Care Home: Fairland House

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What the care home does well This home provides a good service that is clearly appreciated by its residents and their relatives. Comments included: `physical and mental care was exemplary. My mother was encouraged to be active and participate in activities; ` the home is friendly, the meals are good and staff are always there to listen`; `my brother is very well looked after in all aspects`. Residents who completed the surveys told us that they received good information about the home that they got the care and support they needed, and the home was fresh and clean. Activities are frequent and varied, and residents are actively and meaningfully consulted about the quality of the service they receive. Residents receive their care from a stable, well-trained and experienced staff group. What has improved since the last inspection? The recent purchase of a minibus for the home has greatly improved opportunities for residents to go on trips and outings. Residents told us how much they enjoyed these events. A structured activities schedule is now in place and offers residents stimulation and entertainment. The manager has been working hard to make relatives and residents more aware of the home`s complaints procedures, with considerable success as all residents spoken to were aware of how they could complain if they wanted to improve the service. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Fairland House Station Road Attleborough Norfolk NR17 2AS Lead Inspector Janie Buchanan Unannounced Inspection 27th November 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairland House Address Station Road Attleborough Norfolk NR17 2AS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01953 452161 Hewitt-Hill Limited Mrs Lesley Eastoll Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: Fairland House provides residential care for a maximum of 34 older people. The home is located in the market town of Attleborough, equidistant from Norwich, Thetford and Diss in a largely agricultural area. It is within easy walking distance of the town centre, which has all the usual amenities. The home is in a large detached building, set in substantial gardens and has been extended to provide additional purpose-built accommodation. There is a large garden with landscaped features and paved areas, accessible to service users at the rear of the home. Residents rooms are located on both the ground and first floor, with a stair lift and a number of aids and adaptations around the building to allow residents to move about more independently. There are 31 single rooms all en-suite and 2 double rooms, both en-suite. There are 2 sitting rooms, a main dining room and 2 conservatories, all located on the ground floor. Fees range between £349 and £465 depending on residents’ needs A copy of the most recent inspection report from the CSCI is available in the front entranceway. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. For this inspection we (CSCI) visited the home and talked with six residents, three members of staff and the manager. We undertook a tour of the building and viewed a range of documents. We also received information from the home’s annual quality assurance assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Twenty-one questionnaires, asking about the quality of the service, were received from residents, their relatives and staff. These questionnaires generally showed a high level of satisfaction with the overall provision. Three requirements and six recommendations have been made as a result of this key inspection. What the service does well: What has improved since the last inspection? The recent purchase of a minibus for the home has greatly improved opportunities for residents to go on trips and outings. Residents told us how much they enjoyed these events. A structured activities schedule is now in place and offers residents stimulation and entertainment. The manager has been working hard to make relatives and residents more aware of the home’s complaints procedures, with considerable success as all residents spoken to were aware of how they could complain if they wanted to improve the service. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 6 What they could do better: There are a number of ways in which the home could improve its service: • Residents’ care plans must be much more detailed to ensure their needs are properly met and that they receive comprehensive and consistent care from staff. Residents should be more actively involved in reviewing their care plans and the reviews should accurately reflect their changing needs. Staff’s ability to administer medication should be assessed to ensure they are doing it correctly and safely The amount of food served to residents should be reduced to allow them to enjoy it more and reduce wastage. Meals should not be served fully plated up so that residents can choose how and what they eat. Handrails should be installed in the upstairs corridors to ensure residents’ safety when they walk along them. Two people should interview all prospective employees to ensure it is done fairly and consistently All monies spent on behalf of residents must be clearly receipted so that it can accurately be accounted for All staff in the home must receive regular supervision so they have an opportunity to discuss their working practices and so that heir training needs can be identified The home’s policies should be updated to ensure they are still pertinent to the needs of residents and still comply with changes in legislation The due dates for electrical appliance testing and hoist servicing must be more closely monitored to ensure residents’ safety when using these items. • • • • • • • • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. Information available about the home is good ensuring prospective residents have details of the services the home provides and enabling them to make an informed decision about moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose and Residents’ guide that give comprehensive information about the services the home offers and the fees payable. The residents’ guide is particularly good and gives details about recreational activities, meals, furniture, pets and the terms and conditions of residency. It is written in large print so that residents with visual impairments can access it. There is also a website: www.ashleycaregroup.com giving further information. Residents told us that they received enough information about the home before they moved in and many confirmed that they, or their family, had visited the home first to assess it, and meet staff and other residents. All prospective residents are assessed prior to their admission to ensure that the home can meet their needs. The files of two recently admitted residents were viewed and each contained a (basic) assessment. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. Residents’ health care needs are met at the home although their care plans need to be more detailed to ensure residents receive consistent care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for three residents were viewed. The information they contained was variable and not detailed enough to ensure that residents receive their care from staff in a comprehensive and consistent way. Some of the information in the plans was unsigned and undated and it was hard to tell if it was current and relevant. Although the plans had been reviewed monthly, the information was often just repeated verbatim from the month before and there was little evidence that some residents were actively involved in reviewing their plans Residents’ health care needs were recorded on their care plans and their nutrition and weight is monitored closely. Residents told us that they regularly see a range of health care professionals including GPs, nurses and chiropodists. The home has a medication policy and only senior staff who have Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 10 received advanced training administer medications. Some residents manage their own medication and good risk assessments are in place for them. Medication storage and sample of residents’ medication records were viewed. Storage was good, with all medicines accommodated safely and the temperature of the fridge and storage area recorded daily. Medical records were satisfactory although they were are few gasps where staff had not signed that medication had been administered to residents and a few handwritten additions to the MAR sheets had not been signed or dated. The reason why a resident had not taken their medication had not been clearly recorded on a number of occasions. Residents spoke highly of the staff and confirmed that staff treated them respectfully and well. Comments included: ‘ they’re always very polite’ and: ‘the empathy given at all times to my brother is very reassuring’ Care of residents at the end of their life is good. One relative told us: ‘the last 14 years of my working life were in a hospice- mum could not have been better cared for in a hospice. I spent many hour with her in the last weekalways given the space to be alone with her but knowing staff were always there if I needed. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Activities provide entertainment, stimulation and variety for residents and mealtimes are relaxed and enjoyable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is weekly activities schedule that is well advertised around the home and a copy is also given to each resident so they know what’s going on. Regular activities include quizzes, a knitting circle, crafts ands a poetry group. There are regular ‘themed’ dinners, with residents even trying tequila slammers at a recent Mexican meal. The purchase of a new mini bus has greatly improved opportunities for outings. Although the home has only had the bus for a couple of weeks there have already been trips to Banham Zoo, Stoneham Barnes and a garden centre. One resident told us ‘activities have improved, lots more to do and I am enjoying the minibus. There has also been a trip to a sister home in area, giving residents the chance to meet other people. Two residents have electric scooters that allow them to go into town independently. Families and visitors are made welcome at the home and often help with residents’ trips and outings. The manager has introduced a specific newsletter to keep families informed of what’s going in the home. Relatives told us that they were kept up to date with important issues affecting their family member, one stating: ‘I am always contacted when mother is poorly’. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 12 We observed a lunchtime meal that consisted of chicken in white wine sauce or egg and corn beef salad. Lunch was pleasant and unhurried, with residents clearly enjoying their food. However the food was served completely plated up, thereby denying residents choice in what and how much they ate: this practice is a little institutionalised. Residents told the inspector that meals were generally very good, however some felt that portions were too large and that there was a lot of wastage as a result. A tour of the kitchen was undertaken and there were good food storage and preparation procedures in place. The cook had a good awareness of residents’ individual dietary requirements and the importance of enriched food for some residents. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Residents’ complaints are listened to, and taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to complain are included in the home’s statement of purpose and residents’ guide. Despite this however, a recent survey carried out by the home itself showed that relatives and residents were not aware of the complaints procedure. As a result of this, the procedure was more widely around the home, and is regularly discussed at all residents’ meeting. This proactive approach appears to have worked as all relatives and residents who completed CSCI’s own surveys stated that they knew how to make a complaint. Residents spoken to felt confident about raising their concerns: one told us ‘I wouldn’t hesitate to complain and I’m sure Lesley (manager) would sort it soon’. Residents who completed the surveys told us that staff listened and acted on what they said. For example one resident complained about the poor quality of the toilet roll available. This complaint was recorded and investigated and, as a result, a different brand of toilet paper is now in use at the home. This shows a real commitment to taking residents’ concerns, however seemingly trivial, seriously and implementing positive change as a result. All staff have undergone training in protecting vulnerable adults and showed adequate knowledge of the different types of abuse that can be suffered by an older person and of reporting procedures. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,25,26 Quality in this outcome area is good. Residents live in a pleasant, comfortable, safe and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is comfortable and well maintained with good quality furnishings in place. There are large attractive grounds to the rear of the property allowing residents access to fresh air and light. Residents told us they really enjoyed sitting out in the gardens. There have not been any structural changes since the last inspection and, although some bedrooms are an odd shape, residents were happy with their rooms. Each bedroom has an en-suite toilet. Some of the newer rooms to the back of the property have the added bonus of a kitchenette area with a fridge and a microwave allowing residents to make their own drinks and prepare their own meals. The home as a range of aids and equipment to help keep residents independent, however there are no hand rails along the upstairs corridors for residents to hold onto and use to walk Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 15 more safely. One relative suggested that blinds be put up in the summer time to keep the home’s conservatory cooler. All bathrooms have assisted facilities and all hot taps have thermostatic valves. The home has a suitable laundry with sluice cycles on the machine for soiled laundry. The area is easily cleaned with suitable flooring and there is a sink for hand washing. Three of the domestic staff have recently achieved an NVQ in cleaning and support services and the home was very clean and free from any strong smells. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Residents are looked after by competent and trained staff, in sufficient numbers to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are five care staff on duty between 8 am and 2pm and three staff on duty between 2pm and 10pm to meet the needs of 32 residents. A manager is also available throughout the day. Although the ratio of residents to staff is quite high in the latter half of the day, residents told us that staff were around when needed and they didn’t often wait long for help. Staff reported that they have time to spend with residents individually, in addition to completing their usual care tasks. Staff turnover at the home is low, and many have worked there for a number of years. Training records viewed showed that staff had received training in all mandatory areas as well as training in dementia care and nutrition. More than half the staff have achieved an NVQ level 2 in care and six staff have completed an NVQ level 3. This number is well above the minimum standards and is to be commended. The personnel files for two recently recruited members of staff were checked. Each contained appropriate CRB and POVA checks, and two references. However staff interviewed told us that they were only interviewed by the manager of the home. Ideally two people should interview all prospective employees to ensure consistency and fairness in recruiting staff. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. The manager of the home is experienced and qualified, and there is an effective quality assurance system in place to gather the views of residents This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both the home’s manager and the head of care hold an NVQ level 4 in care and the Registered manager’s award. The manager has 14 years of experience in the care sector and 8 years experience managing a care home. There are regular meaningful residents’ and staff meetings and staff reported they enjoyed their work and felt well supported: they described their morale as good. All care staff receive do receive supervision of their working practices however this has not been as frequently as recommended by the standards. Other staff such as domestic and catering assistants do not receive any formal supervision whatsoever. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 18 A number of audit tools have been implemented to ensure a good standard of service: accidents, medication and maintenance is monitored. Feedback about the quality of the service provided is sought from residents, relatives and other visitors to the home via surveys. The home has policies and procedures in place to guide staff in what they do and a sample of these were checked. These were found to be in good order, although some of the home’s policies had not been updated since 2004. The home looks after the monies for some residents and a sample of cash sheets were viewed. Although all money spent on behalf of residents was clearly recorded it was of concern that receipts were not always obtained for some items of expenditure such as chiropody and food shopping. A number of records in relation to health and safety were viewed (portable appliance testing, lift and hoist service records, employer’s liability insurance) and it was noted that electrical testing of equipment was overdue and it was not clear when the bath hoists next needed to be serviced. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x 2 2 x 2 Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Residents’ care plans must contain much more detail so that staff have comprehensive information to care for them consistently. Residents’ medication administration records must be kept accurately to ensure there is a clear record of what they have been given Receipts of all money spent on behalf of residents must be obtained to ensure there is an accurate record of how their money is being spent Timescale for action 01/01/08 2. OP9 17(1)(a) 01/12/07 3 OP35 17(2)(c) 01/01/08 Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. 4 5 6 Refer to Standard OP9 OP15 OP22 OP29 OP36 OP38 Good Practice Recommendations Staff’s competency to administer medication should be assessed to ensure they are doing it correctly and safely. Meals should not be served fully plated up to residents so that they can choose how much and what they eat. Handrails should be installed in upstairs corridors so that residents can walk along them more safely. Two people should interview prospective employees to ensure consistency and fairness in their recruitment All staff should receive regular supervision so that aspects of their practice and the home’s policies and procedures can be discussed The due dates for electrical appliance testing and hoist servicing must be more closely monitored to ensure residents’ safety when using these items. Fairland House DS0000068931.V355662.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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