Care Home: Fairfield Nursing Home

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What the care home does well The residents spoken to said that the staff are kind and caring, and that their privacy and dignity are respected. Resident`s healthcare is maintained and staff ensures there is good access and input into their care by the multidisciplinary healthcare team, including GP`s, district nurses and other services. The residents are looked after as individuals, and all residents spoken to said that "the girls are lovely", and there is clearly a good rapport between staff, residents and relatives. What has improved since the last inspection? Since the last inspection improvements have been made to the overall fabric of the building which has resulted in a more pleasant and homely environment. Care plans have also improved with regard to quality and information, especially wound care. What the care home could do better: Greater documented evidence of resident input into their care plans, and documented Health & Safety training regarding bed rails could be improved. It was also suggested that abbreviations are not used unless they are `universal` accepted abbreviations. CARE HOMES FOR OLDER PEOPLE Fairfield Nursing Home 10 Quarry Road East Heswall Wirral CH61 6XD Lead Inspector Julie King Key Unannounced Inspection 09:30 26th November 2007 X10015.doc Version 1.40 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 Nursing Home DS0000020936.V344204.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 Older People. 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 Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairfield Nursing Home Address 10 Quarry Road East Heswall Wirral CH61 6XD 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) 0151 342 8886 0151 342 8886 admin@fairfield.wanadoo.co.uk Fairfield Healthcare Limited Mrs Elaine Gerrard Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2006 Brief Description of the Service: Fairfield Nursing Home is a large detached house situated in the residential area of Heswall. The home is registered with the Commission for Social Care Inspection to provide nursing care for up to thirty residents under the category of old age. Standing in its’ own grounds there is car parking to the front and large gardens to the rear. All rooms are for single occupancy and a number have en-suite facilities. Communal areas comprise two lounges and a designated dining room. There is also a large conservatory, which is used for entertainment. There is a lift access to the second floor and all areas are accessible to residents. The home is situated close to public transport, local amenities and is easy accessible to visitors. Fees range from local social services rates to £675 per week, dependent upon care and facilities required. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information about Fairfield was obtained through an Annual Quality Assurance Assessment (AQAA) and examination of residents case files and supporting documentation. A tour of the building took place and discussions were held with residents and staff about the standard of care and the management of the home. A part of the inspection process includes sending questionnaires to residents, families and health care professionals in order to obtain their views on the standard of the service provided. Comments made in these questionnaires are included in the report and contribute to the basis of any judgments made. The CSCI is trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently using ‘Experts by Experience’ who are part of the inspection team and help Inspectors get a picture of what it is like to live in or use a social care service. The term ‘Expert by Experience’ used in this report describes a person who has been appointed by Help the Aged, under the direction of the CSCI, to take part in the inspection of services for older people; and sections from her report are contained within this document. What the service does well: What has improved since the last inspection? Since the last inspection improvements have been made to the overall fabric of the building which has resulted in a more pleasant and homely environment. Care plans have also improved with regard to quality and information, especially wound care. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 6 What they could do better: 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 Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are being met, and the home is able to provide assurances to residents and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: The management and staff understand the importance of having sufficient information when choosing a care home, and have developed updated information to help prospective residents understand what services the home can provide. The owner/manager provides a Statement of Purpose that is specific to the individual home and the resident group they care for, and clearly sets out the objectives and philosophy of the service, supported by a Service user Guide. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 9 The guide details what the prospective resident can expect and gives a clear account of the services provided, the accommodation, qualifications and experience of staff, how to make a complaint and recent CSCI inspection findings. All the residents have access to a copy of the Guide, and if requested the provider can supply a copy of the Statement of Purpose and Guide in a different language to suit the needs of the resident. Admissions are not made to the home until a holistic needs assessment has been undertaken. For people whom are self funding and without a Care Management Assessment the assessment is always undertaken by a skilled and experienced member of staff, usually the manager or nominated senior qualified nurse. The assessment involves the prospective resident, and their family or representative where appropriate. If the assessment has been undertaken through care management arrangements the manager obtains a summary of the assessment and a faxed copy of the care plan from the liaising social worker. Prospective individuals are given the opportunity to spend time in the home as either a trial visit, or just a look around and a chat with the current residents. Residents spoken to said that they “had met the matron” from the home prior to admission, and that “my family was involved” during this process. New residents are provided with a Statement of Terms and Conditions/Contract; this sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This gives a clear understanding of what residents can expect, and the manager offers the opportunity for discussion and clarification. Terms and conditions of residence are reviewed on a regular, usually annual basis. Standard 6 was not assessed as this home does not provide intermediate care. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place for all residents. This provides staff with the information they need to meet the resident’s needs. EVIDENCE: A number of resident’s care plans and associated records were examined as part of the case tracking process. All the files seen evidenced that the residents have access to health care services both within the home and in the local community; and the majority of residents are able to choose their own GP and attend local dentists, opticians, etc. Documented evidence showed that health needs are monitored, with monthly reviews, including important risk assessments, such as for nutrition, reviewed regularly. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 11 The home is able to provide the aids and equipment needed by the residents, and there is good evidence in the care plan of health care treatment and intervention, both from the home’s staff and visiting professionals. There are some minor gaps in the daily information, but staff do clearly evidence that they are able to think in a person centred way and are able to give a verbal update of each resident. The staff encourage residents to be as independent as possible, and to take responsibility for their own personal hygiene, with assistance if necessary. The views of residents are sought in the way personal care is delivered, and it was observed that staff clearly had a good rapport with all the residents seen during this site visit. The manager has a medication policy which is accessible to staff, and medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. At the time of this site visit, medications were compliant with current good practice requirements, but it was suggested that checking the storage temperatures of eye drops could be improved, as not all eye medications need to be stored in the fridge. Staff spoken to think in a person centred way when considering an individual’s personal care needs, and appeared aware of the need to treat individuals with respect and to consider dignity when delivering personal care. Residents spoken with said that they “are happy” with the way that staff deliver their care and respect their dignity, and they “could talk to them [staff] at any time”, and that “they ask me what I want”. The expert-by-experience stated in her report, “ staff are kind, but sometimes a little slow to respond to toileting requests”, and “there is a good banter between residents and staff”. The home has policies and procedures, which provide guidance for staff on how to support a person and their family when faced with a terminal illness. The wishes of individuals about terminal care and arrangements after death is not always recorded, and staff are not consistently trained in terminal care but are able to give a verbal account of good practice. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A range of activities is available which provide residents with stimulation to promote social interaction. EVIDENCE: Detailed information is gathered from resident on admission to the home regarding their past life and the social activities that they had previously enjoyed. It was evident from observation and discussion with residents that the staff strived to provide a varied social activities programme in line with their individual preferences and abilities. The home employs an activities coordinator who works full time and plays an active part liaising with relatives to help ensure the residents have as much choice of daily activity as possible. Outside entertainers came in at least once a month, and all Birthdays and notable dates are celebrated. The programme of activities is displayed in the home and includes both in house stimulation and trips out. Resident confirmed that there is a good range Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 13 of activities and that they are free to choose whether or not they participate. Group activities are provided together with one to one stimulation for those who do not wish to or are unable to participate in group events. In addition to the in house entertainment, external activities and events are also provided, and each week an outside physiotherapist attends the home to provide chair exercises and therapeutic activities to music. The expert-byexperience noted that one of the male residents told her that “activities are mainly for women”, but “there is open visiting for family and friends”. Ministers from local churches make regular visits to the home and provide services to group or individual residents on request. Visitors are welcome to visit the home at any time, and one relative’s questionnaire stated that staff were knowledgeable about the care her mother needed and were always on hand whenever they were needed. Meals are served in the dining room or in the resident’s bedroom as they wish. The menu provides evidence that a well balanced diet is offered and a choice of meal is always available. The meal served during the inspection was attractively served and looked appetising. Residents said that the food was “really good” and evidence was available to confirm that they could choose from the menu or request a particular favourite. Another resident told the inspector that he “enjoyed the food and had no complaints”, and someone else said the food “had improved with the new chef”. Special diets can be provided on the advice of the GP or dietician or on request of the service user. The dining tables were attractively laid with condiments and appropriate cutlery, and glasses of wine are offered with meals as the residents wish. The AQAA provided by the registered manager contains information about plans to further improve the service by expanding on the range of activities offered, and to build a raised garden to enable more residents to participate in gardening activities during the warmer months. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good knowledge and understanding of Adult Protection issues to protect residents from harm or abuse. EVIDENCE: The manager has developed a complaints procedure which is detailed in the Statement of Purpose and Service User Guide and is also displayed on notice boards within the home. The procedure gives residents and visitors the details of the person to whom complaints should be made and the timescale in which the complaint will be investigated and responded to within. There have not been any complaints about this service since prior to the last inspection. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 15 All staff have been given training on the Protection of Vulnerable Adults (POVA) and are aware of the different types of abuse and of the action to be taken in the event of it being suspected to ensure that residents are protected. Every member of staff spoken to during this inspection was able to demonstrate their awareness of the procedure to be followed, but it is strongly recommended that all staff, including housekeeping and ancillary, complete POVA training as soon as possible. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most areas seen were clean and can evidence some upgrading, thus helping to provide residents with a homely place to live. EVIDENCE: The location and layout of the home is suitable for its purpose and provides a comfortable and homely environment for residents to live. Residents are accommodated in well-maintained bedrooms, some with en suite facilities. The bedrooms are spacious and bright and it is evident that every effort has been made to assist residents to personalise their rooms with pictures, photographs and items of memorabilia. Some residents have chosen to provide items of furniture to make their room more homely. Specialised equipment such as a lift, assisted bath and shower rooms, hoists, Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 17 specialist beds and appropriate toilet aids are provided to assist service users and maximise their independence. Several ‘profiling beds’ with pressure relieving mattresses have been obtained. All parts of the home are clean and tidy. The AQAA indicated that policies and procedures are in place to prevent the spread of infection, and plans are in place to improve the garden areas next year, and to completely refurbish the ‘peach lounge’. The dining area was seen as follows – tables were each laid with matching damask tablecloths, matching cruet set, knife fork and spoon, drinking glass and on some, wine glasses. Overall Fairfield is pleasant, warm and light. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff demonstrate a good awareness of their roles and responsibilities, thus providing residents with safe, individualized care. EVIDENCE: There are sufficient staff on duty to look after the residents in accordance with their particular needs with additional staff being on duty at busy times of the day. There are also sufficient domestic/catering staff employed to ensure the home is kept clean and tidy and good food is provided. Staff members undertake some external qualifications beyond the basic requirements, and the manager encourages and enables this, recognising the benefits of a skilled, trained workforce, and the home can boast of a high level of NVQ 2 and NVQ 3 trained care staff. Four of the recently employed staff’s personnel files were examined, and all seen contained the required documents and records including CRB checks and references from previous employers. Staff supervision is completed on a regular basis, as are appraisals and high levels of appropriate staff training, accessible for all staff. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 19 The management of Fairfield recognise the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individual residents. Job descriptions and specifications define the roles and responsibilities of staff. Residents spoken with said that the staff are “nice”, and these comments are supported by the numerous letters of thanks and appreciation from relatives, which were seen on the notice board. The Expert-by-Experience noted in her report, “when I asked about the staff, she [the resident] said “ all are good, but sometimes I have to wait a bit before my call bell is answered”. Another gentleman said “the staff look after you-don’t shout at you”. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is run by a person who is fit to be in charge and who ensures the residents are well cared for. EVIDENCE: The registered manager is competent and qualified to run the home for the residents best interests. Staff spoke well of the registered manager saying she is always available for advice and support. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 21 One member of staff commented the residents always come first and the home is well run. Residents also commented on the good management of the home. Quality assurance systems are in place to ensure the ongoing efficient and effective running of the service. This includes monitoring and supporting staff, reviewing administrative systems and consulting with residents and their carers about the care provided. The manager is able to communicates a clear sense of direction, and is able to evidence an understanding of ‘best practice’ operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. Equality and diversity issues are given priority by the provider, who is aware of the varying strands this involves. The manager possess a well-developed awareness and understanding of equal opportunity issues, development and implementation of the service’s policies and procedures. Other professionals spoken to in order to obtain their views on Fairfield said in their opinion, the home provides a good quality service. A system of formal supervision has been introduced into the home, which gives all staff an opportunity to meet with their line manager and discuss their development within their role. Discussion with staff during the visit confirmed they enjoyed their work and they felt well supported in their role. The AQAA indicated that regular health and safety checks are carried out on equipment around the building and supporting policies and procedures are available for staff to refer to. Staff training records indicated that staff have completed different amounts of health and safety training, while it is acknowledged that improvements have been made in this area, further work in relation to the safe use of bed rails needs to be carried out to ensure all staff are trained in this aspect of care provision as soon as practicable. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 4 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 3 3 3 Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 23 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. 1 Standard OP1 Regulation 4 Requirement None at this time. Timescale for action 26/11/07 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 3 Refer to Standard OP18 OP38 OP7 Good Practice Recommendations It is strongly recommended that all staff, including housekeeping, complete POVA training as soon as possible. It is strongly recommended that suitable and sufficient safe use of bed rail training is completed for nominated staff as soon as possible. It is recommended that no abbreviations are used unless they are universally accepted abbreviations. Fairfield Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Merseyside Area Office Burlington House Crosby Road North, Waterloo Liverpool L22 0LG 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 Nursing Home DS0000020936.V344204.R01.S.doc Version 5.2 Page 25 - 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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