Care Home: Fairhaven [Gloucester]

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What the care home does well There are ongoing training courses that are attended in order to enable staff to meet individual residents needs and ensure that those living at the home are protected from harm and abuse. A stringent recruitment procedure is followed to ensure that appropriate staff are employed at the home. The home is adequately staffed to ensure the needs of people living at Fairhaven are met. There has been a consistent staff team at Fairhaven, these staff members know the people who live at the home well and have a sound understanding of their needs and wishes. Staff have developed effective methods of communication and ensure that individuals are consulted with choices and decisions about their life. Individuals access the full range of healthcare services as required, medication is well managed and individuals are supported in this area appropriately. Aids and equipment are provided in sufficient quantity to assist staff in meeting the needs of those who live at the home. The home is well managed and is run in the best interests of the people who live there. The manager at the home monitors the quality of the care and there are sound systems in place to underpin this. What has improved since the last inspection? At our last key visit which was undertaken on 25th & 26th September 2007 three requirements and ten recommendations were set by us. All three of the requirements have been met, these were that: Those living at the home can be assured that information contained within the statement of purpose and service users guide for the home is correct and sufficiently detailed, this requirement had been met as the documents have been reviewed and updated as required. Those living at the home can also be assured that the registered provider is committed to providing a well maintained environment as since our last visit the kitchen has undergone a complete refurbishment and also the first floor shower facility has been updated and is safe for use and meets the needs of the people living in the home. Of the ten recommendations that we made by us at our last visit nine had been met, these ranged from revisiting and re writing risk assessments through to the completion of health action plans. The one recommendation that had not been met was for the home to review the whistle blowing procedure dating from 2000, the manager confirmed to us that this had not been reviewed and would deal with this, the recommendation remains in order to ensure that staff are provided with clear information should they wish to raise concerns over practice. What the care home could do better: The home have maintained standards and people living at Fairhaven are well supported to lead full and interesting lives. At this visit no requirements were made, six recommendations were made in order to improve standards at the home. In order to enhance the quality of the service users guide it is recommended that the photographs used within this document are updated in order to reflect the current environment at the home. In order to ensure that the identified goals within individuals person centered plans are focused it is recommended that these are given timescales, these would make the goals easier to monitor and have realistic, measurable timescales. The home should arrange for manual handling refresher training for staff in order to ensure that they are provided with up to date information in order to move people in a safe, appropriate manner. The home should review fire training records to demonstrate that staff have received sufficient amounts for fire safety instruction and training. The home should review their `lone working` policy to ensure that the information contained within it fully reflects the staffing levels at night and to ensure that staffing levels are sufficient to meet the support needs of those living at the home. In order to demonstrate an ongoing commitment in providing a well maintained environment for those who live and work at the home it is recommended that the lounge carpet is replaced and furthermore that the ceiling in the identified ground floor bedroom is repainted. Key inspection report Care homes for adults (18-65 years) Name: Address: Fairhaven [Gloucester] Wolesley Road Elmbridge Gloucester Gloucestershire GL2 0PJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 1 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Fairhaven [Gloucester] Wolesley Road Elmbridge Gloucester Gloucestershire GL2 0PJ 01452530112 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: abby.rees@brandontrust.org www.brandontrust.org The Brandon Trust care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD Date of last inspection Brief description of the care home Fairhaven provides care for five adults with learning and physical disabilities. There are two bedrooms on the ground floor and three on the first floor. A stair lift is provided to make the upstairs more accessible. There is a lounge, kitchen and dining area as well as enclosed garden with a patio. The home is close to a range of facilities and is near to the city centre. Transport is provided to enable people living in the home to access the local community. The home is run by the Brandon Trust, who took over as service provider in April 2006. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 5 Brief description of the care home Up to date information about fees was not obtained during this visit. Prospective service users and their supporters would be provided with information about the home including copies of the Statement of Purpose and Service Users Guide. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place over 8 hours and was completed in one day. The registered manager and a senior support worker were present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including: - Information provided by the registered provider with the completed Annual Quality Assurance of the service, directly speaking with people who live and work at the home, a review of individuals care records, a tour of the home, an examination of some of the homes records and some observation of staff practices and interaction with the people who live at the home. As part of this inspection visit an expert by experience and their support worker accompanied the inspector. Their focus was to spend time with those who live and work at the home, to view the facilities and to provide an unbiased view from the perspective of those who live at the home. Information provided by them has been included within this report. Care Homes for Adults (18-65 years) Page 6 of 34 The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home and to also review the seven requirements and eight recommendations made during our last key visit to the service which was undertaken in August 2008. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The home have maintained standards and people living at Fairhaven are well supported Care Homes for Adults (18-65 years) Page 8 of 34 to lead full and interesting lives. At this visit no requirements were made, six recommendations were made in order to improve standards at the home. In order to enhance the quality of the service users guide it is recommended that the photographs used within this document are updated in order to reflect the current environment at the home. In order to ensure that the identified goals within individuals person centered plans are focused it is recommended that these are given timescales, these would make the goals easier to monitor and have realistic, measurable timescales. The home should arrange for manual handling refresher training for staff in order to ensure that they are provided with up to date information in order to move people in a safe, appropriate manner. The home should review fire training records to demonstrate that staff have received sufficient amounts for fire safety instruction and training. The home should review their lone working policy to ensure that the information contained within it fully reflects the staffing levels at night and to ensure that staffing levels are sufficient to meet the support needs of those living at the home. In order to demonstrate an ongoing commitment in providing a well maintained environment for those who live and work at the home it is recommended that the lounge carpet is replaced and furthermore that the ceiling in the identified ground floor bedroom is repainted. 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 Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective residents or their families have all relevant information to make a decision about the nature of the home. There is a good pre-admission assessment for any person needing to move into the home, which makes sure that the home can meet the needs of that person. People who live at the home have a contract which outlines the written terms and conditions for the home. Evidence: During our last visit to the service a requirement was made that the home should review and, where appropriate, revise the Statement of Purpose and Service Users Guide. At this visit we reviewed both of these documents and found the quality of information within them to be of a high standard. In order to enhance the quality of the service users guide it is recommended that the photographs used within this document are updated in order to reflect the current environment at the home. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: The documents clearly set out the types of needs that the home can cater for. The information within these documents was comprehensive and contained clear information for residents and their relatives about the services and facilities provided at the home and furthermore contained information about the staff and management arrangements at the home, there was also information about the admissions process into the home and how to raise issues of concern and showed how these would be responded to. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose. Full assessments of needs were undertaken for the person who was most recently admitted to the home. We reviewed this persons records and saw that the home had maintained clear detailed records in order to support this person in their transition to their new home. A support worker told us about this persons admissions process and we saw in this persons records that they were able to visit the home and spend time there before deciding on whether to stay. We saw that following this persons assessment/trial period, that a review meeting had taken place and all of those involved with the decision making process were present, full discussions took place about the placement and the life which was available to the individual, the person chose Fairhaven as their home and records seen by us demonstrated that they had settled in well and were well supported by the home. During our last visit to the service a recommendation was made by us that the manager should concider ways of gaining increased confidence in the handling of referels and admissions, it was clear to us that the manager dealt with the recent admission into the home is a confident, appropriate and professional manner, ensuring the needs and rights of the service user came first, as well as concidering the needs of those already living in the home. Clear contractual arrangements are in place for people living at the home, these are known as contracts, these contain information about the terms and conditions of the placement and provides information about the fees. Contracts had been produced in pictorial format making it more accessible for those who are not able to understand written literature. The home completed an Annual Quality Assurance Assessment (AQAA) of their service in August 2009, within this the home informed us of their plans for improvement over the forthcoming 12 months, which are:- To change from registered care to supported living with the support of care managers, advocates, family, Advance Housing and Brandon Trust senior management. See further information within the next section of Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: this report. Care Homes for Adults (18-65 years) Page 13 of 34 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care plans are in place and individuals assessed needs are well recorded and are extremely well detailed and kept under review. People are encouraged to make decisions which affect their lives and are given the support they need. Evidence: We read in detail two care plans and sampled files of others living at the home as part of the case tracking process. This means that we spend time reaching the records of the people that we select, and decide by meeting them, and talking with the staff caring for them, whether the care plans give the complete picture of how to meet a persons needs. In all instances this proved to be the case. The home uses a person centered and essential lifestyle approach of the persons life in order to try and gather as much information about them as possible. Information from these was included in the care plans we read. There was comprehensive Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: information about meeting the whole range of peoples physical and healthcare needs including details such as recording when the person last has a sight test and the date when they would need an annual check up. The quality of information in person centered plans and essential lifestyle documentation was excellent and it was evident that this information had been gathered over a period of time, one to one time has been spent with the service user and records seen by us detailed all aspects of their life, their wishes and aspirations. In order to ensure that the identified goals within individuals person centered plans are focused it is recommended that these are given timescales, these would make the goals easier to monitor and have realistic, measurable timescales. Communication techniques were also well documented so that staff knew how best to communicate with each person. There was a good reference to information about peoples previous hobbies and interests so that staff would know their preferences for activities and what they may not like. These included religious beliefs. The home have worked closely with the people living in the home and have developed listen to me, information books, these books contain written text, photographs and pictures which outline information to help people who live at Fairhaven live the life of their choice and this book recorded things that are important to them and which affect them. During this visit time was spent discussing the proposals for change of use of the home, we saw that people living at the home had been informed of the proposed changes. We spoke with one person about the proposals, they were unsure and were unclear about what this may mean for them and their future. We recognise that consultations are still in the early stages and it it clear that the manager and staff team ensures the home is conducted to enable those who live at the home are supported to make decisions with respect to their care they are to receive and their health and welfare. Arrangements are being made for the re assessment of individuals needs, by an appropriately qualified person, this is to ensure that all aspects of their assessed needs and personal wishes and choices are known and taken into account. Furthermore, advocacy support has been provided for individuals in order that they can be independently supported to make decisions that affect their life and their future. During our last visit to the service we recommended that the home complete health action plans for the people who live at Fairhaven, these were seen by us at this visit and were found to be well written, and tailored to the specific wishes and identified needs of individuals. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: During our last visit to the service we made a recommendation that the home should revisit and rewrite risk assessments, in particular those that had been handwritten, with written changes that may have compromised clarity. At this visit we reviewed the risk assessments for two people living at the home and saw that assessments had been typed. Risk assessments were seen by us included accessing social and leisure activities, transport arrangements and what individuals would do in the event of a fire, risks at mealtimes; assessments are well written, sufficiently detailed and are kept under review by the home. Peoples end of life wishes had been discussed and recorded in order to ensure that peoples wishes and choices are known and are respected. Care Homes for Adults (18-65 years) Page 16 of 34 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 are supported to take part in activities and to be part of the local community. Evidence: People who live at Fairhaven are supported to lead active lives and are encouraged to make choices which affect them. People take part in a wide range of social and leisure activities which have been provided following consultation, this is done in the form of essential lifestyle planning and person centered planning. Care plans and daily records evidenced the type of activities that people do. At the time of our visit people were attending an arts an crafts event and upon returning home later in the afternoon showed us the cards and picture frames they had made. Another lady was looking forward to attending a disco later that evening. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Within the dining room there are photo/picture/symbol boards which showed individuals weekly schedules. These showed us that people are supported to attend hydrotherapy, horse riding, cinema, music and aromatherapy. People are also busy attending local community and social groups such as the Salvation Army, Rainbow Club, Golden Age Club and St Hildas. People we spoke with said they were happy and enjoy the activities they do. People also visited local shops and visit places of interest, one person recently enjoyed a picnic at the Forest of Dean. People are supported to take a holiday and we saw that one individual enjoyed a trip to Brean Sands in July this year. During this visit an expert by experience spent time with those who live and work at the home within their report to us they fed back: When I was introduced to the residents they were very friendly. There was lots of friendly banter between the staff and the residents and from what I saw good interaction between the staff and residents. The residents I saw were enjoying their meal. In the dining area each resident had their weekly timetable up on the wall. Their timetables are in easy English with lot of pictures. I also saw communication chart for each resident. They were also in easy English with lot of pictures. There were lots of pictures of the residents activities around the walls. Staff really try to communicate in a way each resident can understand. Activities:All the residents do lots of things including:- The residents go to on a Tuesday the Everyman Club it is a social club where they can meet there friends. The Kingfisher Club is where the residents do arts and crafts including making cards. One of the residents showed us a photo frame they made that day with a photo of their brother in it. 2 of the residents go to college one evening per week. Other things the residents do also includes each Wednesday going to a lunch club. One of the residents also goes to a Service User Advisory group. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Another resident is going to see the Nutcracker at a local theatre soon. They will be getting a posh frock to wear. At Christmas the residents have lots of parties and are also going to a pantomime. When there is a suitable film on the residents go to the cinema. All the residents have good family contacts. One residents family live in France they get E-mails and lots of photos of them as attachments. The staff copy the photos on to a CD which can be played on a DVD player or computer. They can then look through them themselves. The other residents write to their family or visit if possible. The home has various board games including a large snakes and ladders game. This can be laid on the floor. This enables one of the residents to play the game as they do not usually engage with the other residents. Another of the residents likes to go to watch rugby. When they arrive at the ground they get VIP treatment. There is a hydrotherapy pool which the residents can use with support. This shows me (expert by experience) that the residents are getting a wide choice of things to do. I was told the residents are changing to supported living this will give them choice and control. Within the conclusion of their report the expert by experience had summarized; The home has a very friendly and lively buzz about it. The staff I saw are very warm and friendly and interact very well with the residents. The residents enjoy a lot of different things and seem to have a lot of choice and control. The home completed an Annual Quality Assurance Assessment (AQAA) of their service in August 2009, within this the home informed us of their plans for improvement over the forthcoming 12 months, which are:- To continue to investigate new activities and social opportunities. To continue to develop community presence. To work on one individuals computer and keyboard skills. Care Homes for Adults (18-65 years) Page 19 of 34 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 are supported with their personal, emotional, physical and healthcare. Medication is well managed at the home and people living at Fairhaven are fully supported in this area. Evidence: Fairhaven provides accommodation and personal care for up to five adults, male or female, who have a diagnosis of learning difficulties. At the time of our visit there are five people who live at the home, there has been one new admission into the home since our last visit to the service, we saw that this person had been well supported and had settled in well at the home. During this visit time was spent with people who live at the home, the registered manager and two members of staff. We were informed of proposals for the change of use of the home and were provided with some information about this. The registered manager has attended two meetings chaired by a representative of Gloucestershires Social Services department. The purpose of this meeting was to discuss the plans to change the current status of the home from one which provides residential care to Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: that of a service which provides supported living. We discussed with the registered manager some of the arrangements and plans currently being developed. The manager and staff team appear committed to ensuring that future changes will be made through full consultation with service users and ensuring that their needs, wishes and choices are respected and met. People living in the home are registered with a local doctors practice. Medicines are supplied to the home using a monthly blister pack system. All the medicines used in the home are given by staff. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support and training from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines were given from the labeled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully. We saw that the home has a medicines disposal book to record how unwanted medicines are disposed of. Staff have received medication training and a senior member of staff confirmed to us that all staff would be undertaking refresher training and that this would would be in the form of an e leaning, a distance learning pack. At our last visit to the service we recommended that the home obtain an up to date BNF book, this was obtained as staff are aware that this needs to be updated on an annual basis. People are supported with their primary healthcare needs such as the dentist, chiropody and optician, these had all been record in individuals health action plans and daily records. We saw that the home contacts individuals GP or any other health service as required promptly. Specialist services are also arranged as and when required and we saw that in the past this has included speech and language therapy and physiotherapy. The manager also confirmed to us that people living at the home are well supported by the community learning difficulties team. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: Care Homes for Adults (18-65 years) Page 22 of 34 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. People at the home are protected by the accessibility of the staff and can be assured that staff have been trained in adult protection. Evidence: There is clear, well written complaints procedure, a copy of this was in each individuals file and also they had a copy of this document in their room. Information about how to raise a concern or complaint in held within the guide about services and is well written within the homes statement of purpose. The home also has a clear policy in respect of how to raise issues of concern and this had been discussed with people who live at the home. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint and the format can be amended in order to be produced in a larger format for those with sight difficulties. It also directs the complainant to the CSCI (now the Care Quality Commission) and Gloucestershire Social Services Department. A copy is made available to residents and relatives should they request it. The Commission has not received any complaints about the home. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: The homes policy and procedures for safeguarding adults from abuse is readily available to staff. Staff told us they have received training in the safeguarding of vulnerable adults and were able to describe the types of abuse and what steps they should take if they had concerns. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, two references and satisfactory Criminal Record Bureau disclosures. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of residents had been reported to the Care Quality Commission. Care Homes for Adults (18-65 years) Page 24 of 34 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Generally individuals live in a home that is safe, comfortable and homely, and equipped to meet their needs. However, attention should be given to replace the lounge carpet and re paint a bedroom ceiling. Evidence: The home has a pleasant large rear garden and seating is provided,this area was seen to be well tended. There is parking at the front of the house. There are communal areas for service users (a lounge and dining room). There is no provision at the home for respite placements. The home has good arrangements in place for wheelchair access. A stair lift has been installed to the first floor of the house, we saw in records that this piece of equipment had been recently serviced and was deemed fit for use. The dining room and lounge were pleasant areas for people to enjoy, we noted that the carpet in the lounge was stained and well worn, in order to demonstrate the home is committed in maintaining a good environment for those who live there, it is recommended that this carpet is replaced. There are adaptations in place throughout the Home and specialist equipment Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: including mobility aids, bathing aids and handrails are in place. We also saw that the home had made arrangements for the making of a bespoke table, this had been especially designed and made for one individual in the home, this enables them to eat alone or join the other residents at the meal table, as per their choice. Toilets are situated in readily accessible parts of the Home near to communal areas and bedrooms. During our last visit to the service a requirement was made by us that the service must undertake necessary work on the first floor shower facility such that it is safe to use and meets the needs of the people living in the home. We viewed this during our visit and saw that this was functional and we were informed by the manager that the repairs required were completed after our last visit and that the shower was in good working order. It was also required by us at our last visit that the home must undertake work on the kitchen such that it is hygienic, safe and fit for purpose. This was because some of the metal strips around work surface joins had sharp edges and also because the work surfaces and work units were in a poor state of repair. At this visit we were pleased to find that the kitchen had been refurbished and units, work surfaces etc.. had been replaced. Making this safe and much pleasant, more hygienic place for residents and staff. A number of recommendations in respect of maintaining a safe well maintained environment were made by us during our last visit to the service in September 2007, these ranged from replacing the radiator in the ground floor bathroom to the letterbox on the front door should be draft proofed, all work had been undertaken as needed. At this visit we viewed some bedrooms all were well furnished and had been personalised with artwork, photographs and soft furnishings to reflect individuals taste and choices, we did note that the ceiling in one of the room was stained and it is recommended that this is re painted. The home completed an Annual Quality Assurance Assessment (AQAA) of their service in August 2009, within this the home informed us of their plans for improvement over the forthcoming 12 months, which are:- For identified areas of the home to be redecorated, this includes dining room and hallway. To investigate further the possibilities of having ceiling tracking put in place. To ensure the environment remains clean and tidy. Care Homes for Adults (18-65 years) Page 26 of 34 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Individuals are cared for by sufficient numbers of competent staff that are provided with training and supervision in order to fulfill their roles and responsibilities. Safe vetting and recruitment procedures are in place. Evidence: At the home there are sufficient numbers of well trained staff available throughout the day and night are able to meet the needs and numbers of the people currently living at the home. The procedures for the recruitment of staff are robust and offer full protect the individuals who live at the home. There have been no significant changes in the numbers of the staff team since our last visit to the service and their remains a stable staff team at the home. Information contained within individual staff files were all of a consistent standard. The files for three staff were reviewed: including a recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: unsuitable to work with vulnerable adults had been checked before the staff started working at the home. We saw that one of the staff members had worked closely with the people who live at the home in order to develop My ideal member of staff, people living in the home had been asked what skills and qualities they would be looking for and books had been created for each individual, the manager told us that this tool would be used as part of the recruitment and selection process for new staff. Since our last visit to the service, as recommended by us, the home have updated their policy on recruitment and selection in order that the policy takes into account changes in legislation and practice. The home have in place a clear audit of core training that has been undertaken by staff at the home, this and individual training records and certificates seen showed us that staff have undertaken training in areas such as first aid, food hygiene and protection of vulnerable adults. We found that there are some staff in need of updated manual handling training and we have recommended that the home should arrange for manual handling refresher training for staff in order to ensure that they are provided with up to date information, this will ensure that when staff move people it will be undertaken in a safe, appropriate manner. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individuals expectations and an evaluation of their performance and how this can be developed. Whilst at the home we observed staff and they were seen to be supportive to people who live at the home. It was noted that staff were very patient and asked people who live in the home questions and encouraged them to make decisions, rather that deciding for them and encouraged individuals to make choices. We spent some time throughout the day talking to staff and observing them carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humored and sensitive towards the residents within a relaxed, calm environment. All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people living at Fairhaven. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 living in the home benefit from a Manager who is competent, caring and promotes their rights. Any decision made is based upon what is best for the people in the home, and they are included as much as possible in that process. Evidence: The registered manager of this service is Miss Abigail Rees, she is experienced, appropriately qualified and committed to improving the quality of life for the people who live at the home. People living in the home spoke positively of the care provided. Practice observed was of good relationships between those who live at the home, staff and management. Miss Rees fully engaged with us during this visit and was able to locate all of the necessary information and documents easily. This shows that the home has good systems in place and is well run. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: assessment (AQAA) is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered was sufficiently detailed. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that Fairhaven complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. The fire logbook, record of fire safety training and accident and incident records were found to be accurate and up to date. We reviewed the fire logbook and saw that all of the required equipment, lighting and servicing checks had been completed as required. Training records in respect of fire training and instruction were not clear. The manager confirmed to us that all staff would be undergoing training in October, however, records must evidence that all staff have received sufficient amounts of fire training and instruction. It is recommended that the home should review fire training records to demonstrate that staff have received sufficient amounts for fire safety instruction and training. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. Staff confirmed that they receive regular training in fire precautions as well as Health and Safety. The home should review their lone working policy to ensure that the information contained within it fully reflects the staffing levels at night are sufficient to meet the support needs of those living at the home. Also, as recommended at our last visit the home should review its whistle blowing procedure to ensure its contents and information fro staff is accurate, this policy has not been reviewed since 2000. The home completed an Annual Quality Assurance Assessment (AQAA) of their service in August 2009, within this the home informed us of their plans for improvement over the forthcoming 12 months, which are:- To achieve all goals set within Service Action Plan. To maintain all Health and safety checks within Fairhaven. To achieve goals set within Equality and Diversity Plan. To produce and send out meaningful quality assurance information. Care Homes for Adults (18-65 years) Page 30 of 34 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 Adults (18-65 years) Page 31 of 34 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 In order to enhance the quality of the service users guide it is recommended that the photographs used are updated in order to reflect the current environment at the home. In order to ensure that the identified goals within individuals person centered plans are focused it is recommended that these are given timescales, these would make the goals easier to monitor and have realistic, measurable timescales. In order to demonstrate an ongoing commitment in providing a well maintained environment for those who live and work at the home it is recommended that the lounge carpet is replaced and furthermore that the ceiling in the identified ground floor bedroom is repainted. The home should arrange for manual handling refresher training for staff in order to ensure that they are provided with up to date information in order to move people in a safe, appropriate manner. The home should review their lone working policy to ensure that the information contained within it fully reflects the staffing levels at night are sufficient to meet the Page 32 of 34 2 6 3 24 4 32 5 40 Care Homes for Adults (18-65 years) 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 support needs of those living at the home. The homes whistle blowing policy should also be reviewed to ensure its content contains accurate information and guidance for staff. 6 42 The home should review fire training records to demonstrate that staff have received sufficient amounts for fire safety instruction and training. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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