Care Home: Fairfield Manor

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What the care home does well Resident comments: `One carer always makes time to help and support me`. `The carers do a very reasonable job`. `The staff work really hard`. A member of staff comments: `I feel well supported by the Team Leaders and Manager and would recommend the home`. `The residents are always asked what they would like for lunch and given choices, sometimes the residents who have dementia change their mind so we always make them something they would like`. What the care home could do better: A resident comments: `I would like to have more outings and play bingo`. `Improvementscould also be made with the laundry service`. A staff member comments: `We need to improve the environment of the home and buy new furniture`. `We need to provide more activities for the residents`. The home needs to improve the recording in the care plans to make sure that the format is consistent and person centred to individual needs. Residents are not involved in the menu planning. Residents do not have the opportunity to have a key and lock their bedroom door. Random inspection report Care homes for older people Name: Address: Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JU two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Penny McMullan Date: 2 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JU 01843860715 01843868516 fairfieldmanor@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sheila Reyes Edrial Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne (Eton) Limited care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users to be accommodated is 36. The registered person may provide the following category/ies of service only: Care home only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Fairfield Manor is an old manor house set in gardens next to Woodlands Care Home, both of which are owned by the same company. Ashbourne (Eton) Ltd is the registered company, which is a subsidiary of Southern Cross Healthcare. Care Homes for Older People Page 2 of 12 Brief description of the care home The building is not ideal for meeting nursing needs, as many corridors are narrow for wheelchair users. However, some adaptations have been made, and include a passenger lift, which provides access to all floors. Ramps are in place to facilitate wheelchair users. Accommodation for residents is provided on three floors and comprises rooms for single use only. Thirty rooms have en-suite facilities. The lower ground floor is used only for staff, and includes the kitchens. The building includes a five bedroom flat which is let to staff. These facilities are entirely separate, so that they do not encroach on residents facilities. There is ample car parking at the front of the building and garden areas where service users can sit out in good weather. Fees ranges can be obtained from the service. These vary depending on the need for residential or nursing care, and taking into account residents dependency levels. Care Homes for Older People Page 3 of 12 What we found: The reason for this inspection was to check compliance with the statutory requirements made at the previous inspection on 10th February 2010 and the outstanding requirements made at the inspection on 16th February 2009. This report details the information as to how the home has improved and met the requirements. This unannounced random inspection was carried out on 27th May 2010 between 9.30 and 4.30pm. The Manager of the home has recently been interviewed by the Commission and will shortly be registered as the Registered Manager. The Registered Manager and deputy of the home assisted throughout the inspection. We looked at the development plan, two care plans, staffing levels and competencies. We made a partial tour of the home and looked at the bathing/showering facilities, the kitchen and how the home maintains a warm environment for the people living there. There were shortfalls identified in these areas in the last two inspection reports. On arrival in the home we rang the bell and no one answered, we waited a few minutes and then walked into the home. We waited five minutes with no contact with anyone in the home. Eventually a carer arrived and we asked to see the manager, at no point did she ask who we were and what we were doing in the home. She told us that the Manager was not in the home and the deputy was completing the medication round upstairs. It was not until the Deputy Manager arrived that we told her what we were doing in the home and the purpose of our visit. The home must ensure that security of the home is improved to make sure residents are safe. The Registered Manager arrived later in the morning to assist with the inspection and told us that there is usually an administrator in the front office who deals with all visitors and she will make sure that this does not happen again. We looked at two care plans. The Registered Manager told us that half of the care plans have been completed with the new format. We found that the recording in the two care plans had improved to make sure that peoples health care needs are monitored. For example, weight charts were completed and up to date, together with records of health care appointments/visits. Outcomes of the visits are recorded to make sure that health care needs are monitored and met. The plans also include details of individual nutritional needs and how to maintain skin integrity and bathing regimes. We cross referenced one visit made by a GP and found that as a result of the visit an anti biotic was prescribed. This information was in the daily notes in the care plan and the medical administration sheet confirmed that the resident had been administered the medication that day. Nutritional supplements are also recorded on the record sheets and administered by the nurse on duty. Staff spoken with told us that changes have been made to the way they record on the fluid charts. They have received additional training to make sure that all fluids are recorded accurately so that that they record meaningful information. They told us that they must report to the Registered Manager if there are gaps in the records. In one care plan the moving and handling risk assessments shows staff what they should do to make sure people are moved safely. However in the other plan, we found insufficient information to clearly show what the carers should be doing and what equipment should be used to make sure that people are safe. For example the plan states Care Homes for Older People Page 4 of 12 I am able to move independently but prefer to be assisted with the following for moving and handling. I like one carer to assist me to stand and help assist to seat me in my wheel chair. It does not indicate how this would be done and what assistance means to the resident. The Registered Manager told us that this information would be included in the plan as soon as possible. She also told us that all of the residents have been assessed by the in house moving and handling assessor. Staff spoken with are confident of how to move people safely and have received moving and handling training. They told us what hoists and other equipment was being used to make sure residents needs are met. There was evidence that the plans had been reviewed and daily records seen were up to date with sufficient detail of the care provided that shift. The Registered Manager told us that all of the care plans will be looked at and improved by the end of June. There is little evidence that the residents have been involved in their care planning to make sure that the plans are person cantered to meet their individual needs. Although the management have been working to improve the care plans, further improvements are required to make sure that the care provided to the residents matches what is in the care plan. Staff told us that the Registered Manager works with them and observes their practice to make sure they are doing their jobs well. Staff were seen talking to the people respectfully and in a manner which promoted their dignity and independence. Residents told us that staff were polite and kind. There are two members of staff in the home who are Champions for Dignity to make sure that the home respects the residents dignity. The new wet room on the first floor can not be locked and therefore does not uphold privacy for the residents. The Registered Manager told us that a lock would be fitted to the door. People spoken with told us that they can do what they wish and are given choices, especially at meal times. The Registered Manager told us that a new Activities Co-ordinator has been appointed to make sure that the activities programme is working well. There are two members of staff who are involved in the activity programme. At the time of the visit residents there was no activities taking place and residents were not interacting or chatting to each other in the lounge. They sat in their chairs with the television on in the background. One resident told us how much she enjoyed reading and sometimes stayed in her room. She also said that she enjoyed bingo but bingo is not played in the home. The church visits her monthly for communion and she is also able to go to the local club of her choice. A member of staff told us that further induction training for activities was taking place and that residents had been spoken to with regard to their personal choices. However there was no evidence to show that this had happened. The newly appointed Activities Co-ordinator was enthusiastic to put plans into place to encourage residents to have something to do during the day. For example, gardening, bingo, discussing the daily news, and arranging outings. He is hoping to make menu cards for the residents, including pictures to make sure those residents who are less able have the chance to show their preferences. The menus have been reviewed and there was a four weekly menu on display in the dining room. Residents and staff told us that there is always choice and in general people have what they wish to eat. Apart from breakfast, the residents are not involved in the Care Homes for Older People Page 5 of 12 menu planning. Staff told us that the menus are planned at head office and they are told what they need to cook. Since the last inspection the Catering Manager from head office visited the home and worked with the kitchen staff for a week. They addressed issues of dietary needs, for example nutritional supplements, providing well presented pureed meals, and how to improve the service. The kitchen has been deep cleaned and a heated trolley is now in place to make sure that the meals are served at the correct temperature. The cook is qualified to NVQ Level 2 and the Registered Manager told us that further training will be provided. We looked at the menus and found that two hot meals are available daily. This is because residents are able to choose when they want their main meal, either at lunch or tea time. The menus also show choices; however only one vegetable is available per hot meal, even roast dinners. Staff told us that this was the case and sometimes, if it is a casserole, there are additional vegetables in the casserole. A review of the menus is required to make sure that the residents are involved in the menu planning and make sure they have more than one vegetable to choose from. When residents dietary needs change, a diet notification form is sent to the kitchen to make sure they are updated with the new requirements. There are also records of what people have eaten to make sure they are receiving a balanced diet. Juices and water are available in the lounge throughout the day. Residents in the home are aware of whom to complain to and raise any issues of concern. Two people told us that the manager listens to their concerns and takes action to make sure their issues are addressed. There is currently an open safeguarding alert in the home. The home is working with social services to make sure that all of the issues raised are being addressed. Further meetings will be held to discuss the outcome of the investigations. At the previous inspection it was found that the temperature in the home could not be regulated and although the home had contacted an organisation to address this issue, the work had not commenced. Two days after this visit the Registered Manager confirmed that thermostatic radiator values are to be fitted to the all radiators on the first and ground floor. The system will then be retested. There is no date at this time of when this work will be carried out. The Registered Manager told us that the home has sent a quote for new windows throughout the home but no further action has been taken at this time. She also told us that residents are having their rooms redecorated. The home is large and there is only one handy person to complete the daily maintenance and decorating so at times progress is slow. Two wet rooms and one bathroom are now in operation. The parker bath has been moved and is now being used, however the new bathroom needs to be redecorated which is part of the refurbishment plan. An additional wet room will also be provided on the third floor. All of the bedroom doors can be locked from the inside and also locked with a coin or Care Homes for Older People Page 6 of 12 small device from the outside. This does not give the residents an opportunity to have a key to their room to protect their privacy. Staff told us that this had been looked into by the company before but nothing further had been done. Improvements are therefore required to protect the privacy of the residents. The refurbishment plans also show that the kitchen will be moved from the basement to the first floor and bedrooms 3, 4 and 5 will be decommissioned. On 10th March 2010 the kitchen was deep cleaned to improve the standard of cleanliness. Due to fire regulations the rest of the basement is not being used at this current time. At the time of the visit there were areas of the home which required hovering. There are only two domestics employed to make sure a very large house is clean and tidy. The Registered Manager told us that the domestic staffing levels are under review and carers are sometimes allocated domestic tasks to help with the cleaning. Cleaning schedules are now in place to make sure that wheelchairs and hoists are cleaned on a regular basis. Since the previous inspection staffing levels have been increased. On a typical day in the home there is the Registered Manager, Deputy Manger (RGN) and six carers. In the afternoon there are five carers on duty. A Chef, Kitchen Assistant, Laundry Person and maintenance person are also on duty. The Registered Manager told us that when the number of residents increase staffing levels will be reviewed, which may result in a requirement for two nurses to be on duty. Since the previous inspection some of the residents who require nursing care have agreed to move to larger rooms in the home and residential rooms have been redecorated. The staff have also been allocated a new staff room. The staff on each shift are allocated a number of residents to look after. Staff told us that staffing levels have improved and that they now work far better as a team. Things can still go wrong but morale of staff is good and they have more time to spend with the residents, for instance when they are helping them to eat or doing their personal care. Three new members of staff have started work since the previous inspection. The staff were recruited via the head office and received their induction and mandatory training from head office before they were sent to the home. There is one vacancy for a Registered General Nurse. The home is not using agency staff and can cover any additional shifts with the existing staff. There is a training programme in place and the Registered Manager is due to commence the leadership award in June. Mandatory training is being provided, however the matrix shows shortfalls in fire safety, food hygiene, moving and handling and first aid awareness. The Registered Manager told us that they are in the process of arranging further training and updates in all of the subjects and this will be provided by the in house trainer. There are scheduled supervision sessions with the staff on a monthly basis and the manager works with the staff to observe their competencies. Staff told us they feel supported by the management team. Care Homes for Older People Page 7 of 12 As required the service provided a development plan to the Commission to address all the shortfalls identified. Although most of the requirements have been met or progress has been made there are still concerns with regard to care planning and the progress of the refurbishment plan. As a result of the last two inspections the owners had to provide an improvement plan to the Commission to address the shortfalls identified. The service has been working hard to implement these changes and the Registered Manager and Area Manager are aware of what still needs to be improved in the home. There is a detailed Improvement Proposal Plan, dated 6th October 2009, and revised on 25 February 2010, which clearly outlines environmental improvements with costings and how long the jobs will take to complete. The plans are detailed and comprehensive and state that the work will commence 10 weeks from approval. However, to date, only some of the work has been carried out, for example the two new wet rooms and bathroom. The home has to wait until Southern Cross allocate the work to their preferred providers which takes additional time. Staff told us that on occasions the work has been scheduled and cancelled at the last minute. The Registered Manager has also been requested to contact the local Fire and Rescue Office with regard to the locks on the wet room and the new refurbishment plans, which include moving of the kitchen. Although improvements have been made the Commission requires evidence that this improved practice will be ongoing and sustained. We have, therefore, requested that Regulation 26 visits (this regulation makes sure that the Owners or their representative visit the home monthly to monitor the quality of the service being provided) be forwarded to the Commission for the next three months. These reports should include confirmation that the care plans are fully completed and what has been achieved in the improvement plan. The Regulation 26 visits must also be carried out by a representative of the organisation and not the Registered Manager. In addition the Registered Provider is requested to forward an updated refurbishment plan by the end of August to the Commission to tell us what progress has been made. This is because of non compliance to the regulations in the past and we are not fully confident that the improvements in the service will be sustained. What the care home does well: What they could do better: A resident comments: I would like to have more outings and play bingo. Improvements Care Homes for Older People Page 8 of 12 could also be made with the laundry service. A staff member comments: We need to improve the environment of the home and buy new furniture. We need to provide more activities for the residents. The home needs to improve the recording in the care plans to make sure that the format is consistent and person centred to individual needs. Residents are not involved in the menu planning. Residents do not have the opportunity to have a key and lock their bedroom door. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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