Care Home: Fairlea

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What the care home does well People hold the home in high regard. Comments include: "We need more homes like Fairlea, flexible, caring with residents needs and preferences at the fore" and "They show understanding and great kindness and people get the best of care". Thought is given and time taken to ensure people`s needs are understood on admission. Staff know what care people need. They work hard to ensure those needs are met through the standard of care provided and close working with health care professionals. People are treated with respect and as individuals. People receive a varied and nutritious diet. They are able to exercise choice. Visitors are made very welcome. The need for improved activities has been recognized and there is a drive to provide people with more fulfilled lives. People are protected from abuse. Their rights are promoted. They are able to raise any concerns or complaint knowing they will be listened to and concerns acted upon. The home is warm, clean, properly maintained and equipped. People`s clothing is laundered to a high standard. Staff recruitment practice protects people from those who may be unsuitable or unsafe to work with vulnerable adults. Staffing numbers are adequate to meet most needs. Staff are well trained and supervised. The manager is competent and caring and the home is well run. The quality of the service is regularly reviewed, taking into account people`s views. Effort is made to ensure new legislation is understood and complied with. What has improved since the last inspection? As no requirements were made during the previous key inspection this section does not apply. What the care home could do better: The home must confirm, in writing, to any person offered a place at Fairlea, that their needs are understood and can be met by the home. This protects both the person and the home. Care plans should be up to date and in a format which staff find most usable. All risks must be assessed, including that of the use of bedsides. Hygienic practices need to be improved. No soiled laundry should be handled by staff and clean laundry must be kept separate from soiled laundry so as to reduce the possibility of cross contamination. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fairlea Chope Road Northam Bideford Devon EX39 3QE     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: Anita Sutcliffe     Date: 0 1 0 7 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 28 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 28 Information about the care home Name of care home: Address: Fairlea Chope Road Northam Bideford Devon EX39 3QE 01237474554 01237424354 pat.lock@devon.gov.uk 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) : Devon County Council care home 33 Number of places (if applicable): Under 65 Over 65 33 33 old age, not falling within any other category physical disability Additional conditions: 0 33 To admit one named service user under the age of 65 years for respite care Date of last inspection Brief description of the care home Fairlea is a detached former Gentlemans Residence. It stands within its own grounds. It accommodates up to 33 older people who may also have a physical disability. The accommodation is all in single occupancy bedrooms, although shared rooms would be made available on request. The accommodation comprises a large dining area, a conservatory and several smaller lounges, most of which are situated on the ground floor. All areas of the home can be accessed by people using either stairs or a passenger lift. Externally there are patio and garden areas, which through the installation of ramps and level access are fully accessible. We were told that the fees charged at Fairlea are £599 a week, with additional charges for chiropody, hairdressing and newspapers. Care Homes for Older People Page 4 of 28 Brief description of the care home General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Older People Page 5 of 28 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: We have collected information about the home since the last key inspection July 2007. In July 2008 we did a review of the service, which included surveying peoples opinion and we concluded that the home was continuing to provide good outcomes for people who use the service. Toward this key inspection the home provided information. This included how they perceive they have improved the service, barriers to improvement and where further improvements can be made. They also supplied data, such as staffing numbers and qualifications. We sent surveys to people who use the service, staff and health and social care Care Homes for Older People Page 6 of 28 professionals. Many were returned, several having been completed by peoples family on their behalf. We did one unannounced visit to the home, where we met people, asked questions of the staff and observed them working. We also looked at records, such as plans of care, medicines and recruitment. We toured the home, including the laundry, kitchen and some peoples bedrooms. The manager was available throughout and provided additional information. People who use the service may be described within this report as residents, clients or service users. What the care home does well: What has improved since the last 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. Care Homes for Older People Page 8 of 28 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs and wishes will be fully assessed and understood before they are admitted. Evidence: Ten people told us through survey that they received enough information to help them decide if this home was the right place for them before they moved in. One said they did not and one did not know. We looked at how the home admits new people. Two health care professional told us that assessment arrangements at the home usually ensure that accurate information is gathered and that the right service is planned for people. One told us they always achieve this. We looked at assessment records and met the last person to be admitted to the home. Care Homes for Older People Page 11 of 28 Evidence: The record contained some good detail from which their care could be planned, although more detail relating to a health care condition would better inform staff about potential problems. Potential risks had been assessed, for example, mobility. There was also information about their interests and hobbies so that all their needs are taken into consideration. The manager is required to confirm to the person, in writing, that their assessed needs can be met. The manager said she was unaware of this but would do so in future. The manager is currently reviewing the homes admission protocol to ensure that new legislation, relating to peoples capacity to make decisions, is included. We found that, whilst people were asked questions about their needs and wishes, a more open approach to questioning may provide a better opportunity for people to express their needs and individuality. The person recently admitted told us that they liked their room, the food was OK and staff were very friendly. They said they had known about the home prior to considering living there. They confirmed that the manager visited them to assess their needs. The home does not provide Intermediate Care. Care Homes for Older People Page 12 of 28 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. Peoples care and health needs are met at Fairlea. They are treated with respect. Evidence: Ten people told us that they always receive the care and support they need and two people said they usually do. One person added: Overall care excellent. Ten people told us that the home makes sure they get the medical care they need, and two people said is usually does. A G.P. said: They ask for appropriate medical attention and the care management seems to genuinely care for their clients. One district nurse told us: They try to accommodate and care for residents to the best of their abilities. They contact the district nursing service as required and are proactive with residents needs. Another said the home works well with the primary health care team and there are no current issues with the standards of care and The care is first class. We looked at the care provided to two people at the home, meeting them and looking Care Homes for Older People Page 13 of 28 Evidence: at their records. We found that their care was planned but not always regularly reviewed and therefore not fully up to date. This has the potential to affect the care that staff deliver should they not know the persons needs very well. Two staff told us through survey they are usually given up to date information about the needs of the people they support or care for and three said they usually are. One person told us You get to know your residents and a lot can express their needs, but plans are perhaps not as much use as they could be. You get so many bits of paper in there. We discussed this with the manager. People looked well cared for and their personal and health care needs are met. However, where a person has bedsides to prevent them falling from the bed the risk from this had not been assessed in that staff did not have the information available to them. We looked at how the home manages medicines for people. We found that they are stored safely and records of their use and disposal are clear and complete. The home reports: Medication audits will be carried out on all staff who dispense and administer medication. The home reports: All residents are asked how they liked to be addressed. Respecting residents is part of induction and continued in supervisions. We saw that staff cared for people with respect and kindness. Care Homes for Older People Page 14 of 28 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 drive to help people lead more fulfilled lives needs to be maintained. People are offered a varied and nutritious diet. Evidence: Four people told us that there are always activities they can take part in, three said there usually are, two said there sometimes are and one person did not know. People, asked how the home could improve, told us: Perhaps a bit more stimulation during the day!, Some sort of gentle physical activity, More social activities needed. Staff said: We need to improve the activities, including all abilities and If there were more staff available we could spend more time talking to residents. The home have recently employed a dedicated activities worker. She told us she is still developing her role and said she has been asking people for ideas of what they would like to do. She told us that quizzes were popular, some people have made biscuits and there has been some reminiscence, looking at coins not now in circulation but familiar to older people. The manager told us there have not been any trips away from the building for a long time, but said: there will be soon now they have a licensed driver. Care Homes for Older People Page 15 of 28 Evidence: The home layout lends itself to differing activities. For example, we saw men sharing one lounge watching the tennis together. We saw staff laughing with people and heard good hearted banter behind closed doors. We saw that people have newspapers to read and heard music in peoples rooms. We saw organized activities the afternoon of our visit and a resident entertaining others on the homes organ. On admission people are asked about their interests, preferences and preferred routines. People confirmed that they can get up and go to bed when they wish. The home reports that they: respect residents different religions and beliefs and residents diverse and individual needs are recorded in their care plans. People told us: The staff are very kind and helpful, not only to residents, but also to relatives and friends. The home reports that they: Maintain good contact with residents family and respect residents wishes if they do not want family involved in some decisions about their daily living needs. There were several comments received about the friendliness of staff to people who use the service and visitors alike. Six people told us through survey that they always like the meals at the home and four said they usually do. People have two choices offered for each meal. The day of the visit the choices were corned beef salad or fish and chips. We saw that people come to the dining room for breakfast when they choose. We saw that the menu was varied and balanced. Care Homes for Older People Page 16 of 28 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. People are fully protected through the homes complaints and protection arrangements. Evidence: All who responded to survey told us that there is somebody they can speak to informally if not happy. Six people told us they know how to make a formal complaint, three said they did not know and two were not sure. Three health and social care professionals told us that the service has always responded appropriately if concerns have been raised. All staff told us through survey that they know what to do if someone has concerns about the home. We spoke with one staff and the manager and they were able to describe how to alert concerns which might be abuse. Staff also knew where the policy on whistle blowing (how to alert concerns which might be abuse) was kept, in case they need that information. We saw that staff receive training on how to safeguard vulnerable adults and one person we asked told us they felt safe at the home. The home reports that staff have been made aware of the Mental Capacity Act and deprivation of liberty safeguards, which protect people who are unable to make important decisions for themselves. We saw that robust steps were being taken to protect a confused person wishing to leave the home but unsafe to do so. Care Homes for Older People Page 17 of 28 Evidence: The manager reports that there have been no complaints made about the service. She says that this is because problems are dealt with promptly. The Commission has received no complaints about the home and there have been no alerts which might have indicated abuse. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in well maintained premises, which meet their needs, but hygienic practices could be further improved. Evidence: Fairlea is a former gentlemans residence and therefore an older type; non-purpose built extended property, which retains many architectural features. It has three separate lounge areas and a large conservatory, which gives people a choice of where to sit. In addition the dining area is spacious, and whilst it has the capacity, via concertina doors, to be split into two smaller rooms, it can also accommodate all the people who use the service for meal times, parties, services and communal activities when a larger space is required. We saw that lounges were homely and appeared comfortable. Bedrooms were personalized and individual. There is easy access to toilets. In order to ensure good hygiene practice sluices are located away from peoples toilets. Nine people told us that the home is always fresh and clean and three said it usually is. One added: If I had a niggle its the cleaning of the rooms daily - could do better. Care Homes for Older People Page 19 of 28 Evidence: The laundry was clean. However, staff were having to take dirty laundry past hanging and stacked clean laundry. Staff working in the laundry told us they hand sluice soiled items to remove the stain and then put them into the washing machine on a sluicing cycle. Soiled laundry should be handled as little as possible and clean and soiled laundry should be kept apart. These measures reduce the possibility of cross contamination. However, we saw that peoples laundry is done with much effort to ensure results are good. We saw no health and safety concerns and staff told us they have the equipment they need. Stairs and stair lifts provide easy access to those with mobility problems. We saw lots of equipment including pressure relieving mattresses, and that which helps people move safely. All bedrooms are single occupancy, which allows privacy and dignity. One person told us how much he likes his room. People can easily access the homes garden area and patio. These are private and to the rear of the property. Care Homes for Older People Page 20 of 28 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. People benefit from a staff which is recruited so as to ensure their protection, in sufficient numbers to meet most needs and trained to be skilled and competent in their work. Evidence: Nine people told us through survey that staff are always available when they need them and two people said they usually are. One commented: The staff are very kind and helpful not only to the residents, but also to the relatives and friends. They always spare time to make you feel welcome and answer any questions and problems you may have. Nothing is too much trouble. A health care professional said: The staff are great and there is enough of them to give time to clients. However, a person using the service told us that his only complaint was the low numbers of staff. All staff told us through survey that there are usually enough staff to meet the individual needs of all the people who use the service. We asked staff if there were enough. One said: You can never have enough, but on the whole yes. We asked whether staff are able to undertake national vocational qualifications (NVQ) in care. We were told that twenty three of the twenty eight care staff have attained NVQ to level 2 or above, an excellent proportion. This indicates staff are competent in Care Homes for Older People Page 21 of 28 Evidence: their work. We were told that all staff are encouraged to take training. Asked through survey if their induction training covered everything they needed to know to do the job when they started one said always and four said it mostly did. The home uses the Skills for Care Induction program which takes new staff through a structured introduction to the home and the work. Both staff and people who use the service told us the induction training equips new staff well enough. Staff also shadow an experienced carer when they are new. Asked through survey if they are being given training that is relevant to their role all staff said they were; all said their training helped them understand and meet the individual needs of people and four said it keeps them up to date with new ways of working. One said their training did not. Three said their training did not provide enough knowledge about health care and medication but two told us it did. We saw that staff have just started some training in dementia care, palliative care and nutrition. Health and social care professionals tell us they are satisfied with the standards provided at the home. Staff described the various training they have received. This includes aspects of health and safety, such as moving and handling and first aid. Although staff told us their moving and handling training is about due we saw that training is well organized. We looked at the homes procedure for recruiting new staff by looking at the records of two staff who had recently been employed. We found that all necessary checks, to ensure they are safe to work with vulnerable adults, had been completed before they started work in the home. Care Homes for Older People Page 22 of 28 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 home is run in the best interest of people who use the service. Evidence: The registered manager, Mrs. Patricia Lock, has been running Fairlea for many years. She has achieved qualifications in care and management and updates her knowledge; she is currently undertaking a distance learning course in end of life care. A social worker said of the manager: The home is very well managed and Pat is in tune with what is happening. There were many comments which indicate a good ethos at the home. They include: The staff are great, Extremely friendly and helpful and Fairlea is a very warm and caring environment. One staff commented on the high standard of team work. The home ensures people who use the service and staff are able to comment and contribute to improving the service. Their views are surveyed, there are meetings and Care Homes for Older People Page 23 of 28 Evidence: the caring and friendly staff attitude promotes opportunity for discussion. However, one persons family told us that sometimes messages left for care workers are not passed on and what the family have asked for repeatedly is still not done for them. The home keeps the Commission well informed of events which affect the wellbeing of people at the home. The management look for way to improve the service. For example, all staff are about to undertake induction training so their knowledge is updated and we saw the manager updating the homes admission documentation in light of new legislation. The home is visited by a representative of the provider organization to check if the service provided meets the expected standard. We saw records of the visits. Staff told us they receive regular supervision of their work they have meetings every two to three months. This will give them the opportunity to discuss their work and training needs as well as broader aspects of the running of the home. Where the home holds money on behalf of people they were seen to be protected by a system where all transactions were recorded, signed for by two staff and receipts retained. Peoples monies are held in a suspense account where interest is calculated individually for each dependent upon the amount of money he/she has saved. Finances are spot checked by the providers auditors. There is ongoing maintenance of the home. We saw a hard backed book into which staff enter any maintenance work, which they considered necessary. Entries in this book, made by the handyman showed that these suggestions had been actioned. The home environment is properly maintained and staff receive the required health and safety training. The only potential risk relates to hygienic practices, as mentioned in the previous outcome area called Environment. We also discussed the need for more assessment of risk at the home, for example, the stairway. Care Homes for Older People Page 24 of 28 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 25 of 28 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 3 14 (1) The registered person 31/07/2009 must confirm in writing to the service user that, having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of their health and welfare. This protects both the person using the service and the home. 2 26 13 (3) Soiled and clean laundry must be kept separate and soiled laundry must not be handled unnecessarily by staff. To prevent infection and the possibility of cross contamination. 31/08/2009 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. Care Homes for Older People Page 26 of 28 No. Refer to Standard Good Practice Recommendations 1 2 7 7 All individual risk should be assessed and always where bedsides are in use. All plans should be sufficiently up to date so as to provide staff with all necessary information. Care Homes for Older People Page 27 of 28 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. 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