Care Home: Fairlie House Nursing Home

Similar services:

• Ashlong House
• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)

What the care home does well The home provides a consistently high quality "person centred" service where people are lovingly cared for round the clock. A holistic approach is taken at the home and the social care needs and the need for stimulation is seen as an integral part of every persons care needs. Appropriate stimulation is given to ensure that each person is enabled to achieve their optimum degree of functioning and fulfilment. The additional complimentary therapies and physiotherapy are beneficial to people using the service.Management is committed to ensuring that service is outcome focused; only the highest standards of care are acceptable. Staff employed are caring, and are skilled and competent in their role. The business invests in ongoing training and development for the staff team so that they have the specialist skills needed to meet the highly complex needs of the people using the service. The service is highly regarded by health professionals in the community. Two specialist nurses from the community PCT sent us the following comments about the home, "The skill mix is excellent in providing a high standard of care for people with highly complex needs, staff are well trained, Looks after people holistically Excellent documentation People are treated as individuals Excellent liaison with the multidisciplinary team". Relatives too speak of "feeling included" and "being totally involved in the care arrangements". Staff demonstrate an empathy with relatives too. Relatives replied with the following comments recorded, "The home always makes me feel welcome when visiting, it is small and homely", "We consider Fairlie House provides a personal and homely but professional environment", "It is a great relief to find one`s loved one is safe, being so well cared for with such kindness and attention", "Staff give the impression that nothing is too much trouble and do all they can to respond to the needs and support family and friends too" The following comments were received from two General Practitioners, "The home is an excellent place for rehabilitation and ongoing medical and nursing care. The care offers an innovative approach in a holistic way, supporting families and friends in addition to the person using the service", "I continue to be impressed by the caring attitude and the professionalism of all staff at the home". Two care managers commented on the reliability of the service, the following comments were received, the home never fails to delivers on high quality and each placement made at this home has achieved successful outcomes" What has improved since the last inspection? Residents and relatives feel assured and comforted by the fact that the right systems are in place for supporting those people terminally ill and approaching the end of life. Individuals can choose to have the care that they wish at this time in the home and not be admitted to hospital unnecessarily. The home has achieved Gold Standard accreditation for end of life care. Accreditation took place following a nine month training programme. The Gold Standard Framework for Care Homes involves a multidisciplinary team in to improving the quality of care for people in their last months of life. The home continues to develop health and safety policies and procedures and have robust systems in place to promote a safe environment. Additional complimentary therapies are available at the home. What the care home could do better: The home continues to deliver an excellent service. It has an effective quality assurance system in place to monitor and evaluate the quality of the service; bench marking is part of this process. Outcomes of the quality assurance process are used to inform future planning and investment. The service recognises where improvements and developments are necessary and supplied this in the AQQA. The only area of shortfall found was in medication procedures. This was addressed and responded to appropriately. Medication procedures were reviewed; additional audits are in place to prevent reoccurrence. CARE HOMES FOR OLDER PEOPLE Fairlie House Nursing Home 2-6 Uffington Road West Norwood London SE27 0RW Lead Inspector Mary Magee, Lynne Field, Richard Turner. Key Unannounced Inspection 09:30 3 & 9 September 2008 rd th 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 Fairlie House Nursing Home DS0000071293.V370896.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. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairlie House Nursing Home Address 2-6 Uffington Road West Norwood London SE27 0RW 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) 020 8670 6090 020 8761 8024 Mathew Aran Fitzgerald Whelan Suzanne Davey Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53), Physical disability (53) of places Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home with nursing - code N 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 - Code OP 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 53 24/04/2007 Date of last inspection Brief Description of the Service: Fairlie House is a registered care centre providing accommodation and nursing care for fifty-three people. It is located in a quiet street in West Norwood, South East London. The home offers rehabilitation and specialist nursing care. The centre is well equipped with the latest aids and adaptations that meet the complex needs of highly dependent people that may have experienced neurological disorders due to trauma or disease. The premises are wheelchair accessible with full size passenger lifts that serve all floors. It is a ten-minute walk from the local train station and bus services. Local shops are available a short walk away, with larger shopping centres accessible by public transport. A pleasant garden is available at the rear of the premises offering solace to relatives and relatives. The service offers twenty four hour one to one nursing care when required; this is reflected in the cost, fees range from £590 to £ 7252 per week. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We carried out this unannounced key inspection over two days in September 2008. Three inspectors assisted by visiting the home. We observed the quality of life shared by people using the service, they together with many relatives present told us of their experiences. Case tracking was used to evaluate the service delivery by observing the documentation in use. The views of families, staff and relevant professionals were sought through surveys and discussions. Over forty feedback comment cards were received from relatives and people using the service. Many external healthcare professionals involved with the home responded to our surveys in writing or in person, these included commissioners from PCT, specialist ventilator nurses, care managers and General Practitioners. We are grateful for the contributions of everyone who responded to surveys and expressed their views to us. A document called an ‘Annual Quality Assurance Assessment’ (AQAA) was completed by the Registered Manager and returned in advance of the inspection. This document informs CSCI on how the service is addressing the National Minimum Standards along with factual information about the care home. All of this information is used to inform judgements and to compile this report. The registered manager and three deputy managers, supported unit managers facilitated the inspection visits; they were helpful and courteous throughout the process. What the service does well: The home provides a consistently high quality “person centred” service where people are lovingly cared for round the clock. A holistic approach is taken at the home and the social care needs and the need for stimulation is seen as an integral part of every persons care needs. Appropriate stimulation is given to ensure that each person is enabled to achieve their optimum degree of functioning and fulfilment. The additional complimentary therapies and physiotherapy are beneficial to people using the service. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 6 Management is committed to ensuring that service is outcome focused; only the highest standards of care are acceptable. Staff employed are caring, and are skilled and competent in their role. The business invests in ongoing training and development for the staff team so that they have the specialist skills needed to meet the highly complex needs of the people using the service. The service is highly regarded by health professionals in the community. Two specialist nurses from the community PCT sent us the following comments about the home, “The skill mix is excellent in providing a high standard of care for people with highly complex needs, staff are well trained, Looks after people holistically Excellent documentation People are treated as individuals Excellent liaison with the multidisciplinary team”. Relatives too speak of “feeling included” and “being totally involved in the care arrangements”. Staff demonstrate an empathy with relatives too. Relatives replied with the following comments recorded, “The home always makes me feel welcome when visiting, it is small and homely”, “We consider Fairlie House provides a personal and homely but professional environment”, “It is a great relief to find one’s loved one is safe, being so well cared for with such kindness and attention”, “Staff give the impression that nothing is too much trouble and do all they can to respond to the needs and support family and friends too” The following comments were received from two General Practitioners, “The home is an excellent place for rehabilitation and ongoing medical and nursing care. The care offers an innovative approach in a holistic way, supporting families and friends in addition to the person using the service”, “I continue to be impressed by the caring attitude and the professionalism of all staff at the home”. Two care managers commented on the reliability of the service, the following comments were received, the home never fails to delivers on high quality and each placement made at this home has achieved successful outcomes” What has improved since the last inspection? Residents and relatives feel assured and comforted by the fact that the right systems are in place for supporting those people terminally ill and approaching the end of life. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 7 Individuals can choose to have the care that they wish at this time in the home and not be admitted to hospital unnecessarily. The home has achieved Gold Standard accreditation for end of life care. Accreditation took place following a nine month training programme. The Gold Standard Framework for Care Homes involves a multidisciplinary team in to improving the quality of care for people in their last months of life. The home continues to develop health and safety policies and procedures and have robust systems in place to promote a safe environment. Additional complimentary therapies are available at the home. What they could do better: 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. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 8 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 Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 9 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 3 4 6 Quality in this outcome area is excellent, This judgement has been made using available evidence including a visit to this service. A range of information is available on the home at the home in the form of a new service user’s guide, it includes photos of the home and details of the specialist services offered. The home has an excellent pre admission arrangement. This assessment arrangement ensures that accurate information is gathered and that the admission is well planned for. This helps avoid the breakdown of placements. The home focuses on achieving positive outcomes for people they admit. They successfully do this by ensuring that the facilities, staffing and specialist services provided by the home meet the medical, social, ethnic and diverse needs of the individual. EVIDENCE: We adopted case tracking to evaluate the quality of care delivered at the home. Of the four people selected for this purpose two of the residents were admitted since the last key inspection. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 10 Relatives present spoke to us about the admission process. We found that staff at the home had made every effort and spend time planning to make the admission to the home as smooth and personal as possible. “We like the fact that staff acknowledge the family unit and involve us fully in the process and the care arrangements”, “this home has the personal touch” were the views we received from two sets of the parents present. Prospective residents and their families receive individualised attention, they are treated with dignity and respect on important decisions they need to make. Full and satisfactory information is given prior to making a decision. This is in the form of a service user’s guide. Based on copies of pre admission assessments for the two new residents and from discussions with relatives we found that the home does not admit a new resident unless it is satisfied that it can fully meet their needs. All new residents receive a comprehensive needs assessment before admission. This is carried out by senior experienced staff with skill and sensitivity. The service is highly efficient and obtains a summary of assessments undertaken through healthcare professionals /care management. Individuals are supported and encouraged to be involved in the assessment process, relatives and those with power of attorney assist as necessary too with assessment process. Information is gathered also from a range of sources and health professionals to assist with the admission plans. We had in depth discussions with a number of staff. It was clear that staff are skilled and have a good knowledge of individuals’ needs before they move into the home. Pre admission preparations take place that include preparing bedrooms in advance to take into account cultural needs and interests, meeting with relatives to get as much information as possible. Staff also give as much assistance to those that have rehabilitated successfully and ready for discharge. One young resident told of his progress, he is delighted with the rehabilitation he received and is awaiting to move to his own flat. One of the letters from a GP involves stated the following, “This nursing home achieves extremely high standards of care with a well integrated multidisciplinary team”. The home is well equipped and demonstrates the capacity to meet the needs of those admitted. It offers a wide variety of services to a range of age groups. The following list reflects the areas of expertise delivered, (1) The service provides intensive multidisciplinary care for people with complex physical needs and neurological impairment. Nurses with specialities in this field are employed. (2) Nursing care for older people. DS0000071293.V370896.R01.S.doc Version 5.2 Page 11 Fairlie House Nursing Home Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 12 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, This judgement has been made using available evidence including a visit to this service. Residents find that staff provide care and support that is of a consistently high standard. Plans are tailored and developed according to assessed needs and constantly reviewed to make sure that current needs are identified and provided for. Residents and relatives feel assured and comforted by the fact that the right systems are in place for supporting those approaching the end of life. Residents can choose to have the care that they wish at this time and not be admitted to hospital unnecessarily. EVIDENCE: Individual needs are identified and recorded in written needs assessments. These assessments are used to inform care plans together with input from the resident or relative where necessary. Care plans for four individuals were case tracked. We met the residents and their relatives. Relatives expressed confidence in the staff at the home; a Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 13 number of families relayed the experiences of the home and of the presence of a caring skilled staff team. On parent quoted the following “It is essential to my son’s well being that he receives the care and attention from staff that know and understands him”. By examining written care plans and associated records it was possible to follow clearly the care and support given. Evidence is present throughout the records confirming that care and support is delivered in accordance with plans agreed. The health care needs of residents are promoted and maintained. Examples were seen of consultations with healthcare professionals; these records provide evidence of access to chiropody, dentist, optician, and psychology. A GP surgery is held twice weekly. Also present on records are recommendations made from these consultations. Daily records are maintained of service users’ conditions, the progress or setbacks, response to changes in conditions and actions taken. The inspectors found that the records are consistently maintained; these are evidence that confirm appropriate action is taken as necessary to meet the health and welfare needs of residents. The records of care given provide evidence that staff respond appropriately to recommendations made. Profiling and care planning cover a twenty-four hour period for residents. Where assessed as necessary one to one nursing care and support are provided to residents with high dependency needs. Individual nurses were spoken to over the visits; consistency is maintained and changes of staffing personnel kept to a minimum. Staff spoken to are knowledgeable of the risks associated with individual conditions, they spoke of the management of risks for people with tracheotomies, those on ventilators. Records were viewed showing that regular clinical observations are made. Risks are identified and highlighted and responded to as instructed in guidelines. As the home cares for people with highly complex needs it has present skilled staff that are confident and competent in these fields. Residents and relatives find that medical care is very good. They value the great support received from the two visiting GPs and the support given by a skilled staff team in assisting them to maintain their health. Observations made include that of good mouth hygiene, tracheotomy care Reports we received from two doctors that oversee the medical care of service users confirm the high standard of care given at Fairlie House. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 14 Reports we received comment on the excellent quality of care delivered and highlighted the holistic approach operated at the home. The organisational structure in place is good with dedicated skilled staff present that take the lead role in all important areas affecting residents and that liaise with external professionals. In place is a link nurse for tissue viability, also for nutrition, continence. A number of residents have medical conditions that impact on mobility; equipment is in place as well as nursing practices to promote tissue viability. Wound care and infection control measures are good with records to evidence this. Continence is promoted discreetly by providing toileting assistance at appropriate intervals. Also too provided are aids such as catheters and continence pads. For a small number of high dependency residents in accordance with needs assessments and care plans one to one nursing care is provided over the twenty-four hour period. A high number of people have PEG feeds. Staff are experienced at supporting and caring for residents with PEG feeds, this was confirmed by nurses from the specialist team. They report that the home staff follow the necessary recommendations and reflect good practice in their role. Systems are in place that ensures that those on particular feeding regimes or at risk of poor nutritional intake are safe well nourished and have adequate nutrition. Records show that nutritional needs are monitored, intake levels recorded, and that specialist nurses from the HEN team are consulted on an ongoing basis. Records are well maintained, there is good detail with clear identification of needs, and charts and risk assessment tools are used appropriately and filled in correctly. The daily records are kept up to date. These refer to individuals’ response to care delivered, as well as what care is given. Records of progress are easily accessed to determine progress or if there are any setbacks. Handovers are important, during this period staff are informed on all events and the welfare of each individual is discussed. Reference is made in records to any additional involvement necessary, for wound care such as tissue viability nurse. Records show that medical attention is given, that swabs are taken analysed, any follow up treatment prescribed is administered. Staff are vigilant about keeping records that validate integrity of skin on discharge. The home is able to demonstrate that it relays all the necessary information to hospitals when an admission to hospital is necessary. There is evidence of a professional approach from the home staff, and of close working relationships with external professionals. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 15 Care plans and risk assessments are regularly reviewed. An audit system is in place as part of the quality assurance process to ensure that care plans are kept updated and that they reflect accurately all areas of need and support. The home is in the process of changing the current care plan system. One of the newly developed care plans was viewed. It is well laid out and makes provision to plan appropriately for all areas of care and support. The home looks after people that are terminally ill and use the Gold Standard Framework to care for these residents. The home delivers consistently a high standard of care; staff are especially skilled at supporting those people in the last years of their life. Care plans and systems are developed using GSF to give residents choice on the care that they want at the end of life, also on the place that they wish to be cared in. Wishes are respected and hospital admissions are avoided. Health professionals, residents and their relatives, as well as staff are involved in the development of care and support pathways. The home has achieved Gold Standard Framework accreditation for end of life care. This accreditation followed an intensive period of adopting the GSFCH training programme and a rigorous accreditation process. Medication procedures were observed for some of those case tracked. No shortfalls were found for these individuals. We found that residents may self medicate if this is deemed appropriate. One of the residents self medicating was spoken to. Risk assessment on file, medication is checked and audited by staff regularly. She receives her prescribed medication regularly and on time. We checked folder where MAR charts are kept. There is a photo of each resident on MAR sheets; each has a Homely remedies form that has been signed by their GP, the resident and the nurse in charge. A designated nurse requests medication each month. All medication is checked when it comes into the home and recorded in the medicine book. They record if there are any shortfalls and if the pharmacy owes them any medication. One of the prescribed medications was out of stock. When we explored this we found that the pharmacist is having difficulties getting the supply. The problem was discussed with the prescriber; the medicine is to be dispensed in another format in future. Medication no longer needed is recorded in the stock book and is sent to be destroyed appropriately. Staff record what is said by GP in resident’s records. Staff confirm they check the labels on medication when it is delivered from the pharmacist. The pharmacist comes in twice a year to speak to staff and address any issues that have arisen. They are invited to medication reviews. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 16 The majority of medicine is dispensed in blister packs, this stock was correct when checked on all three floors. No shortfalls were found in medication procedures except on the first floor. Nursing staff administer prescribed medication. The majority of the nursing team attended training recently in medication procedures. Checked MAR charts and notices had some gaps where medication had been given but not signed for. A small selection of medication is received in the original packets. This is where discrepancies were found in the stock supply for three residents. On more than one occasion a nurse had dispensed the tablets from another resident’s supply and disregarded that they were not from the supply prescribed. We are confident that this shortfall would have been identified at the mid month medication audit, as the home has a long history of full compliance with medication procedure. We revisited the home to check on the action taken. Appropriate action including a full investigation was taken to address this shortfall in procedures with the staff member concerned. Management have addressed the shortfall in the medication procedures found on the first floor and identified the relevant staff for retraining. A requirement is stated. We are confident that the procedures of regular medication audits will prevent a reoccurrence of the shortfall found during the inspection. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 17 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 excellent, This judgement has been made using available evidence including a visit to this service. At this home the social care needs of residents are considered an integral part of an individual’s life. Individuals find that the home offers a lifestyle that meets expectations, preferences and satisfies their social and cultural interests. The home employs dedicated staff with the role of making sure that each resident is supported and enabled to achieve their optimum level of functioning and fulfilment. EVIDENCE: One of the strengths of this service is the consideration given to and the provision made for stimulation that is appropriate to individual needs and interests. Residents’ needs range from younger people with highly complex needs and cognitive impairment to older people requiring nursing care. The social care needs of residents are identified and seen as an integral part of every day life. These needs are combined with and included in care and support plans. Activity coordinators are employed to organise both group and individualised activities. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 18 The activities coordinators devise a range of stimulating activities according to individual tastes and capacities. These range from reading the sports results to service users to playing classical music. Important dates are celebrated such as those that reflect culture. A range of creative arts is also provided. Indications were that the likes and preferences of individuals are well researched. Individualised routines and activities are tailored and provided to suit preferences and capacities. In addition to nursing and care staff the service offers physiotherapy, speech and language, complimentary therapy including aromatherapy. A sensory and stimulation room is also provided. Many of the residents require highly specialised nursing care. A detailed enhanced care profiling system that includes leisure activities is in place. This ensures that each resident is supported to achieve the maximum degree of function and fulfilment. We observed a number of activities in progress throughout both days. Yoga classes were in progress in the small lounge with a number of residents participating. A resident that experienced brain trauma from a cerebral accident was receiving support in using the latest technology that responds to stimulus and recreates this in music... In the afternoon a musical event was held in the large lounge with an entertainer present. Residents and relatives speak of the quality of the entertainment and leisure facilities provided. Equipment such as oxygen machines are not a barrier when residents attend external events. Prior to the inspection a resident attended a jazz event the previous weekend. Others receive support to attend football matches or visit shopping centres. We recognise the planning and arrangements involved and commend staff for successfully enabling residents to access these events outside the home. Numerous positive comments were received about the quality of life from relative’s residents and external professionals, the father of one resident sums up the facilities available, he says “social activities are varied, interesting and inclusive, everyone gets to be involved”. We were invited to share lunch with residents in the dining room. We found the meals of Portuguese style fish and the alternative of a salad dish to be delicious and nourishing. Reports received from residents confirm that they are pleased with meals and that particular choices are always considered. Meals are prepared by dedicated staff that uses a range of fresh meat, fruit and vegetables. There is a daily menu that runs on four week cycle. Choices of meals are offered for breakfast, lunch and evening supper. Special diets are catered for. Much success has been achieved in this area. Residents Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 19 that were admitted and needed weight reducing diets have benefited from short stay admissions. Two of the residents requiring this programme were discharged home recently following the success of the programme. A high proportion of residents are on PEG feeds and do not have meals. A speech and language therapist assesses those with swallowing difficulties and makes the necessary recommendations for staff to follow regarding consistencies and positioning. Reports received from the specialist team confirm that staff are skilled in this area and that they ensure the safety of individuals. Residents have personal possessions with them that enable them to feel at home. The majority of the younger residents have rooms personalised in a manner that reflects previous leisure pursuits, cultures. Residents handle their own financial affairs for as long as they are able and have the capacity to do so. In the majority of instances where residents lack capacity relatives or solicitors have power of attorney. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 20 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 excellent, This judgement has been made using available evidence including a visit to this service. An open culture is fostered at the home, which enables residents, relatives and staff to feel confident in raising any concerns or to make suggestions. Robust procedures are in place that safeguard vulnerable adults from abuse or neglect EVIDENCE: Management has an open door policy, residents, relatives and staff are welcomed at any time to raise issues. A great strength of the service is the inclusiveness that relatives and friends speak of, this helps if there any issues raised. Concerns or complaints are addressed promptly and responded to appropriately. The home has an active resident relative committee who meet regularly and organise many events and fundraise. During our meetings with relatives the following are a sample of the comments received from the parents of two residents, “we are consulted on and involved in all aspects of her care”, “we feel part of the family at Fairlie House, if there is anything wrong we can speak to staff and know that it will be put right”. Another relative visiting his brother said “Staff gives us the impression that nothing is too much trouble and do all they can to make relatives welcome and accommodate their requests. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 21 The rights and welfare of residents are protected. Management and senior staff advocate on behalf of those that lack capacity. Examples seen of this included making representation to statutory services and bodies regarding unacceptable shortfalls experienced by individuals in services. We had lengthy discussions with numerous staff over the visits. The service provides training in safeguarding procedures that protect people from abuse or neglect. It was evident from discussions that staff at the home are knowledgeable on safeguarding adults use the training on safeguarding policies and procedures with future training planned. All incidents relating to residents are recorded and maintained on file. Appropriate notifications are made promptly to relevant bodies. There have been no allegations of adult abuse or neglect made at the home. Staff are pro active in safeguarding adults that are vulnerable and should observe any practice they find unacceptable it is reported promptly. An incident occurred where a member of staff observed use of inappropriate behaviour. This was dealt with under the disciplinary measures with appropriate action taken. Student nurses are placed on assignment at the home, some were spoken to. They told us that they found that they learned very useful and essential training on promoting good practice during this assignment. The home provides service to people with highly complex needs. Staff skills competencies and diligence make sure that individuals receive excellent nursing care and that medical and nursing needs are delivered. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 22 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 22 24 25 26 Quality in this outcome area is excellent, This judgement has been made using available evidence including a visit to this service. People using this service benefit from living in a homely comfortable and safe environment that is well maintained. Systems are robust to prevent and control infection. All the necessary and latest equipment and adaptations are provided to maximise residents’ independence and promote their health and welfare EVIDENCE: We toured the premises. The business invests in maintaining the premises to a safe and comfortable standard adapted to meet appropriately individual needs. Doorways are wide allowing adequate access for particularly wide wheelchairs. The home provides good facilities both internally for group activities; sensory room, smoking room, large and small lounges. Some of the most up to date technology is in use if it is found to benefit the resident; one that is popular is Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 23 called the Sound This was observed in use, it receives a very positive response from a number of residents that are cognitively impaired. The home has a very pleasant garden to the rear with a veranda area for wheelchair users. In addition there is a small secret garden area for residents to entertain relatives and friends outdoors. A range of garden furniture is supplied. Following the acquisition of property and land next door there are plans to develop a new therapy room and laundry area. The home is divided up into three units. The Gael unit is purposely designed and fitted with the latest technology and equipment to meet the complex needs of a particular high dependency group of service users. Profiling beds and ceiling track hoist as well as pressure relieving mattresses and cushions are supplied. Rooms on the ground and second floor are also similarly equipped. We received reports from external professionals with comments such as “the home is always willing to purchase any equipment and gives consideration to the benefits rather than the costs”. Bedrooms are comfortable and homely despite the clinical equipment present. The home offers physiotherapy, occupational therapy, speech and language. Emphasis is placed on infection control with excellent systems in place to control the spread of infection, clinical wipes placed at points throughout the home with advice to visitors on infection control. We observed good working practices with staff taking care to wash hands and use appropriate aids supplied. As part of the monthly management reports statistics are compiled of infections, their treatment and follow up. Audit reports on infections indicate the success of the infection control procedures at the home. Laundry facilities are good with a full time person employed in the laundry. Clinical waste is managed appropriately. We did not tour the kitchen but observed that a recent environmental health inspection did not highlight any issues. The benchmarking system used considers nutrition, it also includes the kitchen operation and identifies if any developments are required. Bedrooms are tastefully presented and decorated according to individual’s choice. We found that if a resident is unable to personalise his bedroom that staff work with relatives to do this and reflect an individual’s preferences and interests. Bedrooms we found to be comfortable and spacious. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 24 Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is excellent; This judgement has been made using available evidence including a visit to this service. At all times people benefit from being well cared for and in the safe hands of a highly professional and skilled staff team. Only staff that are vetted thoroughly and suitable for the role are employed. The service invests in the staff team; it makes sure that staff receive all the necessary training and development that equips them for their role. EVIDENCE: “Training of staff is we understand and it shows constantly undertaken to maintain the high standard of nursing care we observe”, this was the written comment supplied by one of the families that responded to our questionnaires. Staffing levels are always high; this reflects the highly complex needs of the residents. In addition a number of residents (8) receive one to one nursing care twenty four hours a day. Staff retention levels are good; the home experiences a small turnover of staff which maintains the continuity in the service. The home is recognised for delivering high standards and is approved as an assignment centre for student nurses. An external health professional that reviews regularly residents at the home commented, “The skill mix is excellent at providing high standards of care” The calibre and quality of staff is evident in the home. People with highly complex needs are admitted and cared for lovingly and safely. Commissioners Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 26 and care managers tell us that they have placed people at the home for many years; they have always found the quality of care delivered to be of a consistently high standard. Recruitment procedures are good and make sure that only staff that are vetted thoroughly are employed. The home is selective, it employs good staff that are committed and that have all the necessary skills. Staff tell us they enjoy working there, people feel valued and enjoy using their skills and receiving more learning opportunities. “We enjoy the variety in the service, it is good to be able to make a difference”, this was the comment received from a nurse on duty; it is consistent with the many reports received from staff members. The service provides ongoing training and development that makes sure that staff acquire all the necessary skills and competencies. We observed training sessions taking place over the visit where senior experienced sisters explain the ethos and expectation of the service to interested staff. We found that senior line management offers support and encouragement for the staff team to continually deliver on good practice. Any shortfalls identified are responded to appropriately and used as an opportunity for learning and development. A range of informative material is available for staff to read, also are displayed on staff board are notices on future events and training opportunities. A training matrix shows that staff training is consistently kept updated and any additional training needs are identified and planned for. Staff received training on GSF for nine months and demonstrated this in working practice, this led to accreditation. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 27 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 32 33 35 36 38 Quality in this outcome area is excellent, This judgement has been made using available evidence including a visit to this service. This home is influenced by and benefits from the ethos and leadership of strong management. A spirit of openness and respect is fostered; people living and working within the home feel valued and are confident that the service is run in the best interest of people using the service. Health and safety is protected and promoted by rigorous procedures that safeguard residents and staff. EVIDENCE: The registered manager was available during the unannounced visit to the home and facilitated the inspection process. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 28 The manager is enthusiastic and passionate about enhancing the lives of residents, and this is reflected in her commitment and drive to the continuous development of the service. In place is a continuous programme of self-auditing and benchmarking that contributes to the effective quality assurance system. The views of residents, relatives and external stakeholders are welcomed. A resident/relative committee is in place. We met with some of the members who are busy organising fund raising events for leisure activities. The home’s management team recognise that there is always room for improvement; this is acknowledged in the AQQA completed, also from speaking to the managers. The manager is highly regarded both in the home and by external professionals. She works closely with other health professionals in the community, written comments from doctors and commissioning officers rated the home highly. Management is open and direct in approach, communication with staff is excellent. Handovers are thorough with staff informed on the welfare of each resident at this time. Other procedures in place that assist with maintaining consistency within the staff team include regular staff meetings, one to one supervision at a least two monthly, training and development. We observed staff practice during the visit; staff are aware that only high standards are acceptable and respond accordingly. There is a strong emphasis on learning, incidents or shortfalls found in practices are addressed appropriately and used as an opportunity for learning. We met numerous relatives eager to share their experiences. All relatives spoken to are complimentary of the service, they most appreciate that the family unit is considered and included. They speak positively of the quality of care delivered and have confidence in the home, the parents of a resident said “We feel that this home looks after our daughter very well, we feel reassured that staff always takes appropriate action to any issues raised”. There is a good organisational structure in place; as well as the registered manager there are three deputy managers with a sister in charge of each unit. This structure assists the service to be reliable and consistent. All three deputy managers were also present on duty too at the time of the visit. The registered manager is a qualified nurse and has managed this home for over nine years. Prior to this she acquired extensive nursing experience in palliative care services. She has used this expertise and developed the palliative care service at the home. She was instrumental in improving the quality of care for residents in the last years of life and avoid hospital admissions where possible, and Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 29 participated fully in the Gold Standard Framework Care Home Training Programme. The home has since achieved “Gold Standard” accreditation for end of life care. At the time of inspection we are told that this is the only care home in London achieving this accreditation. Record keeping is of a high standard. The management reporting system helps to maintain this high standard with regular audits of records. Current insurance liability is on display. For a number of residents (that case tracked) relatives (parents)have power of attorney. Those with capacity have access to their own money. Safeguards are in place to protect the financial interests of residents. A resident’s giro bank account is held with statements of interests and balances held. These are audited on a regular basis for accuracy. Safe working practices are promoted. New staff are trained in safe working practices as part of induction programme, records show that ongoing mandatory training in this area is also provided. Direct on the floor observations are made by management and team leaders to identify any areas of shortfalls. Staff spoken to told of the opportunities for learning, they have a good understanding of health and safety measures, good practice observed included good hygiene control. The home provides clinical wipes at strategic points throughout the building. A new health and safety manual was introduced recently. A building inspection is done monthly; this includes the furniture and fittings. A report is done to inform planning for repairs and replacements. The premises are maintained to a safe and comfortable standard with a rolling programme of maintenance. A handyperson employed acts promptly to address repairs. All essential equipment including fire fighting equipment is regularly serviced and well maintained according to records received. An engineer was present servicing fire fighting equipment. Fire evacuation and drills are undertaken in accordance with recommendations and staff receive ongoing training on fire evacuation procedures. Risk assessments for safe working practices are kept updated. Records are made of all incidents to relevant authorities. Staff ensure that risk assessments are undertaken for all residents including one for the use of equipment such as oxygen cylinders when attending events outside the home. Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 30 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 4 x 4 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 3 4 3 x 4 x 4 4 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 x 3 4 x 4 Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NA 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 OP10 Regulation 13 (2) Requirement Staff must administer the prescribed medication as supplied by dispensing pharmacist from the original container. (This was addressed before the draft report was written) Timescale for action 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Extracts may not be used or reproduced without the express permission of CSCI Fairlie House Nursing Home DS0000071293.V370896.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!