Care Home: Fairhaven Residential Care Home

What the care home does well The inspection of three residents care plans, consultation with residents and relatives new to the home agreed that people could expect to received a `pre admission` assessment of their care needs from Fairhaven to ensure that the home could support them properly. A new resident to the home and their relative confirmed that they had been encouraged to visit as often as they wished before making any decisions and that they had received enough information to be able to decide whether the home was the right place for them commenting;`I am quite happy here`. A relative completing the survey confirmed this when commenting about their own experience;`during the assessment process, the home addressed my ` mum/dad ` directly and we were able to visit as often as needed`. A care plan of the most recent resident was inspected and showed that the home had completed the appropriate pre admission assessments. One of the new residents relatives confirmed that the home had considered the residents personal preferences prior to them moving in, commenting; `they asked `mum/dad` what colour they wanted in their room, and all the bed linen was new`. Fairhaven offered residents a friendly and homely environment that was clean and tidy and met the residents expectations. Feedback from the surveys issued on the day of the inspection ,were all very positive about the home; `we are always made welcome when visiting ,bedrooms always clean and tidy`. `there`s always a friendly, homely atmosphere. We are always made welcome. Staff are hard-working, kind and showed a great deal of patience with my `dad/mum` and other residents`. This was observed throughout the inspection. The home made available a visitors questionnaire to encourage feedback from relatives and there was also details about `how to make a complaint` both were available and in a prominent position in the entrance hallway next to the visitors book. When there was a problem one relative commented; `the home, rang straight away last week when mum/dad was ill, whenever there is anything needed they will ring`. Staff files inspected showed that they were well trained and able to meet care needs of the residents and their relatives and the homes manager was open and approachable. Comments from relatives completing the survey included; `all staff are very patient, gentle and supportive of his,her dementia and disability. He/she is given sufficient time to perform everyday tasks, and support them in a caring manner`. This was observed and throughout the two-day inspection. ` most importantly my mum/dad is much happier since moving to Fairhaven`. `they make the care home seem like your own home and not an institution which is lovely for mum/dad`. `after all the scare stories in the media concerning care of the elderly I am so pleased that my mum/dad is so well looked after`. What has improved since the last inspection? There were no requirements made at the previous inspection. What the care home could do better: Overall this was a very positive inspection and there was only two requirement necessary. The home was required to ensure that residents were not exposed to unnecessary hazards inside and outside of the home. This applies particularly to the garden and patio area. And for the registered manager to clarify whether or not he intends to continue to manage the day-to-day business of the home or whether he intends to employ a new manager. No further requirements were made because the plans to address all of the following issues were discussed with the registered manager and business manager or recorded in the AQAA and were being addressed . They included; That all existing care plans were being transferred into the latest care plan format that had been introduced at the home. That all medication, including medication taken from `time to time`,such as, painkillers would be entered in the ` Medication Administration Records` rather than using a separate record book. That a new storage system for residents medication and measures to ensure medication was kept at the correct temperature would be in place within six weeks. That the home was reviewing its policies and procedures and in particular its policy relating to updating and storage of records such as, safeguarding outcomes and personnel records. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fairhaven Residential Care Home 76 Cambridge Road Aldershot GU11 3LD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Damian Griffiths     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Fairhaven Residential Care Home 76 Cambridge Road Aldershot GU11 3LD 01252322173 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : fairhaven@ntlworld.com Mr Robert Allan,Mrs Colette Allan care home 13 Number of places (if applicable): Under 65 Over 65 0 13 dementia old age, not falling within any other category Additional conditions: 13 0 The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category/ies of service only: Care home only - 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 Dementia - DE Date of last inspection Brief description of the care home Fairhaven is registered to provide care and accommodation to 13 older people, including those with dementia. The home is situated in a residential area within a mile of Aldershot town centre. The home is adjacent to a number of local shops and other facilities and within easy travelling distance of Fleet and Farnborough. Information about the service provided at the home is made available to potential residents by providing a copy of the homes Service Users Guide and brochure. A notice is on display in the hall of the home informing people that a copy of the last inspection of the home by the Commission for Social Care Inspection is available to see. Care Homes for Older People Page 4 of 33 Care Homes for Older People Page 5 of 33 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 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 unannounced key inspection took place over a two-day period due to the home requiring more time to retrieve personnel records that had been stored in another location. A total of 10 hours was spent at the home. The homes registered manager Mr Robert Allan and the homes business manager were available over the two-day inspection period. A tour of the premises took place and a number of documents and files including 3 of the residents care plans, five care personnel files and the homes Annual Quality Assurance Assessment, AQAA was examined as part of the inspection process. A selection of CSCI (now the Care Quality Commission,CQC) surveys were distributed and completed during the inspection by one residents, seven relatives, two care staff Care Homes for Older People Page 6 of 33 and one of the main healthcare practitioners attached to the home and all were consulted throughout the inspection process. The manager advised that the weekly fees ranged from 400 to 415 pounds per week. In respect of confidentiality, comments made, during the inspection and in the surveys have been slightly changed to protect the identity of all those involved in the process What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 33 There were no requirements made at the previous inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 9 of 33 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 10 of 33 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. New residents to the home received a pre admission assessment , useful information and time to make decisions prior to moving into Fairhaven. Evidence: Three of the residents care plans were inspected to ensure that preadmission assessment had been completed prior to residents moving into the home. Personal care needs, healthcare needs, preferred activities, food and daily routines had all been assessed to ensure that the home could provide support in these areas. A care plan of the most recent resident was inspected and showed that the home had completed the appropriate preadmission assessments. People new to the home confirmed that they had been able to visit the home on a number of occasions in order to get a feel for the place and they said; during the assessment process, they addressed my mum,dad directly and we were able to visit as often as was needed, two, three times, in one week once mum,dad had made their mind up and went on to say, they asked my Care Homes for Older People Page 11 of 33 Evidence: mum,dad what colour they wanted in their room, and all the bed linen was new. A resident completing the survey issued confirmed that they had received enough information prior to moving into the home and commented; I am quite happy here. The relatives of the residents completing the CSCI surveys confirmed that they had; always received enough information about the home to be able to make decisions. A relative commenting about the quality of care received said; always first-class. All the residents care plans inspected contained a preadmission assessment and as the comments indicate, all the residents and relatives consulted were satisfied with the information they received and the homes admission processes. Care Homes for Older People Page 12 of 33 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. Residents benefited from the homes day-to-day monitoring of their healthcare needs including administration of medication and the sensitive and consistent way that care staff provided support. Evidence: The homes Annual Quality Assurance Assessment, AQAA commented; the home has a good care plan format that allows the staff to document all areas of personal care and health issues. The three care plans inspected contained details informing how each service users care needs differed and what support they required. The main areas of support were in relation to;personal care needs, healthcare needs, activity preferences and routines. Each care plan had a detailed dependency profile to reflect the level of need for residents with dementia care needs. The home had introduced a new care plan format that was easy to use and contained all the necessary information about how the residents would be supported on a day-today basis. The home was still using the old care plan system resulting in two styles of Care Homes for Older People Page 13 of 33 Evidence: care plan recording. This made it difficult to obtain information about the residents care needs that was confusing and time-consuming . The registered manager confirmed that the home was in the process of reviewing all its procedures and practices and the home was undergoing the changeover to the new system. To meet the demands of residents with dementia care needs the home had ensured that regular assessment of mental capacity was included within the new care plan format. However only one of the three residents care plans inspected had received an assessment using the new system . The home was using a dependency rating system that assessed similar areas of need to ensure that mental capacity had been established. The home was reviewing these processes and the registered manager confirmed that this area was being actioned. Risk assessments were in place that endeavoured to reduce risk of accident and support the residents to live the life they chose, for example; a resident enjoyed a cigarette and a risk assessment had been completed to ensure that fire safety precautions had been considered in the event of an accident. The resident and care staff were aware of where in the home the resident could smoke and the resident have access to healthcare information relating to smoking. Other areas of risk had been recorded and monitored for example; daily monitoring of falls, blood tests, diets, fluid intake and skin care were all being completed including records of GP visits and outcomes. This reduced the risk of injury and infection and promoted the healthcare needs of the residents and demonstrated how the home was taking care of the residents healthcare needs. This was also confirmed by a health care practitioner completing the survey. They agreed that the home always sought advice and acted upon it to manage and improve the residents health care needs and commented,that staff; keep in touch well with the surgery. An inspection of the homes medication administration practice was completed. Residents medication was kept in a lockable kitchen cupboard situated in the laundry room and there was potential risk of damage due to humidity and damp as the washing machines were situated in the same area. There was no evidence at hand to show that the home had taken measures to record the temperature of the storage area. The Inspector was advised by the manager that the home was in the process of obtaining a new lockable trolley and refrigerator within the next six weeks. The cabinet temperature was taken during the inspection and showed that it was below the recommended storage temperature and did not pose an immediate threat to the quality of the medication. During the interim period the manager advised that he would ensure that the temperature of the storage area would be regularly monitored until the new refrigeration units arrived. The healthcare practitioner completing the survey confirmed that they were confident about the homes ability to ensure residents received their medication on a daily basis and that a new trolley was on order. Care Homes for Older People Page 14 of 33 Evidence: The homes Medication Administration Records, MAR, were inspected and a sample of the residents tablets counted and compared to the records. Most residents medication was provided in blister packs. All records inspected corresponded with the dosage as prescribed by the GP ,recorded daily details and the initials of the care worker providing this support. A record of spoilt or medication to be returned to the pharmacy was in place and also a book for recording medication, such as, painkillers was being kept up-to-date. The keeping of a record book for this purpose was discussed with the manager and it was agreed that it was not necessary. Records of all medication being given to the residents should be recorded in the MAR. The manager advised that they would do this instead of keeping a record book. A resident completing the survey confirmed that they always received the care and medical support they needed. Relatives of service users confirmed that the residents different needs were being met. This was in respect of their age, disability, gender and ethnicity. Comments included; all the staff are very patient, gentle and supportive of his,her dementia and disability. They are given sufficient time to perform everyday tasks and support in a caring manner. And, the care is exceptional and we are both very happy with the home. The health care practitioner completing the survey also confirmed that the home respected residents privacy and dignity. Care staff were observed working with residents in a sensitive and consistent manner, respecting their individuality by addressing them by their first names, as preferred and working discreetly if privacy was needed. Care Homes for Older People Page 15 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided residents with the opportunity and choice of daily social activities, the provision of cultural and religious activities and a varied and nutritious diet. Evidence: Feedback from relatives and residents completing the surveys distributed regarding choice of activities, meals and the overall attitude and practice of care staff support was very positive. A relative commented;as far as Im concerned the staff are fully able to care well for my mum/dad. Relatives completing the section of the survey titled; Does the care service support people to live the life they choose confirmed that the home always does this and one commented; as far as is possible according to their abilities. Weekly activities were listed in a prominent position for the residents to see in the main lounge area, these included; ball games, quizzes, painting, arts and crafts , hoopla and bowling. A gentle ballgame designed to assist residents with dementia needs to interact with each other and a quiz were observed during the inspection. Residents were observed laughing and joking about their experience during and after the activities. The residents care plans sampled showed evidence that the home had recorded the Care Homes for Older People Page 16 of 33 Evidence: residents preferences in regard to their daily routines, for instance; reading the daily paper and detailing the activities and food they enjoyed. A resident consulted said that they didnt like the activities preferring instead to socialise and chat with other residents. This had been noted in the residents care plan. Their son/daughter confirmed that the home ensured that their relative was able to do the activities of their choice,included;going out with their family,friends to visit local garden centre, having a cigarette, puzzles, quizzes and reading the daily newspaper. Other relatives consulted confirmed that the home ensured the activities enjoyed by residents were always available and commented;nice relaxed atmosphere activities are on daily. The homes business manager advised that new reminiscence activities were planned to be introduced in the next 12 months including, memory books, creating pictorial family trees and the development of a sensory stimulation touch and feel therapy session. The business manager went on to say that the home would be exploring an interactive activities program available on DVD. This demonstrated the homes commitment to developing new and creative activities that were relevant to meeting their needs. Residents were supported to maintain family links and care staff were observed talking to the relatives visiting the residents throughout the two-day inspection. The home operated an open door policy whereby relatives were able to visit at any reasonable time. Relatives comments confirmed this; there is always a family, homely atmosphere. We are always made welcome the staff are hard-working, kind and show a great deal of patience with my relative and other residents. Another relative stated that whenever she visited unannounced, the home was; always well organised and the care staff were never fazed by her being there. very friendly, welcoming and support the residents. The staff always upbeat and chatty, they work hard and have fun with the residents. I think it is important to have a warm and relaxed environment and that the staff encourage this at the home. Residents cultural and religious needs were respected and regular access to religious services was available. Relatives completing the section of survey concerning equality and diversity at the home all agreed that the home always respected the wishes of the residents. Comment included;they are very patient, gentle and supporting of his/her dementia and disability. He/she is given sufficient time for everyday tasks and supported in caring manner. Care need assessments detailed what food residents preferred throughout the day including; breakfast time, lunchtime and evening meals. Residents said they enjoyed their meals and a four week menu plan was in place for residents to view. Residents had fishcakes a selection of vegetables and fruit for lunch on the day of the inspection and confirmed that the food was good. Menus contained a wholesome and nutritious selection of fresh fruit and vegetables. Special diets were available for residents with a Care Homes for Older People Page 17 of 33 Evidence: glucose intolerance and pureed food these were detailed in individual care plans. Residents also confirmed that the the home provided their favourite meals, such as, fish and chips and roast chicken from time to time. A relative confirmed that since her, mother/father had become a resident at Fairhaven he/she had put on weight for the first time in years, cant find fault. Residents and relatives confirmed that the home provided activities every day, that residents were able to do as they chose,residents preferred to go out with their relatives. Residents were satisfied with the level of activities provided and that the home respected their routines. Mealtimes were enjoyed and care staff ensured that they had plenty to eat and drink throughout the day. This was confirmed by a relative who said; care staff are very responsive to differing levels of care needed to match residents needs and went on to say; Christmas and summer parties are arranged every year, the staff go around all the time getting residents drinks, turning the TV up or down. Care Homes for Older People Page 18 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives were aware of the homes complaints policy,were confident that any concerns would be listened to and that the home was committed to the safeguarding of residents and improving record keeping practices. Evidence: A resident completing the survey confirmed that; staff listened and acted on what they said, were always available when they needed them and that they knew how to make a complaint. The AQAA stated that;The home provides a complaints procedure which is located in the hallway next to the visitors book and situated on the wall above the visitors book and will find a copy in the service users guide. Relatives completing the CSCI survey, also agreed that they knew how to make a complaint. Comments included; Whenever I come to see mum/dad, the home is clean and tidy and Im made to feel welcome Ive no concerns about the staff, and another confirmed that the complaint procedure was in the hall confirming the AQAA statement and the relatives understanding of the procedures. An inspection of the homes complaints records and procedures showed that there had been no new complaints made over the last 12 months. The Statement of Purpose produced by the home detailed its commitment to safeguard residents from all forms of abuse and that it supported its care staff to Whistle Blow, Care Homes for Older People Page 19 of 33 Evidence: if they were concerned about the homes response to any safeguarding issue. Another measure taken to ensure the safety of the residents was for visitors badges to be distributed and for staff to ensure that the visitors book was always signed. CQC (previously CSCI) had been informed by the local authority about one safeguarding issue since the last inspection that related to night care and required the manager to conduct a review of staffing levels. There was limited detail about the outcome of the review recorded in the homes records but there was evidence of a successful resolution and there had been no further concerns refered to the commission from the local authority. The family had sent a Thank You card to the home in gratitude for the way the home had cared for their relative. The manager advised that the records had not been kept due to the resident not living at the home anymore. This showed evidence of the home working successfully with residents and their relatives but highlighted a shortfall in the homes record keeping practices. The home was aware of the need to ensure that residents were safeguarded and that care staff were aware of the correct procedures to follow. Care staff files inspected showed that training was received in this area of care and care staff commented that; they knew how to respond if a relative or friend had concerns about the home; I would report straight to the manager for an immediate response. No further safeguarding incidents had been reported to CQC this year. The manager advised that the home was undergoing a management review of all policies and procedures including the homes policies relating to keeping records. Care Homes for Older People Page 20 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fairhaven made sure that residents and their relatives were welcomed and provided a comfortable and homely environment that was clean and tidy but there were some areas requiring improvement to ensure that residents health and safety were not put at risk. Evidence: A tour of the premises was conducted at the beginning of the inspection to meet the residents and confirm that the home was fit for purpose. The entrance to the home was accessed by a long driveway that provided parking for three to four cars. One side of the drive was lined with conifers that had recently been trimmed. The manager advised that he was considering the removal of these trees in order to provide more light to the home. The front door led to a hallway that was tidy and contained a noticeboard and shelf where the visitors book could be found alongside useful information about the home and other useful topics of interest. The homes communal areas were clean, tidy and airy providing a homely environment for the residents. Residents had access to a patio and garden area via the lounge that was the main centre of activity containing comfortable chairs, TV and dining area. There was another room adjacent to the Care Homes for Older People Page 21 of 33 Evidence: lounge that accessed the patio area and provided a light and airy refuge for residents to relax away from the main activities of the home. The rear of the property could be accessed by a secured back gate.The patio was assessed by doors situated in the living room areas of the house. The large rear garden led off from the patio area and was accessible to the residents and their families to enjoy. Relatives consulted confirmed that this was a favourite area used to relax and entertain and that the home use this area throughout the year, for example,Summer Parties. In the centre of the lawned area there was a significant slope leading down to the bottom of the garden that could be hazardous to residents as there were no steps, rails or fencing in place. The manager advised that residents do not use this part of the garden and that residents preferred to relax on the patio area where there was a table and chairs available. One of the relatives and stated; mum,dad not really interested in the garden and likes to sit on the patio. There was no risk assessment in evidence and this contradicted the homes policy relating to safeguarding the residents from unnecessary hazards. To the right of the patio the home had a garden shed that housed tumble dryers that were in constant use. Grab rails attached to the side of the shed leading to the lawned area were rusted,did not promote confidence or health and safety as had been originally intended. There was also a large disused armchair next to the shed that the manager advised was waiting to be disposed. The homes fire escape was at the rear of the building and led to the lawned garden area at the bottom of the slope and appeared to be in good condition. Paint on window sills and frames was flaking and in need of attention. The manager advised that this would be done as a matter of routine maintenance work. Residents bedrooms had been decorated to the residents requirements. A relative completing the CSCI survey said; the home, asked mum,dad what colour they would like their room before they moved in. Most of the bedrooms had been decorated recently but in one bedroom there were signs of wallpaper damage in the corner of the room. The manager was informed about this and agreed to investigate and repair any damage. Bathrooms and toilets were clean and fresh containing adequate washing facilities. A relative completing the survey commented; they make the care home seem like your own home and not an institution which is lovely for mum,dad . The homes laundry room was approached by the homes central corridor and was kept locked in respect of health and safety. As mentioned, the tumble dryers were housed Care Homes for Older People Page 22 of 33 Evidence: in the garden shed. There was a kitchen sink and drainer available that was in need of attention due to everyday wear and tear. The cupboards available underneath the sink, drainer was used for the storage of cleaning materials and chemicals. The homes washing machines had variable programmes and a sluice facility that ensured that a high temperature wash necessary to eliminate soiled clothes was available. The home was required to ensure that all parts of the home that were accessible to residents were free from hazards to ensure thier health safety. The manager advised that the following actions were in the process of being implemented and would be completed before the next inspection. 1. Repairing the wallpaper in the residents bedroom and explore the cause. 2. Grab rails leading to the lawned garden were being replaced. 3.All external woodwork in need of repainting was to be actioned. 4. The disused recliner chair, in the patio area was being removed. Care Homes for Older People Page 23 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care staff provided care consistently throughout the day and night ensuring the health, welfare and safety of the residents . The home practiced robust recruitment procedures to ensure the safety of its residents who were cared for by staff that had received training from the home to meet their care needs. Evidence: The homes AQAA stated;the home provides good number of staff to meet the service users need day and night, staff rotas are put up every week and four weeks are always on the notice board for staff to see their hours in advance, the home ensures that standards are met with the domestic side and mealtimes. With regard to the safeguarding issue referred to in the Complaint and Protection section concerned over night staffing levels. Residents, relatives, care staff were consulted and an inspecting of care plans including one specifically devised for the residents overnight care was also inspected. The service user completing the survey confirmed that staff were available when they needed them. Relatives confirmed that the care home met the needs of the residents and that staff had the right skills and experience to look after the residents properly over a 24 hour period commenting that care was; always first class , another comment focused on the care at night; the night care plan allows dad,/mum to be able to get up through the night and sit up if he/she wants to. Other comments received were; the care home as far as I can see, is well run, and residents Care Homes for Older People Page 24 of 33 Evidence: including my father/mother appear to be well looked after. whenever I visit unannounced the home is well organised and staff on duty are never fazed dad/mum, is doubly incontinent but are always clean and well looked after. Comments from a health care practitioner also confirmed that care staff; know when to ask for help. There had been no further reports or concerns reported to CQC and there was no evidence to show that night staffing levels were in need of review. Five care staff files were sampled to confirm whether recruitment practices were in line with the care home regulations and the homes commitment to safeguard residents. The manager advised that the relevant documentation was being stored at another location due the home undergoing a business review. It was agreed that the inspection would continue the next day in order for the home to ensure that personnel records of care staff could be thoroughly inspected. The records inspected the next day showed evidence that the home had made sure that proper recruitment procedures had been observed. Care staff had received a criminal record check from the Criminal Records Bureau,passport ID, immigration documentation, employment history and references ensured that the current recruitment checks had been carried out at the home prior to care staff working with the residents. Care staff completing the survey and consulted during the inspection confirmed that they were given training which was relevant to their role and helped them to understand and meet the diverse needs of residents. Care staff also confirmed that they were kept up-to-date with new ways of working. The business manager was at the home to oversee staff training for the national vocational qualifications,NVQ. The homes small office was being used for this purpose and was used throughout the period of the inspection.The care worker was using the homes computer and working through a DVD training programme. The home provided a wide range of training. Care staff consulted said this was welcomed and appreciated. Personnel files contained examples of training covering the general everyday needs and the specific care needs of the residents these included; safe manual handling techniques, health and safety, basic food hygiene, infection control, medication administration and fire awareness training. The specific training given to meet the needs of residents included; dementia awareness, mental capacity and safeguarding vulnerable adults. Care staff were observed working with residents in a consistent and sensitive manner. The manager advised that further training was being planned for the next 12 months to equip staff with further knowledge of dementia care and different ways of providing specific and relevant activities. Care staff feedback included; there has been a lot of ideas regarding dementia training and activities. This will be good for the home. Care staff agreed that the home did well in providing;very good support to all staff and residents families. Feedback from relatives supported this view and included; they seem to improve all the time. And I think it is important to have a warm and relaxed environment that staff encourage at this home. This confirmed the homes Care Homes for Older People Page 25 of 33 Evidence: committment to provide relevant training to ensure the provision of good outcomes for residents and their relatives. Care Homes for Older People Page 26 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home was based on openness and respect and had systems to measure the homes quality assurance. Residents and relatives were satisfied with the level of contact they had with the management and care staff who were committed to implementing health and safety improvements to ensure residents best interests were being met. Evidence: The manager advised that he is a registered mental health nurse and was at one time a charge nurse and clinical tutor with 30 years experience working in special hospitals in the national health service. Since the last inspection the manager has employed a business manager to help improve standards at the home. The registered manager Mr Robert Allen is accountable for the day-to-day running of the home. We were advised that the manager was considering whether the home needed to be managed on full time basis due to his other business commitments, including a number of other care homes. The manager is required to confirm whether or not he intends to continue to Care Homes for Older People Page 27 of 33 Evidence: be in full-time day-to-day charge of the care home or whether he intends to employ a new manager. Care staff feedback indicated that they felt well supported and commented in the section of the CSCI survey titled, Are you given up-to-date information about the needs of people you support, said;yes, my business manager is always there to update all care if my manager is not here and another commented; very good support to all staff and residents families. The manager advised that he was committed to providing good outcomes for the residents of Fairhaven and the home was currently reviewing all the policies and practices of the home in order to improve current practice where necessary. We were advised by the registered manager that personnel files were not available at the time of inspection due to reorganisation. This was being completed at another of the registered managers homes where care staff files were being compiled. All files were made available the next day. The home was also keen to implement new ways of working in areas such as; care planning, training and developing new activities for its residents and purchasing new equipment in places where it recognised the need for improvement. Overall a very positive inspection. There were a few areas of improvement that were being addressed and where the manager advised that he would implement change as soon as possible. These included; all care plans being updated to the new format, more extensive use of MAR to record medication taken, medication storage and reviewing the homes current day-to-day practices, updating records and storage. It was necessary to make one other requirement relating to the potential hazards identified at the home, predominantly in the garden area. The manager stated in the homes AQAA that; I ensure that I adapt a fostering atmosphere of openness and respect to the families, service users and staff and that they feel valued and their opinions matter. The manager advised that a quality assurance questionnaire was made available to all visitors to the home in order to create an annual development plan. Although there was no evidence of any recent results from this form of consultation, there were questionnaire forms available next to the signing in book. Comments received from the surveys distributed indicated the level of satisfaction from the people who use the home. For example; A healthcare practitioner commented in the section of the survey titled, What do you feel the care service does well,stated; high standards of cleanliness and staff,know when to ask for help. A resident completing the survey confirmed that they felt; the staff listened and acted on what they said, staff were always available when they needed them,they knew how to make complaints and who to speak to if they were unhappy and stated; Im quite happy here. Relatives commented; They always treat residents with the utmost respect, the way they speak to residents and staff, always go around all the Care Homes for Older People Page 28 of 33 Evidence: time asking residents if they want a drink or turning the TV up or down. They asked my parent what colour he/she wanted in thier room. Im always made to feel welcome when visiting. Activities are run daily. the staff and the residents always seem to be very happy together, most importantly my mum/dad is much happier since moving to Fairhaven. These comments showed that the home was operating in the best interests of the residents.The manager advised that a full review of business practices was being conducted by the business manager. The manager confirmed that the home did not hold any money on behalf of residents. It was noted that residents had lockable storage area in their bedrooms and in most cases realitives confirmed that they managed the residents money. There had been no concerns regarding residents finances made during the inspection or since the last key inspection. As described in the previous paragraphs of this section there were some health and safety areas that required attention to reduce the possibility of accidental. Health and safety training was given to care staff and comments from relatives confirmed that the home was always clean and tidy. The home had completed a health and safety audit on the 24th March 2009 and a gas safety inspection on the 2nd February 2009. The home had the required Public Liability Insurance and fire extinguishers had been recently inspected. The electrical appliances had been tested the previous year. A summary of the relatives completing the surveys confirmed that the home always provided information about the care home to enable them to make decisions, always, met their relatives needs, kept them up-to-date with important issues, gave the support and care to their relatives that they expected, had the right skills and experience, met their relatives diverse and cultural needs and responded appropriately if they had any concerns. The comments from the people using the home confirmed that Fairhaven provided good outcomes for its residents and relatives. Care Homes for Older People Page 29 of 33 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 30 of 33 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 1 20 23 The home must ensure that all parts of the home to which residents have access are free from hazards to their safety and that any risks to health and safety are identified and appropriate action taken. Residents and their relatives expect the home to ensure that there are no unnecessary hazards either inside or outside of the home. 26/06/2009 2 31 8 The registered provider 26/06/2009 must appoint an individual to be rigistered to manage the care home if he does not intend to be in full-time dayto-day charge at the home. Residents, their relatives and advocates must have access to a registered manager on a day-to-day basis. Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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