Care Home: Fairfield Residential Care Home

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What the care home does well People who are considering moving into the Home have their needs assessed before agreement is reached to move in, this helps to ensure that the Home can meet these needs. People are encouraged to visit and chat to staff and other people that live at Fairfield to help them decide that this Home is the right place for them. They are given information about the Home before agreeing to move in. Care plans are developed upon admission. People`s needs are identified and recorded. Detailed information tells staff the action to take to meet people`s needs. Those people spoken to were happy that their needs are met. People have access to advice from health professionals such as dentist, chiropodist and optician where they need it, so their health needs can be met. Medication records were easy to read and up to date. Medication storage and administration was satisfactory. One person said "we get our medication at the same time each day, they call the GP whenever needed, we also see the dentist, optician and chiropodist regularly". Various activities take place on a daily basis to ensure that people lead interesting lives and participate in activities which they enjoy. Visitors are welcome at any reasonable time, people are encouraged to maintain contact with family and friends. Choice and independence is considered important and people are able to continue to do things independently if they are able. People are offered choices in things that affect their daily life. The Home is odour free, clean and comfortable. Fixtures and fittings are in a good state of repair. Bedrooms were personalised with people`s own pictures and ornaments. the Home provides a welcoming, relaxing atmosphere. One relative commented in our survey "the Home is always clean and tidy" Staff attend National Vocational Training Courses in Care and various other training courses are provided to help ensure that they have the knowledge and skills to meet the needs of those under their care. Staff have a good relationship with the people that live at Fairfield. Staff were seen to be patient and kind and attentive to people`s needs. One relative said "the staff are usually caring and polite". One person spoken to said "staff are friendly and polite" Service Users Money is well managed and records were up to date and in good order. Other comments received are detailed below:"the Home is great, the best thing since sliced bread, everything is tip top". "staff make a fuss of you, the Home is clean and tidy and your clothes are always clean" "the room is clean, the laundry is great, the staff are lovely". "the manager has made some good improvements". What has improved since the last inspection? Risk assessments are now in place for areas such as risk of falling, nutrition, pressure areas and mobility, these are being reviewed on a monthly basis. Medication management has improved and all documentation seen was in good order and up to date. Further improvements have been made to the number and range of activities that take place. People were happy that activities take place most days. The laundry area was clean, hygenic and there were no unpleasant odours. There was no backlog of items waiting to be laundered and people commented that the laundry service is good. What the care home could do better: Further information is required in the Service User`s Guide to ensure that people have all of the information about the Home that they need. This should include information about the facilities and services available to them at Fairfield i.e. staffing, number of bedrooms, management arrangements. Conflicting information in care plans should be removed. It should be evident which is the most up to date information for staff to follow. The privacy and dignity of everyone living at Fairfield must be maintained at all times. This should include the use of appropriate screening in shared bedrooms to ensure that personal care can be provided without compromising privacy. Any televisions that are broken should be repaired or replaced to ensure that people are able to watch a television in the lounge if they wish. A choice of meal is available on a daily basis, however there was no documentary evidence to demonstrate that the choices available are suited to the wants and needs of those that live at the Home. Sufficient food supplies should be available at all times in the Home to ensure that people`s food preferences are taken into consideration, this should include sufficient amounts of fresh fruit and full fat milk. The Home`s record of complaints received with details of any action taken to address complaints should be available at all times. Laundry processes should ensure that the extra handling of soiled laundry does not increase the risk of spread of infection. Documentary evidence should be available to demonstrate that all new staff have undertaken induction training in line with the Skills for Care Common Induction Standards. Documentary evidence should be available to demonstrate that discussions are held with people regarding daily life at the Home, choices available and to ensure that the quality of care provided meets the needs and expectations of everyone living there. Key inspection report Care homes for older people Name: Address: Fairfield Residential Care Home 27 Old Warwick Road Olton Solihull West Midlands B92 7JQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Shelton     Date: 2 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Fairfield Residential Care Home 27 Old Warwick Road Olton Solihull West Midlands B92 7JQ 01217062909 F/P01217062909 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Dilip Mayariya,Santok Mayariya Name of registered manager (if applicable) Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Service users admitted to the original six first floor bedrooms must be ambulant. The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home Only (Code PC); 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) 18 Date of last inspection Brief description of the care home Fairfield is a large extended detached house providing care for up to 18 older residents. The home is located in the Olton area of Solihull and is readily accessible to amenities such as shops, places of worship and public transport. The home comprises of 16 single bedrooms, thirteen of which have en-suite facilities and there is one Care Homes for Older People Page 4 of 37 Over 65 18 0 0 9 0 2 2 0 0 9 Brief description of the care home double bedroom. Accommodation is provided on two floors and on the upper floor there are rooms, which can only be accessed via a few stairs, which means they would only be suitable for people who are fully mobile. There is a ramp to the front of the home to allow for easy access into the building. There are two lounges separated by glass doors, which when opened creates one large lounge area, there is a television based in both areas. A dining room and conservatory are also provided. There is a shaft lift to the upper floor. There are attractive gardens to the rear of the property, which are accessed via a ramp from the conservatory enabling access for service users in wheelchairs or with a disability. Handrails are also provided. Limited parking facilities are available at the front of the building and there is also off-road parking outside the home. Fees are detailed in the Service User Guide for the home at at the time of this inspection were £360 to £375 per week. Additional charges are made for personal items such as newspapers, dentist, hairdresser, chiropody, clothing and toiletries. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. This visit took place on Tuesday 20 October 2009 The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, Care Homes for Older People Page 6 of 37 how it can improve and statistical information about staffing and residents. During this key inspection we used a range of methods to gather evidence about how well the service meets the needs of the the people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service, staff and visitors to the Home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the Home were identified for case tracking. This involved reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Two people living at the Home, two relatives and four staff completed survey forms; their comments are included throughout this report. Care Homes for Older People Page 7 of 37 What the care home does well: People who are considering moving into the Home have their needs assessed before agreement is reached to move in, this helps to ensure that the Home can meet these needs. People are encouraged to visit and chat to staff and other people that live at Fairfield to help them decide that this Home is the right place for them. They are given information about the Home before agreeing to move in. Care plans are developed upon admission. Peoples needs are identified and recorded. Detailed information tells staff the action to take to meet peoples needs. Those people spoken to were happy that their needs are met. People have access to advice from health professionals such as dentist, chiropodist and optician where they need it, so their health needs can be met. Medication records were easy to read and up to date. Medication storage and administration was satisfactory. One person said we get our medication at the same time each day, they call the GP whenever needed, we also see the dentist, optician and chiropodist regularly. Various activities take place on a daily basis to ensure that people lead interesting lives and participate in activities which they enjoy. Visitors are welcome at any reasonable time, people are encouraged to maintain contact with family and friends. Choice and independence is considered important and people are able to continue to do things independently if they are able. People are offered choices in things that affect their daily life. The Home is odour free, clean and comfortable. Fixtures and fittings are in a good state of repair. Bedrooms were personalised with peoples own pictures and ornaments. the Home provides a welcoming, relaxing atmosphere. One relative commented in our survey the Home is always clean and tidy Staff attend National Vocational Training Courses in Care and various other training courses are provided to help ensure that they have the knowledge and skills to meet the needs of those under their care. Staff have a good relationship with the people that live at Fairfield. Staff were seen to be patient and kind and attentive to peoples needs. One relative said the staff are usually caring and polite. One person spoken to said staff are friendly and polite Service Users Money is well managed and records were up to date and in good order. Other comments received are detailed below:the Home is great, the best thing since sliced bread, everything is tip top. staff make a fuss of you, the Home is clean and tidy and your clothes are always clean Care Homes for Older People Page 8 of 37 the room is clean, the laundry is great, the staff are lovely. the manager has made some good improvements. What has improved since the last inspection? What they could do better: Further information is required in the Service Users Guide to ensure that people have all of the information about the Home that they need. This should include information about the facilities and services available to them at Fairfield i.e. staffing, number of bedrooms, management arrangements. Conflicting information in care plans should be removed. It should be evident which is the most up to date information for staff to follow. The privacy and dignity of everyone living at Fairfield must be maintained at all times. This should include the use of appropriate screening in shared bedrooms to ensure that personal care can be provided without compromising privacy. Any televisions that are broken should be repaired or replaced to ensure that people are able to watch a television in the lounge if they wish. A choice of meal is available on a daily basis, however there was no documentary evidence to demonstrate that the choices available are suited to the wants and needs of those that live at the Home. Sufficient food supplies should be available at all times in the Home to ensure that peoples food preferences are taken into consideration, this should include sufficient amounts of fresh fruit and full fat milk. The Homes record of complaints received with details of any action taken to address complaints should be available at all times. Laundry processes should ensure that the extra handling of soiled laundry does not increase the risk of spread of infection. Documentary evidence should be available to demonstrate that all new staff have undertaken induction training in line with the Skills for Care Common Induction Care Homes for Older People Page 9 of 37 Standards. Documentary evidence should be available to demonstrate that discussions are held with people regarding daily life at the Home, choices available and to ensure that the quality of care provided meets the needs and expectations of everyone living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: Three people were chosen to case track during this inspection. This involved talking to the person, looking at their care files and other paperwork regarding their life at Fairfield, talking to the staff about the care that they give and looking at their living areas and other facilities available to them. One of the people being case tracked had recently moved into the Home. Their care file was looked at to review the pre-admission and admission systems at the Home. The manager usually completes all pre-admission assessments. Standardised paperwork is used to find out information about the person before agreement is reached for them to move in. Care Homes for Older People Page 12 of 37 Evidence: Pre-admission paperwork seen had been signed by the manager. This recorded enough information to enable the manager to decide whether they would be able to care for the person if they came to live at the Home. Contact details for the next of kin, GP and social worker were also available. The Home are therefore able to contact these people for further information or support if needed. Some information regarding personal preferences for daily life and personal care were recorded along with brief details of needs and abilities. The number of staff required to provide help and the tasks that the person needs help with were recorded. This gives information to staff so that they can help the person as soon as they move into the Home. A conversation was held with the person whose care file was seen. This person said that they had enough information about the Home before they moved in. I came and looked around with my son and he left me here for a few hours and I had a chat and a look around. They also said that they had settled in well and the staff are kind and helpful. From documentation seen, discussions with staff and a person living at the Home, it was noted that pre-admission processes are satisfactory. Sufficient information is obtained about people before a decision is made for them to move in. People are also given enough information about the Home, including a visit for the day to help them decide whether they would like to move in to Fairfield. The Service Users Guide is available for anyone to view in the entrance porch of the Home. Some of the recommendations made at the last inspection regarding the Service Users Guide have been addressed. The Home now include a copy of the report summary from our last inspection. A copy of the inspection report is available on a noticeboard in the Home. The Service Users Guide should include information to give people an idea of what facilities and services are available to them. This should include the number of bedrooms that have en suite facilities, a sample menu, and information about staff and management qualifications. Some of this information was available in the Statement of Purpose. This should also be available in the Service Users Guide so that people do not have to read two lengthy documents to find the information that is useful to them. The contract of residency for the person who moved in to the Home recently was Care Homes for Older People Page 13 of 37 Evidence: seen. This document had not been dated or signed by a representative from the home or the resident. People are admitted to the Home for a trial period and this may be the reason that this contract had not been signed. Care Homes for Older People Page 14 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good access to a wide range of health professionals and their health and personal care needs are met. Evidence: The care files of the three people being case tracked were reviewed. Some of the information recorded in these files had not been dated or signed by the person recording the information. It is therefore difficult to identify whether this information is still relevant or the most up to date available. Some details recorded were confusing, for example a body chart used to show areas of bruising/pressure areas, records that a person has a pressure sore, there was no record of the size or depth of this sore. The pressure area care plan does not record that this person has a sore, this was dated the same day as the body chart. However, there was another care plan regarding pressure areas with the same date which records that the person has a pressure sore to their bottom and right heel. Sufficient information is recorded in this care plan. It is difficult to identify why there are two Care Homes for Older People Page 15 of 37 Evidence: pressure sore care plans both dated the same with different information recorded. Having conflicting information may be confusing for staff. In one file the preferences regarding hairdressing appointments were recorded differently on separate forms, on one form it was recorded as the hairdresser is to visit once per week and on the daily living sheet it records once per fortnight. Care plans seen contained sufficient information to enable staff to meet the identified needs of the people under their care. Care plans were reviewed on a monthly basis and documents had been signed by the persons next of kin to show their agreement to the care prescribed. Risk assessments were in place regarding developing a pressure area, falling, mobility and nutritional risk. These were all reviewed on a monthly basis. One mobility risk assessment checklist had not been dated or signed by person completing the information. Assessments were recorded regarding peoples manual handling needs and the staff assistance and equipment needed to provide assistance. Although some of these had not been dated or signed. A monthly care plan review is completed for each person by a senior member of staff who records details of any actions taken during the month or issues to monitor. People are asked questions about cleanliness of the Home, choices, worries or concerns etc. Peoples responses are recorded and they can sign the care plan review if they are able. Peoples weight is monitored and records are kept. Records showed that peoples weight is reasonably stable and where weight loss is identified action is being taken such as introducing food supplements. Daily reports are recorded per shift. Night records detail each time someone has requested staff assistance and the action taken i.e. toileted, cup of tea offered, taken down to breakfast. Satisfactory information was recorded for day and night entries for records seen. Records of visits made by the GP, optician, chiropody, district Nurse are kept on a separate file, records indicate that external professionals are called as necessary. Although staff said that there is a choice of male or female care staff, there was no documentary evidence to demonstrate that people are given the choice of personal care being provided by only male or female staff. The medication, storage and records of the people being case tracked was reviewed. A Care Homes for Older People Page 16 of 37 Evidence: large box of fortisip was being stored in the staff toilet and should be removed to a more suitable storage area. Records show that there was no co-codamol available for one person and none received on the prescription for this month. Staff said that they would re-order immediately and confirmed that the pharmacy were very quick to deliver. The remaining medication records for the three people being case tracked were all correct and up to date. Controlled drugs were checked and found to be stored and recorded correctly. A controlled drugs register is used to record drugs received and given. Records were correct. Copies of prescriptions are available for review. Storage of medication was found to be satisfactory. One person spoken to said we get our medication at the same time every day, they call the GP when you are unwell, you can see the optician, chiropodist or dentist Five ladies were sat in lounge on the morning of the inspection, all were dressed appropriately for the time of year. Some of the ladies were wearing makeup, all had their hair nicely brushed and their finger nails were clean and short. One shared bedroom was seen. Curtain screening is used to provide privacy between the two beds. This screening was too short to maintain privacy and dignity of anyone receiving personal care whilst sitting on commode as the bottom half of the person would be seen underneath the curtains. The two curtains being used were not wide enough to stretch the whole way around the curtain rail and there was a large gap in between the curtains when they were pulled across which people could see through. This screening did not maintain the privacy and dignity of the people sharing this room. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although a choice of meal is offered on a daily basis, there is limited evidence to demonstrate that the choices available are in accordance with the preferences of those that live at the Home. Supplies of fresh fruit and full fat milk should be sufficient to offer people a choice. Evidence: Discussions were held with staff and five people who live at the Home regarding daily life and any activities that take place. One person said that they join in all of the activities just to break up the time, someone suggested that it may be nice for staff to just sit and chat about the old days, do puzzles with people, hold their hands, another person said we have a choice of activities but not one wants to join in. An activity plan is on display in the lounges. Staff said that these are a guide only and are not necessarily the activities that take place. Activities such as bingo, progressive mobility and ball games are recorded. The Home do not employ activity staff. Care staff complete any leisure activities with anyone who wishes to join in. A member of staff was seen asking people whether they wished to join in with a game of bingo. The activity took place in the rear lounge and Care Homes for Older People Page 18 of 37 Evidence: lasted approximately fifteen minutes. Everyone appeared to enjoy the bingo. One person spoken to after the game said that it would be nice if we got a little prize of chocolate or something if we win. On the day of inspection those people sitting in the lounge by the conservatory did not have the use of a television as it was broken. One person said that the television had broken yesterday and that they had mentioned this to the Home Owner so that it could be repaired or replaced. There was no music playing in this lounge, two ladies occupied themselves by reading magazines and two other ladies slept or sat quietly. Two gentlemen sat in conservatory and listened to the radio. During the inspection the Home owner was seen talking to one person about the repair of the television. During the afternoon of the inspection staff sat and chatted to people. Staff appeared to have a good relationship with those under their care and were patient and kind, listening to peoples requests and offering assistance. An activity diary is used to record activities and the names of the people who joined in. Records were viewed for one week in October and these demonstrated that various activities take place such as arts and crafts, ball games, progressive mobility, church service, puzzles and card games. Activities such as watched TV and talked were also recorded on some days. The number of people who join in with the activity varied from everyone living at Fairfield to one person. No activities take place on a Sunday as this is recorded as a rest day. We were not shown any evidence during this inspection that people have been asked if the activities that take place are suited to their wants and needs. One person who responded to our survey said that the Home only sometimes arranges activities that you can take part in if you want. A member of staff spoken to confirmed that there are activities most days. She said that she asks what people would like to do for example singing or painting. Activities are done every morning for a short time, there is progressive mobility every Thursday and a priest and hairdresser visit once per fortnight. There are approximately two trips per year, we have been to the Botanical gardens and Bourton on the Water. Care plan records show that people are offered the choice of a bath or shower, times for rising and retiring and people were seen choosing where to spend their time in the Home. A member of staff said that male care staff are employed. However, there was no documentary evidence in care plans to show that people have been given the option of being cared for by either a male or female member of staff. People spoken to said that generally they are able to get up and go to bed when they want. Care Homes for Older People Page 19 of 37 Evidence: Visitors were seen in the Home during the inspection. Staff made visitors welcome and offered them hot drinks. Visitors are welcomed at any time but staff said that they are asked to avoid visiting at lunchtime if possible as this can be distracting for people whilst they are eating. Discussions were held with people regarding the meals available, the responses received were mixed. One person said staff are lovely, everything is great, there is only one problem and that is the food. The breakfasts are not good. Someone else said The Home is clean and the laundry is good, the staff are lovely but it is only the food. Someone else spoken to said the food is excellent. Other comments included food is good, you cant please everyone all of the time but in general it is good. There was a problem with variety but this is sorted. A member of staff spoken to confirmed that people get a choice of food every day plus they can have an alternative if they dont like the choices. There was no menu on display in the lounge or any information on display about the choices available for the meal of the day. Menus seen showed that people are offered a choice for breakfast, lunch and evening meal. There is a choice of cereal, porridge and toast each day with a different hot breakfast for example one day would be scrambled egg, another day boiled egg, the next day, beans. Tea/coffee and fruit juice are also served. Menus record that a drink biscuits and fresh fruit are served at 10am. People were seen being offered a hot or cold drink and biscuit but no fruit was offered. Menus also record that a mid morning snack such as tea, coffee or water is also available. During this inspection those people seated in the rear lounge were not seen to be offered a mid morning snack. The lunchtime meal served on the day of inspection was beef stew and rice. The two people sat in the lounge to eat their meal appeared to enjoy it. Staff offered both people the desert of sponge pudding and custard. Both replied that they did not like custard. The staff member did not offer them the sponge pudding without the custard. One person ate a banana instead. Menus showed that a variety of main meals and second choice of food is served such as salmon/parsley sauce, roast chicken, fish and chips, second choice of pasta bake and salad, sausages mashed potatoes, curry and rice, pork chops, faggots. However, the records that the Home keep regarding peoples food choices show that the main Care Homes for Older People Page 20 of 37 Evidence: meal of sausage on 19 October was only eaten by one person, all others had pasta bake and salad and the second choice of sausage on the 4th and 15th October was not eaten by anyone and a second choice of beefburger was offered on the 3rd, 7th and 14th October which was only eaten by one person on the 14th October. It appears from records seen that the second choice of meal is not varied and is not always the same as that recorded on the menu. It also appears that a majority of people do not always like the second choice of meal provided. Menus also record that a choice of drink, cakes and fruit is offered at 3pm. Again it was not evident that fruit was offered at this time. Fresh fruit was seen at the table at lunch time. However, this was not seen to be offered to people seated in the lounges, or cut up so that people could have a small piece of fruit if they wished. The evening meal is recorded as a choice of hot meal such as spaghetti on toast, jacket potato, soup and rolls, omelet salad or a second choice of sandwiches and fruit. People were seen eating sandwiches. There was no salad or crisps with the sandwiches. One person asked about this said usually there is a bit of salad or a pickle or some crisps but not always. According to the menu a drink of tea, cakes, crumpets, jam on toast scones, cheese and biscuits are offered at supper time Food storage areas were seen, stocks of fresh fruit and vegetables were very low and would not be sufficient to provide choice for all who live at Fairfield. During the afternoon the only fresh fruit and vegetables seen were two apples, one banana, onions, lettuce, cucumber and a few tomatoes. Staff reported that the Home owner goes shopping most days. There was no full fat milk in the fridge. Semi skimmed ultra heat treated (UHT)milk was seen in the storage area. Staff said that they have a delivery of full fat fresh milk every morning. However, it would appear on the day of inspection that the delivery received was not sufficient to last the whole day. Any drinks made in the evening would have to be made with UHT milk. Care Homes for Older People Page 21 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Evidence: The complaints procedure is on display on the noticeboard. This is not available in large print to help those with poor eyesight read this procedure. Complaints forms are available for people to complete if they have any worries or concerns and a suggestions box is available at the entrance to the Home for people to make anonymous suggestions if they wish. The member of staff spoken to said that the manager or one of the Home owners is available if people wish to speak to them. Two surveys were completed by people living at the Home, both people said that they knew how to complain and confirmed that there was someone informally to speak to if they were not happy. Two relatives completed our surveys and they were also aware of how to make a complaint if they needed to. The member of staff who helped with the inspection process was not aware of any complaints received since the last inspection. The complaints folder could not be located and was therefore not seen at this inspection. Care Homes for Older People Page 22 of 37 Evidence: Staff spoken to were aware of the action to take if abuse is suspected and of how to blow the whistle on poor practise. Staff said that they would not hesitate to act upon any issues which affect the health and wellbeing of the people that live at Fairfield. A majority of staff have undertaken training regarding the protection of vulnerable adults this year. Staff were seen moving and handling people appropriately. Hoists were used to transfer people into their wheelchairs as needed, staff were patient and kind giving reassurance to the person being hoisted. Care Homes for Older People Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has enough space and the required facilities for people to lead the life they choose and to meet their needs. Bedrooms are comfortable and have a homely feel. Improvements are required to some infection control practises to reduce the risk of spread of infection. Evidence: Fairfield is located in a residential area in Solihull. This is not a purpose built Home but has been adapted to meet the needs of those that live there. The ground floor has two lounges, a dining room and a conservatory. The kitchen is also located on the ground floor, the laundry is in the cellar. All communal areas on the ground floor were clean and no unpleasant odours were noted. The two lounges are separated by glass doors which can be opened if required. Decor in the lounges was in reasonable condition although a little dated. As previously mentioned the television in the rear lounge was not working. The television in the front lounge was in good working order. An unsightly brown patch was noted on the ceiling in the rear lounge, this had been re-plastered, the rest of the ceiling was wallpapered. Care Homes for Older People Page 24 of 37 Evidence: The conservatory was being used by two gentlemen. Various items such as wheelchairs, games and puzzles were being stored in the conservatory making the area look a little cluttered. A small areas in the ground floor corridor needed some plastering/decoration work as it looked unsightly. The dining room which is located next to kitchen was set out nicely for the main lunchtime meal. There are three communal toilets, one of which is located in the conservatory. Disposable hand towels and liquid soap were noted in all communal bathrooms/toilets. This helps to ensure that the risk of spread of infection is reduced. The bedrooms of the three people being case tracked were seen plus two other rooms. An unpleasant odour was noted in one bedroom. No odours were noted in any of the other rooms seen. Bedrooms had been personalised with pictures and ornaments and had a homely feel. Aids and equipment was available to suit the needs of the person staying in the room such as a pressure mat by the bed of someone who often falls, call bells, raised toilet seats in en suite bathrooms. Commodes are cleaned in the sluice room which is located on the first floor. This room was not locked shut when not in use. It was noted that cleaning chemicals are not stored in this room. However, to reduce the risk of spread of infection by people entering the sluice room, this should be locked shut when not in use. Adapted bathing facilities are available on the first floor. A communal toilet is available in the bathroom on this floor. No odours were noted in the bathroom. Three of the bedrooms on the first floor do not have en suite facilities. The communal toilet located in the bathroom is available for them to use. There are three small steps in the first floor corridor. A chair lift is available for those with limited mobility. This ensures that people have access to all areas of the Home. All laundry is put into red bags and taken to the laundry. Laundry is then taken out of the red bags and sorted. Soiled laundry is put on a sluice cycle. This extra handling of soiled laundry could increase the risk of cross infection. There are two washing machines and two tumble dryers in the laundry. All equipment Care Homes for Older People Page 25 of 37 Evidence: was in good working order. Disposable gloves and aprons were available for use. Fridge and freezer temperature records are taken once per day. A new thermometer has recently been purchased. The freezer is defrosted on a monthly basis. The temperature of hot food is also recorded. Care Homes for Older People Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff on duty to meet the needs of residents. Records do not clearly identify whether sufficient catering staff hours are provided. Evidence: Staffing levels were discussed with staff on duty and a copy of the duty rota was taken for review. The number of staff on duty on a daily basis varies according to the duty rotas seen. The manager works Monday to Friday between the hours of 8am - 2pm completing management duties. The Home does not have a deputy manager. The hours that the cook works is not recorded on the duty rota. There are no kitchen assistants, duty rotas show that the handyman does the cooking at the weekends and care staff cook during the week. Care staff are not allocated care duties when they are working in the kitchen. During the week of 5th - 11th October a domestic worked for six days between the hours of 9.45am - 1.45pm. A member of staff confirmed that a domestic is employed for six days per week and said that the handyman does the cleaning one day per week. The domestic does the laundry in the mornings and care staff are responsible for putting the laundry back in peoples rooms in the evenings and at any time that the domestic is off sick. Staff on duty on a daily basis are as follows:Early - 8am - 2pm 3 care staff, (seven days per week) Care Homes for Older People Page 27 of 37 Evidence: 4pm - 8pm 1 care staff (Monday to Friday) Late - 2pm - 8pm 2 care staff (Monday to Friday), 3 care staff (Saturday and Sunday) Night 8pm - 8am 2 care staff (seven days per week) This means that between the hours of 2pm - 4pm there are only two staff on duty Monday - Friday. This could mean that people may have to wait for assistance if both staff are occupied assisting a person who requires hoisting or any other task that requires the assistance of both members of staff. One person spoken to commented about the number of staff on duty and said staff are busy, you have to wait to be helped, it was 11.35pm the other day before I was taken to bed,it has gone different these days, I think they are short staffed. People living in the Home spoke highly of staff and made the following comments, the staff are lovely, but there have been a lot of changes recently, there was one member of staff who was a bit dodgy but she has been sacked, everyone else is great its all fantastic, Staff are nice and friendly. staff are all lovely, kind and friendly. One of the two people who responded to our survey said that they always receive the care and support needed and staff are always available when you need them whilst the other person responded that they usually get the care and support needed and staff are usually available when you need them. Staff were seen to have a good relationship with those under their care. During the inspection staff were attentive to peoples needs and spent time when possible chatting to them. A staff training matrix records dates of training with the number of staff who have completed the training. This shows that staff receive a varied amount of training which will help them to meet the needs of those under their care. The training record shows that eighteen staff are employed and thirteen of these staff have undertaken a national vocational qualification in care. Care Homes for Older People Page 28 of 37 Evidence: During 2009 staff have also undertaken training regarding dementia, moving and handling, infection control, food hygiene, fire safety, first aid, health and safety and adult protection. Records show that not all staff have undertaken all training but a majority of staff employed have undertaken the above courses. The personnel files of three newly employed staff were reviewed. Each file contained sufficient pre-employment checks to ensure that only suitable staff are employed at the Home. Two written references are obtained as well as a protection of vulnerable adults check. Criminal records bureau checks are still awaited for two of the staff very recently employed. Completed application forms, health declarations, job descriptions, interview questions/responses were also available in each file along with copies of proof of identity such as birth certificates. Staff are given a copy of their terms and conditions of employment and various policies such as confidentiality, adult abuse, staff grievance, whistle blowing, privacy and dignity and health and safety. One of the files seen contained an induction workbook regarding understanding the principles of care this showed that the member of staff had completed a six week induction to care work. Two other files contained evidence that the staff had undertaken in house induction training provided by the Home. All staff should undertaken in house induction and the Common Induction Standards training in line with Skills for Care requirements. This induction records the minimum expectations of the learning outcomes that need to be met so that new workers know all they need to know to work safely and effectively. Evidence should be available to demonstrate that all newly employed staff have undertaken or are completing the Common Induction Standards. Staff spoken to said that they are provided with sufficient equipment to enable them to look after people in the Home and they are provided with regular training and updates. Staff said that the manager and Home owners are approachable and helpful and they said that they are happy working at Fairfield. Care Homes for Older People Page 29 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A suitably experienced and qualified manager is in place who aims to ensure that the best interests of the residents are maintained. Health and safety systems are in place, although further documentation is required to demonstrate that all safety checks are up to date. Evidence: The manager was on annual leave and was not available at this inspection. There have been no changes to the management arrangements in place since the last inspection of the Home. People living at Fairfield gave positive feedback about the manager. It was noted that the Home has improved so much since the new manager has come into post, there is no deputy so the manager is extra busy. The manager has made some really good improvements. I can speak to the manager or the owners at any time and I will complain if I need to. Care Homes for Older People Page 30 of 37 Evidence: Quality assurance systems and practises were discussed with the Home owner and some of the people that live at Fairfield. One file seen contained satisfaction surveys for 2006 and 2007. This included staff surveys. A separate file was seen which contained recent satisfaction surveys. Questionnaires have been given to people in May, September and November 2008. The satisfaction survey for March 2009 showed that all people surveyed apart from one were satisfied with the care and services received. The manager had written responses to issues raised on surveys to demonstrate any action taken. The satisfaction surveys of June and Sept 2009 asked people if they are happy with the services provide by the Home, the food, the activities, complaints, cleanliness etc. No other recent quality assurance documentation was seen. A discussion was held with the owner and people that live at the Home regarding residents meetings. The minutes of residents meetings could not be found. One person spoken to said that the residents meetings are not really meetings, a member of staff apparently stands in the middle of the room, reads out the satisfaction survey and people answer. Another person said that you dont get the opportunity to air your views at meetings. One person said that some people may not wish to offend anyone by telling them that they are not satisfied. One person often gives an answer and everyone agrees and that is what staff write down. Residents spending money records were reviewed and found to be satisfactory. The records for two of the people being case tracked were reviewed. Receipts are available for expenditure and two staff sign the spending money record book to agree to any income or expenditure. The Home only hold personal allowance monies on peoples behalf and do not get involved in collection of pensions etc. A selection of records were reviewed to evidence whether the health and safety policies and practises are satisfactory. The Homes health and safety policy was reviewed in June 2009. The last Landlords Gas Safety certificate on file was dated February 2008. The Home owner gave her assurance that a more recent Gas Safety Certificate is available but this could not be located at this inspection. The environmental services contract for disposal of waste was dated February 2008, the most recent contract was not showed to us. Portable electrical appliances have been checked in September 2009 to demonstrate that they are safe to use. Nurse call and emergency lighting systems were tested in June 2009 and records show regular Care Homes for Older People Page 31 of 37 Evidence: maintenance and servicing of the passenger lift. Fire systems and fire safety practises were reviewed. Records show that emergency lighting was tested on a monthly basis up until June 2009, there was no documentary evidence that emergency lighting had been tested after this date. Emergency lighting should continue to be checked regularly to ensure that it is in good working order for use in emergency situations. Fire alarm call points are tested on a weekly basis. Staff fire safety training certificates show that training is up to date. Records of fire drills show that only one drill has taken place during 2009. Other records seen regarding water testing and electrical testing were up to date. In addition to the above the manager of the Home undertakes a monthly safety inspection audit. A checklist is used to review prevention of falls, lighting, clinical waste, electrical safety, kitchen safety, laundry, outside of the building. An annual audit is also undertaken to review health and safety systems such as COSHH, food rotation, fire log book records etc. This was last undertaken in 2009. Care Homes for Older People Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should contain information regarding all of the facilities and services available to people who live in or wish to move in to the Home. This helps to ensure that people know what they can expect from the Home. Care plans should clearly identify the most up to date information, conflicting information regarding pressure sores may be confusing for staff which could mean that care needs could be missed. All information in care plans should be dated and signed by the person recording the information. This helps to ensure that staff are following the most up to date information available. Documentary evidence should be available to demonstrate that people are offered the choice of having personal care provided by either a male or female member of care staff. A more suitable storage area should be found for the large stocks of fortisips currently stored in the staff toilet. Suitable screening should be available in shared bedrooms to ensure that personal care is provided whilst respecting Page 34 of 37 2 7 3 7 4 8 5 6 9 10 Care Homes for Older People 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 peoples privacy and dignity at all times. 7 12 People should be able to watch a Television in the lounge if they wish, any television which is broken should be repaired or replaced as soon as possible and an another television made available in the meantime. Sufficient stocks of fresh fruit, vegetables and full fat milk should be available to ensure that people are able to have these at any time throughout the day and night. Documentary evidence should be available to demonstrate that the second choice of meal avaialble to people is in accordance with their likes and dislikes. Fruit should be made available to people each day as recorded on the Homes menu. People should have the option of having a desert without custard if this is their choice. The complaints log book and associated information should be available at all times for inspection and to assist staff should they need any information about complaints received. Work should be undertaken to make good the ceiling and improve the decor on the ceiling in the rear lounge. Improvements are required to laundry practices due to the current systems for handling and washing soiled laundry as this presents a risk of spread of infection. The sluice room should be locked shut when not in use to reduce the risk of spread of infection. Duty rotas should clearly demonstrate that sufficient catering staff hours are provided on a weekly basis. Documentary evidence should be avaialble to demonstrate that staff undertake induction training in line with Skills for Care requirements. Systems should be in place to ensure that the quality of service provided meets the needs and expectations of those that live at the Home. All health and safety documentation should be kept up to date, this should include the most recent certificates regarding Gas Safety, Waste Contracts and Emergency 8 15 9 15 10 11 12 15 15 16 13 14 19 26 15 16 17 26 27 30 18 33 19 38 Care Homes for Older People Page 35 of 37 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 Light testing. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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