staff team in sufficient numbers to meet their needs. The staff are well trained and support and the majority are qualified. People are not being fully protected by the homes recruitment practices. EVIDENCE: Usually four staff are on duty during the day and when the manager is in the Home there are five, unless she is covering a gap on the rota. This level of staffing provides flexibility for people to be supported with their activities, outings or health appointments. Staff turnover has been quite low but there are two vacancies and new starters are expected in April. The last three months of rota showed staffing levels have dropped to three 4-6 shifts each month. Miss Mellings felt this was acceptable as there are only five people living in the Home at the moment. She said they have two good relief workers who work regularly to cover gaps. Staff reported that when there is only three staff on duty outings are affected but that structured in-house activities are arranged. As detailed above the main staff team is supported by a team of specialised staff. Feedback from surveys was positive about the staff team and they were described by one family as going the extra mile. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 23 Staff on duty interacted with people in a friendly and appropriate manner. They demonstrated an awareness of their needs and agreed boundaries. Handovers are held between shifts and these are now held away from communal areas to help maintain a low arousal atmosphere. Full staff meetings are held every 4-6 weeks but small team meetings have been introduced recently where various practice issues are being discussed. The worker spoken with was positive about the service that was being provided. She had found her initial shadow shifts helpful and had read the care plans during this time. She had been involved in debriefing sessions after an incident and had learnt from feedback from more experienced staff. She felt the staff team worked in a consistent way and the morale was good. She felt supported by her team leader and found the supervision and training she received helpful. She said Miss Mellings is professional and open to new ideas. Staff training arrangements are managed centrally. A rolling programme of core and basic training is provided at Winslow Court. New staff attend a four day induction and then complete their core training in the first six months. Existing staff who need refreshers are called to attend these sessions as required. This programme has led to them gaining their Learning Disability Award Framework. The organisation is aware that they need to introduce the new Learning Disability Qualification that is replacing this. Staff then go on to start NVQ awards. Miss Mellings reported in the AQAA that staff usually start a qualification within a year of joining the team. Currently four staff hold a level 3 NVQ award, another four hold a level 2 and four are working towards level 2. It is very positive that over 50 of the team are now qualified. Some specialised training is routinely provided for staff e.g. Autism Awareness, Adult Protection, Epilepsy, Positive Approaches to Challenging Behaviour and Physical Intervention training. Annual refreshers are provided appropriately to help ensure good practice is maintained. Staff had recently attended signing training and risk assessment training. Miss Mellings had asked those who attended to develop risk assessments for cooking in the training room to put their learning into practice. All staff should attend training in the Mental Capacity Act. All staff have a training record and a training plan for the year is developed centrally. Recruitment is managed centrally from Winslow Court where a personnel (HR) officer is based. Procedures are in place and applicants are required to complete an application form, provide evidence of their identity and attend an interview. Job descriptions are in place, and contracts and training agreements issued. The recruitment record for one worker was sampled. After the interview the HR officer carries out the checks required and Miss Mellings does not see the file again until the worker has started. Records showed that although two references and other checks had been obtained before the worker started these were not the ones first requested or the most relevant for the post. One main employer had refused to give a reference and another arrived several weeks after the start date. There was no record of the decision Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 24 making process and Miss Mellings had not been consulted. The check list in place that has a place for the manager (who is legally responsible) to approve the person starting was unsigned. Miss Mellings was not aware that the reason an applicant left previous employment with children or vulnerable adults needs to be established from the employer before they start. Because some relevant references were not back before the start date this had not been established for all relevant previous jobs. Shortfalls in recruitment were identified at the previous inspection and a requirement was made. The issues identified on this occasion were less serious but still show that the organisation needs to improve procedures and communication between HR officers and the registered person. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home are benefiting from a well run service that is being developed in their best interest. EVIDENCE: The manager that was registered when the service opened left in December 06. Miss Mellings transferred from Winslow Court where she had been a unit manager to take over the role. She was registered in May 07. She holds the Registered Managers Award and has an NVQ 2 and 3 in Health and Social Care. She is working towards the NVQ 4 and has just started a Management Diploma organised by the providers that she expects to finish in July 08. Miss Mellings hours are not usually included in the care element of the Home’s rota, however the small nature of the service means she has close contact with the people living there. She is directly supported by three team leaders who run shifts. The manager of Winslow Court provides supervision and she is line managed by the company’s head of adult services. She was seen to engage competently Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 26 with service users and feedback indicates that she is respected by staff and families and viewed as an open and progressive manager. She has communicated openly with us and reported issues of concern quickly. Some quality assurance systems are in place e.g. monthly provider monitoring visits and health and safety checks. A more formal quality assurance system has recently been put in place by the providers and this will include quarterly audits and will cover all areas of the service. Miss Mellings sent feedback questionnaires out in May 07 to relatives and staff. Three were returned from families and their feedback was discussed at their children’s next review meetings. Consultation with other stakeholders should also be considered. The findings from the quality assurance systems and consultation should be linked more closely to the AQAA next year. It was positive that some development aims for the service are included in the AQAA but other planning processes can be further developed e.g. a rolling programme for redecoration and refurbishment of the house. Company policies and procedures are in place. An external company has recently been engaged to keep these up to date and in line with changes in legislation. Records are being stored securely and the information is being kept up to date. Miss Mellings has improved the level of recording in many areas such as care information, medication and incidents. Records relating to one person’s finances were sampled. The receipts showed money was being spent on appropriate things such as chiropody and a disco. The records were clear and up to date. The information about what was actually purchased is kept on the office computer. The records and cash balance for each person is checked on each shift even if no money has been used. Money matters are discussed at people’s reviews and joint decisions are made about expensive purchases. For people with a high balance in their accounts consideration should be given to supporting them to open a savings account, however the previous manager found banks unhelpful in this area. Financial risk assessments need to be further developed. They do not say why people are not being supported to keep their money in the bedrooms, who is acting on the person’s behalf or how decisions are going to made on the person’s behalf. Miss Mellings is supported to manage health and safety matters by a H&S officer based at Winslow Court. She reported in the AQAA that essential equipment servicing and safety checks are being carried out routinely e.g. fire alarm tests. Risk assessments are in place relating to the environment e.g. staff have walkie-talkies for their protection while supporting people to use the training room in the garden. Those linked to care practices should be reviewed as mentioned under the care planning section. All staff have Food Hygiene certificates and attend core safety training in their induction. Accidents and incidents are being recorded and monitored through the monthly provider’s visits. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 x LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 x Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA6 YA7 Good Practice Recommendations The current fees should be included in the Service User’s Guide in line with Regulation 5. Review care plan information comprehensive and consistent. and ensure it is Develop person centred planning and help people identify personal ambitions. Review risk assessments and ensure they take account of the Mental Capacity Act and show more clearly how decisions balance the risks to the person against their rights as an adult. Develop financial risk assessments and consider how people can be supported to keep some of their money in their bedrooms and be more involved in looking after it. Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 29 3 YA14 YA12 Review the activities being offered to each person and ensure their plan meets their assessed needs and they are receiving equal amounts of staff input to support them to lead stimulating lives. Complete a Health Action Plan for each person to demonstrate their current and future health needs are being looked at in a holistic way. Ensure there is evidence that the GP has given delegated responsibility to the Winslow Court site nurses if they provide any direct nursing treatment to people in the home. 4 YA19 5 YA20 Store the schedule 3 controlled drug in a CD cabinet and keep a running balance of stocks in a CD register. Access a copy of the new guidance for Care Homes issued by the Royal Pharmaceutical Society. 6 YA30 Review the cleaning schedules and ensure they are comprehensive enough to maintain the required hygiene standards in all areas. The providers should review their recruitment procedures to include the following areas. The reason an applicant left previous employment with children or vulnerable adults needs to be established with the employer as part of the pre-employment checks. Ref:DofH POVA Guidance July 04 Annex C and amended Care Home Regulations July 2004. The registered manager needs to take responsibility for authorising that suitable checks have been received and a new worker can be given a start date. 7 YA34 Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fairfield House DS0000064842.V352236.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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