Care Home: Fairlight & Fallowfield

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What the care home does well Offering people the information they need to help them decide if the home is the right one for them, and making sure prospective residents are assessed to ensure the home can meet their needs. Giving its residents care and support, and ready access to health and social care services. Enabling residents to choose how to spend their time, and supporting them to keep in touch with their families and friends. Providing residents with a diet that is balanced and nutritious. Making sure residents live in a home that is clean, comfortable and well maintained. Protecting and supporting residents by requiring that people who apply for posts at the home undergo a thorough recruitment and selection process. Supporting their staff to undertake training that is relevant to their work and benefits residents. Seeking the views of residents and their representatives about the running of the home. What has improved since the last inspection? The handling of concerns and complaints has improved. Residents and their representatives can be confident that if they raise concerns or complaints they will be taken seriously and will receive a response. Staff members` learning from adult protection training has improved. There have been improvements in care planning and documenting care delivery. There is increased provision of hoists to assist less able residents to move about the home. The promotion of good food hygiene practices has improved. What the care home could do better: Repair or replace the medicines refrigerator on the residential unit and make sure all medications to be administered as required or as directed have full administration guidelines in place. Take every opportunity to preserve residents` dignity and enable them to exercise choice and control over their lives. For example, encourage staff members to always use the particular term of address each resident prefers and make sure that, if a resident has a bib at mealtimes, this is to meet a need or preference identified for that individual. Review the recent change in staffing arrangements on the nursing unit, to make sure it is contributing to improvements in residents` care. Carry out a formal review of the reported accidents on both units, to identify any patterns or trends that have an impact on residents` health and safety. CARE HOMES FOR OLDER PEOPLE Fairlight & Fallowfield Ashfield Lane Chislehurst Kent BR7 6LQ Lead Inspector David Lacey Key Unannounced Inspection 20th May 2008 10:30 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 Fairlight & Fallowfield DS0000010134.V362844.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. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairlight & Fallowfield Address Ashfield Lane Chislehurst Kent BR7 6LQ 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 8467 2781 020 8468 7028 admin2@millsgroup.fsnet.co.uk The Mills Family Limited Patrick Sena Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places Fairlight & Fallowfield DS0000010134.V362844.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 (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 68 2nd October 2007 Date of last inspection Brief Description of the Service: The home is located in a residential area of Chislehurst. It is an older style building with new bedrooms and communal facilities having been added. Bedroom accommodation is located on all floors. The main communal area is on the ground floor of the home with additional quiet rooms. The home is in two separate sections and provides nursing and residential care. Previously, Fairlight and Fallowfield have been two separate care homes but are now connected by a walkway and have one registration with the commission. However, it is often referred to as two homes and staff tend to maintain it as such, for example, the staffing for the home is organised separately and the provider supplies separate reports of monitoring visits. The fees for this home (as at May 2008) are £550 - £950 per week. Fairlight & Fallowfield DS0000010134.V362844.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 two stars, which means that people using the service receive a good service. This key inspection included an unannounced visit to the care home, which was undertaken over two consecutive days. To gain the views of people living in the home, I spoke with residents and relatives. I also met with the registered manager and some members of the home’s staff. I sampled documentation such as care plans and records of care provided, staff recruitment files, and policies and procedures. I provided detailed feedback to the manager at the end of the visit, to enable him and his colleagues to take early action about issues raised. As part of the inspection, we invited written comments from a sample of residents. We had received fifteen responses in time for inclusion in this report. Their feedback is included within this report and has been taken into account in forming our judgements about the home. Also, the care home has provided us with its annual quality assurance assessment (AQAA). This self-assessment document focuses on how outcomes are being met for residents and also gives us some numerical information. What the service does well: Offering people the information they need to help them decide if the home is the right one for them, and making sure prospective residents are assessed to ensure the home can meet their needs. Giving its residents care and support, and ready access to health and social care services. Enabling residents to choose how to spend their time, and supporting them to keep in touch with their families and friends. Providing residents with a diet that is balanced and nutritious. Making sure residents live in a home that is clean, comfortable and well maintained. Protecting and supporting residents by requiring that people who apply for posts at the home undergo a thorough recruitment and selection process. Supporting their staff to undertake training that is relevant to their work and benefits residents. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 6 Seeking the views of residents and their representatives about the running of the home. What has improved since the last inspection? 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. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are offered the information they need to help them decide if the home is the right one for them. Prospective residents are assessed to ensure the home can meet their needs and are provided with a contract/statement of terms and conditions. EVIDENCE: The home provides a statement of purpose and a service user guide, and makes sure these are available to residents, relatives and other visitors to the home. The service user guide contains the most recent CSCI inspection report. Prospective residents and their representatives are encouraged to visit the home before making a decision to move in. Of the fifteen residents who responded to our survey, all except two stated they had received enough information about the home before they moved in so they could decide if it was the right place for them. Those who had not received information commented that their families had received it as they had made decisions on their behalf. A visitor told me she and other members of her family had chosen Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 9 the home for their relative, after visiting to see what it was like. They had visited a number of homes before choosing this one. Examination of a sample of residents’ care documentation showed their needs had been assessed to make sure the home could meet those needs. Residents whose placement had been arranged through a local authority had received care management assessments. The manager or another senior member of staff carry out pre-admission assessments. Contracts/statements of terms and conditions were evident on those residents’ files sampled for inspection. Of the fifteen residents who responded to our survey, all except three confirmed they had received a contract. Those who had not received one stated the contract had been supplied to a relative. This care home does not offer intermediate care, thus standard 6 does not apply. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 10 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. All residents have a plan of care that sets out their individual needs. The home ensures its residents receive care and support, and have ready access to health and social care services. Medicine administration is generally satisfactory, though some issues need to be addressed. Generally, residents are treated with respect and their right to privacy and dignity maintained but staff must always use each resident’s preferred term of address. At the time of death, staff treat people and their families with sensitivity and respect. EVIDENCE: The care plan format used by the home is comprehensive and includes activities of daily living, care plans and risk assessment. The four care plans I sampled were based on assessed needs and had supporting risk assessments in place for falls, continence, nutrition, pressure care, and moving and handling. Information about the residents’ backgrounds and social needs was included, and there was evidence of individual or family involvement in the development of their care plans. I asked nursing staff about continence promotion. I was told how the home’s nurses carry out continence Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 11 assessments, ensure regular toileting unless the person has an indwelling catheter, and make sure the correct pads are used for day or night. Residents I met during the inspection visit were well groomed, with hair tidy and nails clean and trimmed. They were dressed in suitable clothing for the time of year. Residents who I met with said they were being cared for well. Those I met with in their bedrooms had call bells and fluids at hand. Of the fifteen residents who responded to our survey, most stated they always received the care and support they need. Two said they usually received it and two that this was sometimes the case. A visitor said she was happy with the services provided. Her relative is cared for well, she said, and has settled in the home and is comfortable and cheerful. Residents responding to our survey were generally satisfied with the medical support they received, stating they either always or usually receiving the medical support they felt they needed although one resident stated this was only sometimes the case. A local GP practice provides medical support to the home, with visits as required. There was documentation on residents’ files relating to GP visits and visits made by members of the multidisciplinary team. On the nursing unit, the nurses give medicines and on the residential side carers who have completed medication training carry out the medicine rounds. There was a list of initials and signatures of those staff administering medications. There were no residents administering their own medicines at the time of my visit. Medicines were seen being given to several residents during the inspection and were administered safely. Medication on Fallowfield is stored in a locked trolley in a locked room. There is no natural ventilation in this room, which has a small electric vent. The nurse in charge was aware the room temperature must be kept within safe limits for storing medication. The administration of controlled drugs (CD) had been recorded correctly. On Fairlight, a locked trolley is chained to a solid wall outside the unit manager’s office. There is also a locked cupboard on this unit, which contains a controlled drugs cabinet. The drugs fridges on each unit were being used for the correct medicines and the temperature is recorded daily. Those medications with a short shelf life had been dated on opening. However, the drugs fridge in the kitchen on Fairlight had no lock and the temperature had been consistently too high. It was understood the fridge is due for replacement and the need for this to happen without delay was discussed with the manager during the inspection visit (requirement 1). I discussed current legislation about CD storage with the manager who agreed to check the locks on the CD cabinets meet the new requirements. Medicine administration records (MAR) had been completed well, and included information about any allergies and a photograph of the individual resident. On the residential unit, handwritten amendments had been signed by two staff who have had medication training, and two nurses sign on the nursing side. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 12 There were records of medications received into the home and no overstocking noted in the medication trolley. On the MARs sampled on the residential unit, there were a number of medications prescribed to be taken “when required” that did not have full guidance for staff to help them make decisions about administration. This omission was raised with the manager and must be addressed, as it may lead to errors (requirement 2). Two residents I spoke with said they are treated with respect and their right to privacy and dignity maintained. Observations during the inspection generally confirmed this. For the most part, staff were seen to address residents respectfully though it was not always evident this was by their preferred names. For example, a staff member on the residential unit repeatedly addressed a resident as “poppet”. It seemed this was likely to be a training need and was discussed with the manager so he could take appropriate action (requirement 3). A previous requirement about communicating effectively with residents who have sensory impairment had been met. People can choose to spend their final days in the home. The home has a policy and procedures for supporting people and their families during a resident’s terminal illness. The home will arrange for specialist support if this is needed. The manager and staff team are sensitive to any particular religious or cultural needs of the individual resident and their family. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents choose how they spend their time and are supported to maintain contact with their families and friends. Planned activities are available for residents to join in with as they choose. Menus show that residents’ diet is balanced and nutritious. A more individualised approach to meal times is needed on the nursing unit. EVIDENCE: There was a calm, relaxed atmosphere in the home when I arrived for the unannounced visit. Residents were either in the lounge or their rooms. It was evident the home supports residents to maintain contact with their families and friends, providing this is their choice. Visitors are welcomed at any reasonable time. Relatives visiting the home said they were always made to feel welcome. A resident I met with said she enjoys trips out of the home each week with a relative. A programme of planned activities was on display. The activities coordinator who works across both units spoke with me while she was recording in residents’ care documentation the activities they had undertaken. The coordinator said that she encourages residents to engage in gentle exercise as part of activities, and that music and movement sessions are offered each Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 14 week. She organises trips out from the home; this week some residents were going out to lunch at a local carvery restaurant and a trip to Greenwich Park had been arranged for the following month. The home’s gardens are used for tea parties when the weather is nice. It is recognised organised group activities are not suitable for everyone, and that an individual approach is also needed. The coordinator visits residents who prefer to be in their rooms, chats with them, for example, about items in that day’s newspapers. There were different views about activities provision from the residents who responded to our survey. Respondents stated there were either always, usually or sometimes activities arranged by the home that they can take part in. Three residents said this was never the case, their comments including, “I choose not to participate in these activities”; “games are for those who want to play”; and “I prefer to stay in my room”. The fifteen residents who responded to our survey had mixed views about the meals provided. Four residents stated they always like the meals, one commenting, “they are very good”. Six said they usually like the meals and five sometimes like them. One commented that, “I sometimes have to order something different”. At lunch on both units during the inspection visit, it was evident residents had been offered a choice of meal from the menu. They could also ask for an alternative if they did not want what was on the planned menu. A resident on a special diet said that staff are very careful to make sure she gets the right diet. Three residents said they were enjoying their meal. The use of plate guards and adapted feeding mugs was helpful to less able residents. Carers were available to assist residents where necessary, encourage them to take their drinks and provide general supervision. The residents on the nursing unit using wheelchairs at lunchtime were mostly on one table, which helped to allow easier movement around the dining room. These residents were positioned so they were comfortable and were given assistance with feeding as required. However, it was disappointing to see that every resident in the Fallowfield dining room was wearing a bib without it being clear that the use of bibs is due to individual need or preference. At the previous inspection, this had been raised as an issue for the home to address. This important matter that relates to residents’ dignity and independence has been raised again with the manager and we will consider enforcement action if necessary (requirement 4). Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that if they raise concerns or complaints they will be taken seriously. The home has policies and procedures for complaints and for safeguarding adults. Staff receive training and know about protecting residents from abuse. EVIDENCE: The home has an appropriate complaints policy and procedure, which is included in its service user guide and displayed prominently on the premises. Since the last inspection, the commission has been informed of one complaint made to the provider about the home. Information provided to the commission by the home showed that two complaints had been received within the past twelve months, which had been resolved within the timescales set out in the home’s procedure. This information was followed up during the inspection visit. It was evident each matter had been properly recorded and investigated, which showed a previous requirement in this respect had been met. Nearly all of the residents responding to our survey knew who to speak to if they were not happy, though two said they were not sure. All the residents except one stated they knew how to make a complaint. The home’s prevention of abuse policy and procedure was reviewed in November 2007. It included the local council’s safeguarding flowchart, which gives clear guidance to staff to follow the locally agreed procedures. The home’s whistle blowing policy gives a summary of the relevant legislation and Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 16 how it applies to staff members. We are aware of a safeguarding alert made to Bromley social services in October 2007, following a resident’s unexplained bruising and a fracture. In liaison with social services, the provider carried out an investigation. No evidence of abuse was found. During my visit, there were signs of wellbeing amongst residents, who appeared comfortable and relaxed when interacting with members of the staff team. Staff had attended training in the protection of vulnerable adults, and the home actively promotes whistle blowing and the protection of residents from abuse. We have recommended previously that the home makes sure there are effective outcomes from the adult protection training provided to staff. I spoke with staff members who had received training in safeguarding adults, and found improvement in this respect. They all understood about raising any concerns they might have about residents’ safety and welfare, though one person showed less understanding about the multi-agency approach to dealing with allegations of abuse. I raised this with the manager at the end of my visit, as it is important that every member of staff has a clear understanding of the local authority’s safeguarding procedures. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 17 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, 21, 22, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean, comfortable and well maintained. The home has infection control procedures for its staff to follow to ensure effective hygiene. EVIDENCE: The home is comfortable and homely. It has been adapted and extended to meet residents’ needs. There is ample communal space of a good standard, with views over the large, well-kept gardens. The home has satisfactory provision of communal toilets, showers and assisted baths. The company is gradually reducing the number of shared bedrooms in the home, converting them into single rooms. When questioned, the manager told me it is the company’s intention when these changes are completed to apply to the CSCI for a variation to the home’s registration to reflect the final reduction in numbers. The bedrooms that I saw were comfortably furnished, and most were personalised with the resident’s own possessions, family photographs or pictures. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 18 Over the two days of my visit, the areas of the home that I saw were clean and tidy, with no odour. There is an on-going programme of redecoration and refurbishment. At the time of the inspection, some corridor ceilings were being replaced and better lighting installed. Fourteen residents responding to our survey stated the home is always fresh and clean, and one resident stated this is usually the case. A resident commented, “I am quite satisfied with the facilities here at the home”. At the previous inspection, we recommended the hoist provision be reviewed to make sure the home has enough to meet the dependency needs of its residents. The home has now obtained a new standing hoist and an additional full hoist. At the time of previous inspection, the passenger lift on the residential unit had not been working. This had been repaired and residents said it had been working properly since this work had been carried out. It was in good working order during the inspection visit. The home’s self-assessment confirmed it has an infection control policy and that staff have received training to enable them to use good infection control practices. A laundry person is employed to launder bed linen, towels and personal laundry. Red alginate bags are used to launder soiled items. The laundry was operating effectively and staff understood basic infection control principles. The home has two sluices, which are fitted with disinfectors for the effective cleaning of commode buckets. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified and competent staff are employed to meet residents’ needs. Staff are supported to undertake training that is relevant to their work and benefits residents. There are appropriate recruitment procedures, which are carried out to ensure they support and protect residents. Recent changes to staffing arrangements on the nursing unit need to be kept under review to see if they are benefiting residents. EVIDENCE: Staff rotas showed that the nursing unit has two qualified nurses on duty during the day, with one nurse on duty at night. Six carers work in the morning, three in the afternoon/evening and two at night. The residential unit normally has six carers in the morning, three in the afternoon/evening and two at night. There had been occasional use of agency staff on both units to cover vacant shifts. Most residents responding to our survey stated that staff are either always or usually available when needed, though two stated this was only sometimes the case. One resident commented, “Sometimes when you ring the bell it takes sometime for them to come”. Another resident said that staff were always prompt in giving attention, she just has to ring her call alarm. When I arrived at the home unannounced, there were enough staff on duty on the morning Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 20 shift to meet the needs of the people in residence. My observations while case tracking a sample of residents showed their needs were being met promptly. I was told the home had introduced a new staffing arrangement in January 2008 for Fallowfield whereby one of the two nurses on the afternoon shift also works on the unit as a carer. It was not possible to determine from our survey responses which unit each resident was living on. However, comments from Fallowfield staff showed some concerns about the new arrangement for afternoon staffing. For example, it was said that having a nurse working as a carer during the afternoon and evening is not helpful as they get called away to deal with emergencies. The manager stated the rationale for this change was that the home’s bed numbers had decreased as the company is gradually reducing the shared bedrooms in the home by converting them into single rooms. At the time of the inspection, the home could cater for a maximum of 59 people, even though it is still registered for up to 68 people. The manager confirmed he is aware that staffing levels and skill mix need to be determined by the dependency of the residents, not simply by how many there are. The use of a nurse as a carer had not been mentioned in the home’s recent self-assessment (AQAA) information and it was not clear during the inspection how this change would contribute to improvements in residents’ care. The recent change in staffing arrangements on the nursing unit needs to be kept under review, as part of assuring the quality of services, to ensure residents’ needs continue to be met promptly and effectively. We will expect to be able to see evidence of this review, which could be included in reports of the provider’s monthly unannounced visits (requirement 5). Thirteen residents responding to our survey said staff listen and act on what they (the residents) say but two stated this was only sometimes the case. A visitor told me she and her relative had found staff members to be kind and approachable. I discussed with the manager the rate of staff turnover as set out in the home’s AQAA. He said there had been consistency of nursing and other senior staff at the home but a regular turnover of care staff. He stated the home had been able to recruit to vacant posts, and that there were three care staff vacancies at the present time. There were no vacancies for ancillary staffing. Staff members I spoke with outlined the recruitment and selection process they had undergone before taking up their posts. They said this had included an interview, references and Criminal Records Bureau (CRB) checks. I examined a sample of three staff files, all of which contained the necessary recruitment information. The home was able to provide me with evidence that confirmation of current Nursing and Midwifery Council (NMC) registration had been obtained for all the nurses employed at the home. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 21 The home had produced an electronic training matrix covering all staff, which provides management information by showing when mandatory training has been completed or is overdue. The matrix covers staff training in medication, manual handling, first aid, food hygiene, fire safety, health and safety, infection control and adult protection. The home has a Skills for Care induction period for new staff. Staff I spoke with confirmed they receive statutory training and staff files contained details of training completed. Carers are supported to undertake NVQ awards in care. The home’s AQAA dataset showed 18 of 43 staff had completed NVQ Level 2 or above, with another four staff members currently working towards this qualification. Nurses are supported to undertake continuing professional development, in line with NMC requirements for maintaining their nursing registration. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 22 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s manager is registered with the commission as fit to manage this care home. The home seeks the views of its residents and their representatives about the running of the home. Residents’ financial interests are safeguarded. The home promotes the health and safety of residents, staff and visitors but needs to formally review its recent accident records. EVIDENCE: The manager is a qualified nurse and an experienced manager, with previous experience of managing a care home before taking up post at Fairlight and Fallowfield. He undertakes continuing professional development to maintain his nursing registration. The manager promotes equal opportunities and showed he understands the importance of person-centred care and ensuring good Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 23 outcomes for residents. The home’s statement of purpose confirms the manager is available to discuss any issues or ideas residents may have. It was apparent that an open style of management is practised, so that residents, visitors and staff may give their views about the running of the home. A particular issue arose where this management approach will be of benefit. There are two communication books on the nursing unit, one for nurses and one for care staff. I asked staff members how else they communicate with each other about residents’ progress and needs. There was some difference of opinion, which I recommend is explored, perhaps at a staff team meeting (recommendation 1). A nurse said she speaks with carers and residents during each shift, records relevant information and shares it with colleagues at staff handover. She said that it is care staff’s responsibility to report any changes with residents to senior staff. A carer agreed but offered the view that communication between senior staff and carers could be improved, with seniors always making sure to find out from carers about individual residents they have been caring for on a particular shift. The self-assessment (AQAA) provided to us by the home’s manager was clear and contained relevant information. The AQAA told us about changes made and also where the home still needs to make improvements. The data section of the AQAA was fully completed. The home has strategies to assure the quality of its services. I saw the reports of quality assurance surveys of residents and visitors that had been carried out in 2007. The results of surveys carried out in the first half of 2008 have been obtained but not yet collated into a final report, as this will be made available at the end of the year. The provider carries out monthly visits in compliance with regulation 26 and reports were available in the home for inspection. The monitoring reports are compiled separately for the nursing and residential units. No money is held on residents’ behalf by the home. Residents or their families are invoiced for any extra charges, such as hairdressing and newspapers. Some residents keep small amounts of money, which allows for more dignity and independence in buying small items without always relying on others to assist them. As noted in the Environment section of this report, the passenger lift on the residential unit had been repaired and was in good working order. The manager confirmed the home would always in future meet our previous requirement to tell us about a passenger lift breakdown that cannot be repaired immediately. It is important that we know about such an event as it may adversely affect the wellbeing or safety of residents. Health and safety documentation that I sampled for inspection was up to date and within the appropriate timeframes. These included certificates for gas safety, fire safety, and inspection of lifting equipment. Our previous requirement for an up to date water-testing certificate had been met. Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 24 The local (Bromley) environmental health service visited the home in November 2007. It was evident the two issues raised at that visit had been addressed. Our previous requirement to ensure good food hygiene practices had been met. There was evidence that the home takes fire safety seriously. The provider had carried out an annual review of the fire risk assessment in November 2007. The fire authority (LFEPA) had visited in December 2007 and found that the premises complied with legislation. Fire prevention equipment had been inspected in January 2008 and records showed the fire alarm is tested each week. The format for the fire alarm testing record does not have a space for a signature so it is not possible to identify from the record the person(s) who carried out the test. It is suggested the home consider changing this format, to enhance accountability and audit (recommendation 2). The provider had identified at a monthly monitoring visit that not all staff had attended regular fire drills. To address this, three drills had been held so far in 2008, with staff attendances of 19, 8 and 12 respectively. The home’s accident file contains records of individual incidents and monthly summaries. It was evident that over the previous two months many more accidents had been reported on the residential unit than on the nursing unit. Also, reported accidents on the residential unit in April 2008 were twice the number reported in January 2008. These statistics were discussed with the manager, who confirmed they had already been considered. He said examination of the reasons for the figures had concluded they were due to several factors. People living on the residential unit are more independently mobile and thus exposed to more risk of accidents. The manager gave an example of a resident who had a number of falls but who stopped having falls when transferred to the nursing unit. Also, staff on the residential unit had been encouraged recently to report all incidents, regardless of severity. However, there was no written report of this review of accident statistics, which is important given both the difference in the level of reporting between the units and the increase in accidents on the residential side (requirement 6). Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13 Requirement The registered person must ensure the medicines refrigerator on Fairlight is repaired or replaced, so that medicines needing chilled storage can be stored safely and within the correct temperature range. The registered person must ensure that all medications to be administered as required or as directed have full administration guidelines in place. The registered person must ensure that staff members always use the particular term of address each resident prefers, as this shows respect for the person and helps to maintain their dignity. The registered person must ensure it is evident that where a resident has a bib at mealtimes, this is to meet a need or preference identified for that individual. Previous requirement. The registered person must ensure it is evident the recent change in staffing arrangements DS0000010134.V362844.R01.S.doc Timescale for action 30/06/08 2 OP9 13 30/06/08 3 OP10 12 30/06/08 4 OP14 12 30/06/08 5 OP27 18 31/07/08 Fairlight & Fallowfield Version 5.2 Page 27 6 OP38 13 on the nursing unit is being kept under review, to ensure residents’ needs continue to be met promptly and effectively. The registered person must ensure it is evident that a formal review has been carried out of the reported accidents on both units, to identify any patterns or trends that have an impact on residents’ health and safety. 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP32 OP38 Good Practice Recommendations The registered person should ensure methods of staff communication about residents’ care are discussed, to enable a shared understanding and consistent practice. The registered person should consider amending the format for the fire alarm testing record, so the person(s) undertaking the test can include their signature(s). Fairlight & Fallowfield DS0000010134.V362844.R01.S.doc Version 5.2 Page 28 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. 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