Care Home: Fairlight Manor

What the care home does well The atmosphere at the home is relaxed, with communication between staff and residents open and friendly. The staff and management of the home are welcoming to all visitors and staff was found to be very helpful, and people spoken to about the service commented on this positive approach. What has improved since the last inspection? The CQC were made aware of the new management arrangements in the home. A new washing machine and tumble dryer have been purchased for the home and a new boiler fitted. The AQAA details that audit results are now included in the Statement of Purpose, a new falls risk assessment, moving and handling and environmental risk assessment are now in place, the notice board in the home is an available area of information for visitors to the home detailing activities, staff have received training including the importance of communication and documentation, there has been the introduction of blue disposable aprons to be worn by care workers when handling food, of soluble bags for soiled laundry, new cleaning schedules for night staff and key workers, the number of staff with NVQ Level 3 training has increased, policies and procedures in some areas have increased, a new Manager has been working in the home since June 2009 to provide the home with a more stable structure, and a staff restructure has also taken place with the role of senior care being introduced. What the care home could do better: The new Manager was able to demonstrate a number of areas of development and improvement in the systems and monitoring of the care provided in the home. Where shortfalls have been identified a Requirement has not always been made as the Manager was able to demonstrate an awareness of the shortfall, and or work in place to rectify this, or stated that it would be addressed with immediate effect. But there are two of areas where improvements were required at the last inspection, which have not been done or fully complied with in relation to staffing and the maintenance of the building, equipment and services. This has been a factor in the quality rating of adequate and there is a need for urgent action to remedy these shortfalls. Not all the required paperwork was available to view during the inspection and a Requirement has been made to ensure that this information is available to reference and evidence systems in place to protect residents and staff. The Statement of Purpose and Service Users Guide need to be updated and kept up-todate to ensure prospective residents and their representatives have accurate information to refer to. The recording of pre-admission assessments, residents individual care plans and falls risk assessments need to be developed to detail individual care needs, provide specific guidance for staff to follow and is devised in consultation with the resident or their representative. To ensure that residents care needs continue to be met. Residents would benefit from a review of how their personal clothes are washed and that they are appropriately dressed to ensure that their dignity is maintained. Persons undertaking moving and handling risk assessments should be appropriately trained and receive the required training updates to protect residents and staff. Care workers should not undertake any moving and handling in the home until they have received the required training to protect the residents and the staff. Clear criteria guidelines for medicine prescribed on an `as required` needs to be developed, and records of administration of medication maintained and developed to detail a clear record of administration to protect residents and staff. The records of individual resident`s food consumption should be further developed to record and evidence that an adequate diet is provided. Residents would benefit from the continued development of activities provided to ensure that their social care needs are met. A system should be put in place to enable the continual review of staffing numbers and skills to ensure appropriate staffing levels are maintained to meet the assessed care needs of residents in the home. A robust recruitment procedure should be followed to ensure the receipt of two written references prior to new members of staff commencing work in the home to protect residents. A Requirement has been made. Key inspection report Care homes for older people Name: Address: Fairlight Manor 48 Fairlight Avenue Telscombe Cliffs East Sussex BN10 7BS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judy Gossedge     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Fairlight Manor 48 Fairlight Avenue Telscombe Cliffs East Sussex BN10 7BS 01273582786 01273582786 ashnazpatel@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Fairlight Manor Ltd Name of registered manager (if applicable) Miss Michele Message Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 19 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Date of last inspection Brief description of the care home Fairlight Manor is located in a quiet residential area of Telscombe Cliffs, near to the seafront and local shops and amenities. The property comprises of two large semidetached houses, which have been made into a single building and extended. Residents accommodation is presented over three floors; a passenger lift is available to all floors. The home has a large sitting room with television and stereo, with a smaller dining room situated just off, between the sitting room and the kitchen. Residents have access to the garden at the rear of the premises that is equipped with garden furniture and umbrellas in the summer for them to use during the fine Care Homes for Older People Page 4 of 30 Over 65 0 19 1 3 0 5 2 0 0 9 Brief description of the care home weather. The home provides personal care and support to residents who are both privately funded and those who are funded by Social Services. The homes fees at the time of the Inspection range from £465.00 to £495.00 per person per week. Additional costs are charged for hairdressing; chiropody, newspapers, toiletries and contributions are requested for outside activities. The homes literature states that `the home is committed to working with these individuals, and believe that however impaired they are, they still deserve to be treated with respect and dignity. A Statement of Purpose and Service Users Guide is available to reference. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Fairlight Manor care home will be referred to as residents. This unannounced inspection took place over five hours between 10.35 and 15.35 on 30 November 2009 and was undertaken by two Inspectors. Mr Patel the Registered Manager/Provider was not present during the inspection. Mr Patel has made a person responsible for the day to day running of the home, who commenced working at Fairlight Manor in June 2009 with Mr Patel overseeing management matters through her. An application for a new Registered Manager for the home has been sent to the CQC. The person appointed is referred to as Manager in the report and facilitated part of the inspection. Care Homes for Older People Page 6 of 30 Following this inspection and prior to the completion of this report Miss Michele Message has been registered to become the new Registered Manager for the home. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and information detailed within is quoted in this report. A random inspection was undertaken on 13 May 2009 to monitor compliance with Requirements made at the last key inspection undertaken on 18 December 2008. It was evidenced there had been areas of improvement in areas highlighted following the last inspection. Four of the five Requirements were reviewed and evidenced they had been met. Further Requirements were made following the random inspection. The communal areas and a selection of residents bedrooms were viewed. A sample of residents individual care records, staff recruitment and training records, staff rotas and documentation in relation to health and safety in the home were viewed and are detailed in the report. Eighteen residents were resident, two residents were spoken with individually in their bedroom, and a number were spoken with in the communal areas. The care that four of the residents received was reviewed as part of the inspection process. The opportunity was also taken to observe the interaction between staff and residents in the communal areas. Three care workers, the cook, the domestic and maintenance person and the Manager were all spoken with during the inspection. No residents or care workers surveys were sent out on this occasion. Information was sought from one relative and a health care worker who were visiting the home during the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The new Manager was able to demonstrate a number of areas of development and improvement in the systems and monitoring of the care provided in the home. Where shortfalls have been identified a Requirement has not always been made as the Manager was able to demonstrate an awareness of the shortfall, and or work in place to rectify this, or stated that it would be addressed with immediate effect. But there are two of areas where improvements were required at the last inspection, which have not been done or fully complied with in relation to staffing and the maintenance of the building, equipment and services. This has been a factor in the quality rating of adequate and there is a need for urgent action to remedy these shortfalls. Not all the required paperwork was available to view during the inspection and a Requirement has been made to ensure that this information is available to reference and evidence systems in place to protect residents and staff. The Statement of Purpose and Service Users Guide need to be updated and kept up-todate to ensure prospective residents and their representatives have accurate information to refer to. The recording of pre-admission assessments, residents individual care plans and falls risk assessments need to be developed to detail individual care needs, provide specific guidance for staff to follow and is devised in consultation with the resident or their representative. To ensure that residents care needs continue to be met. Residents would benefit from a review of how their personal clothes are washed and that they are appropriately dressed to ensure that their dignity Care Homes for Older People Page 8 of 30 is maintained. Persons undertaking moving and handling risk assessments should be appropriately trained and receive the required training updates to protect residents and staff. Care workers should not undertake any moving and handling in the home until they have received the required training to protect the residents and the staff. Clear criteria guidelines for medicine prescribed on an as required needs to be developed, and records of administration of medication maintained and developed to detail a clear record of administration to protect residents and staff. The records of individual residents food consumption should be further developed to record and evidence that an adequate diet is provided. Residents would benefit from the continued development of activities provided to ensure that their social care needs are met. A system should be put in place to enable the continual review of staffing numbers and skills to ensure appropriate staffing levels are maintained to meet the assessed care needs of residents in the home. A robust recruitment procedure should be followed to ensure the receipt of two written references prior to new members of staff commencing work in the home to protect residents. A Requirement has been made. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is detailed information available for residents and their representatives to view, but this needs to be kept-up-to-date and provide accurate information. Potential new residents are individually assessed prior to an admission to ensure that their care needs can be met in the home, but the documentation should be fully completed and available to reference. Intermediate care is not provided in the home. Evidence: The AQAA details that a copy of the Statement of Purpose and Service Users Guide are available to reference in the home. The Service Users Guide was read during the inspection. The document still refers to Fairlight Manor having nurses working in the home although the CQC had been informed that this information had been removed. Staffing information and the care to be provided also need to be reviewed to ensure the information details the current staffing structure in place in the home. The AQAA details that a copy of the last inspection report is available to reference in the home. A relative was spoken with during the inspection who stated that they had enough Care Homes for Older People Page 11 of 30 Evidence: information about the home and services it provides and they had been able to visit the home on behalf of the prospective resident. The AQAA detailed that a comprehensive assessment is undertaken prior to any admission, to ensure individual residents care needs can be met in the home and to provide staff with information on the care to be provided. For two new residents admitted to the home since the last inspection for one there was detailed preadmission information viewed which had been completed, for another the documentation had not been fully completed. The assessment documentation was also viewed for a resident to be admitted the following day. The Manager stated this was still in the process of being completed and that it would be ensured that the information received at a pre-admission assessment is fully recorded and available to reference. So a Requirement has not been made on this occasion. A letter is sent to the prospective resident or their representative with regard to the needs assessment completed and to confirm that the care needs of the prospective resident can be met in the home. Both the new residents and the prospective resident had a copy of a letter which had been sent. Where a resident is returning to the home following a hospital admission there should be a record that it has been ascertained that the residents care needs can still be met in the home. The Manager stated that following a training audit completed with staff it had been identified that the Manager and two senior staff have attended dementia training but care workers in the home have not undertaken this training. The AQAA details that this is an area planned to be improved over the next twelve months. The Manager stated that she is currently in the process of looking for training for staff in the home to attend. Intermediate care is not provided in the home. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents individual care plans should continue to be developed detailing choices and preferences and providing guidance to staff as to the care to be provided, and health care needs. Supporting risk assessments are in place. Further guidance should be recorded on the management of any issues highlighted from the falls risk assessment to protect residents. Medication practices should be reviewed to develop the recording of administration of medication and that this is maintained to protect residents. Evidence: A sample of five of the residents individual care plans was viewed. All the residents had an up-to-date photograph in place. Each resident had an initial assessment from which the care plan was developed, although the detail of the information recorded varied. The care plans are pre-written and then adapted to detail individual residents care needs, preferences and choices and recorded that they had been reviewed. These should continue to be developed to ensure that all the residents care needs are identified and to give a clear picture of the care that is being provided. All had records of regular checks of the residents weight. Risk assessments include nutritional screening, mobility and the risk of falls, and all of the five residents documents had Care Homes for Older People Page 13 of 30 Evidence: risk assessments in place. Falls risk assessments should be further developed to ensure where any issues are highlighted these are documented as to how the risk is to be minimized for staff to reference. The documentation was well structured and presented and storage of this information has been reviewed to ensure confidentiality. Residents were observed in the lounge during the inspection and a number of the residents were dressed with clothing that had been damaged through washing, some of their clothes did not match, some female residents had bare legs and were not wearing stockings and one male resident was wearing sandals with no socks. One resident spoken with was distressed as their jumper had become out of shape in the wash and did not fit well, and spoke to the Inspectors about this. This was discussed with the Manager who stated she was aware of the issues and that a new quality group has been started in the home which would be looking at the care provided in the home and where improvements could be made. The minutes from the first meeting was viewed and detailed this as an agenda item as an area for improvement. The Manager stated that the actions taken would be then monitored to ensure continued improvement in this area. So a Requirement has not been made on this occasion. The care documentation recorded regular contact with health and social care professionals and a visiting community nurse confirmed that they are involved as necessary with the residents care. Where health care is provided to individual residents this should be undertaken in the residents own bedroom and other residents bedrooms not used. This was discussed with the Manager who agreed to address this. The AQAA details that medication policies and procedures are in place. The home has a designated locked facility for the storage of medication and a sample of the storage and recording of medication administered was viewed. At the time of the inspection none of the residents were self-administering their medication. A list of staff sample signatures for those administering medication was in place. There was a gap in the administration records of one resident who was due to be administered medication during the morning of the inspection and of creams which were due to be applied. It was not clear for one resident where medication had been stopped, why this had occurred, nor was there a record of where and when the instruction had been received and who had made the changes. For one resident it was not clear from the records or staff spoken with if the medication was still being administered or not. Some residents are on medicines on an as required basis and there was some guidance to staff on when to give this medication, which would benefit from further development. This was discussed with the Manager who stated this information and recording of medication administration would be developed to protect residents and staff. So a Requirement has not been made on this occasion. Staff confirmed that a pharmacist regularly Care Homes for Older People Page 14 of 30 Evidence: visits; the records were not viewed on this occasion. The Manager stated that all staff that administers medication has received training provided by an external provider. The training records viewed recorded a number of staff had attended this training. The care worker administering medication during the inspection confirmed they had attended training. Care workers were seen to be respectful to residents and visitors. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from the continued development of opportunities to participate in social and recreational activities, residents are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. Evidence: The AQAA details an activities schedule is available to view in the home. Activities recorded as being provided included ballgames, nail care and memory activities. Staff and the relative spoke of external entertainers visiting the home and of opportunities to be taken out to local facilities such as a garden centre. No activities were facilitated during the morning of the inspection and a care worker put up the Christmas decorations with a small group of residents in the lounge during the afternoon. Feedback received and the sample of records viewed did not evidence that activities are being regularly organised in the home. Where younger residents are admitted to the home activities should continue to be developed to ensure all the residents social care needs are met. The AQAA details that it is an area for improvement over the next twelve months and part of the development is to create an activities committee to include staff and relatives to organise more events and fund raising for outings and activities. Care Homes for Older People Page 16 of 30 Evidence: The AQAA details that staff will discuss and help facilitate any requirements to meet individual residents spiritual needs. It was evidenced that this is discussed with residents and their representatives as part of the admissions process. The AQAA details that it is planned to have as part of the improvements planned over the next twelve months to have a regular religious service in the home for those residents who would like to attend. During the inspection one relative was observed visiting the home. Staff was seen to be welcoming. The relative was spoken with and confirmed there is flexible visiting and they could see their relative in private if they wished. A cook was spoken with, who with a second cook between them work in the home seven days a week. The cook stated she holds a basic food hygiene certificate. Training records viewed recorded that both of the cooks have a basic food hygiene certificate. The weeks menu was read, and the Manager stated the menu is currently being reviewed again. Choices were documented to be available at all meals. Lunch on the day was, chicken casserole with mashed potatoes and mixed vegetables, or ravioli or vegetable pie, and followed by prunes and custard or blancmange. The cook stated that fresh fruit is regularly ordered and available in the home, and a bowl of fruit was in the lounge. Special diets are catered for. Residents were observed eating their lunch in the dining room or in their own bedroom and it was a relaxed environment taking into account the different length of time that individual service users would need to finish their meal. A sample of records were viewed which detailed what individual residents had eaten during the day. It was not clear from the records was the amount of food consumed. This was discussed with the Manager who agreed to ensure that the records were developed to reference and that residents have had an adequate diet. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to enable residents or their representatives to raise any concerns about the care being provided, also to ensure that residents are protected from abuse but it should be ensured that these are followed to protect residents. Evidence: The AQAA details that there is a complaints policy and procedure in place. That the Service Users Guide details the complaints procedure and a complaint, concerns and compliments suggestion box is now in place in the home. The AQAA detailed two complaints had been received at the home during the last year but were not upheld. There were no records to view of the complaints received or the outcomes. A Requirement has been made under Standard thirty-seven. The CQC was made aware of one concern in relation to the care provided at Fairlight Manor, which was investigated under safeguarding adults procedures. The AQAA detailed that there are policies and procedures in place in relation to the protection of vulnerable adults. It has been previously evidenced that a copy of the East and West Sussex County Council, Brighton and Hove safeguarding adults procedures is available to reference in the office. The Manager stated she has received training in safeguarding adults and is planning to undertake further training on facilitating training for staff in safeguarding adults procedures and whistle blowing procedures. The training records viewed recorded that six staff have received the training this year and the AQAA details that over the next twelve months it is planned Care Homes for Older People Page 18 of 30 Evidence: to provide further safeguarding training to staff in the home. One care worker spoken with stated they had received this training and for another this had not yet been covered in their induction. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fairlight Manor provides residents with a homely and pleasant environment. Evidence: The AQAA details that a maintenance person works at the home to ensure that the home is well maintained and a gardener attends the grounds. The Manager stated that a new washing machine and tumble dryer had been purchased and a new boiler has been fitted in the home. The AQAA details that plans for improvement over the next twelve months includes to decorate the home to take into account the residents dementia care needs. The communal areas and a sample of bedrooms were viewed. The home has a light and airy feel to it and provides a pleasant environment for residents. There are seventeen single bedrooms and one double bedroom on all floors in the home. A number of bedrooms were viewed and some had been personalised with pictures and ornaments, where one had not this was discussed with the Manager who stated that this was being discussed with residents representatives. One bedroom had a frayed carpet at the entrance to the room. This was discussed with the Manager who stated this would be addressed to ensure the safety of the resident. All bedrooms have an emergency call bell system. Five of the single bedrooms have en-suite facilities of a shower, wash-hand-basin and Care Homes for Older People Page 20 of 30 Evidence: toilet. Communal bathroom and shower facilities are provided throughout the home. A passenger lift is available from the lower floor to the second floor. The communal area is attractive and allows for flexible use and provides a lounge area and dining room area. The room and adjoining corridors and have been personalised with photographs of residents and activities they have participated in.This is where the majority of the residents congregate during the day. Heating is provided by a central heating system. The homes records of checks of the hot water supply were viewed and did show again that there was some recording of temperatures lower than the recommended safe temperature of 43 degrees centigrade. This has been an ongoing issue and a Requirement was made at the last key inspection. This was discussed with the Manager who stated that a new boiler had just been fitted in the home to help address this and as part of this work the temperature would be looked at and work actioned where needed to address this. So a Requirement has not made on this occasion. There is a garden to the rear of the home, which has been made secure. Access to the garden is via the patio doors off the lounge by steps leading onto a patio area adjoining a sharp drop to the lawn. The Manager stated that it is still planned to fix railings to protect the residents and quotes have been sought for the work to be completed in the 2010/2011 budget. The Manager was not aware of a risk assessment in place to protect residents until this work has been completed. No residents were observed to go into the garden during the inspection. The Manager stated that she would ensure a risk assessment was in place. So a Requirement has not been made on this occasion. The AQAA details that there is a policy in place for managing infection control and that an action plan is in place to deliver best practice in prevention and control of infection. That all staff have received infection control training. Supplies of disposable gloves, liquid soap and disposable paper towels were in the home for their use and the Manager stated that routine checks in the home are made to ensure accessibility of this equipment. A part-time domestic and maintenance person works in the home five days a week. The home was clean and free from offensive odours at the time of the inspection. The domestic and maintenance person has previously stated he has received training and guidance in infection control or the control of substances hazardous to health regulations (COSHH.) The care staff undertake all the laundry duties in the home. Care Homes for Older People Page 21 of 30 Evidence: Recording was viewed of routine fire checks that had been carried out in the home. Staff confirmed the regular checks that are undertaken. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels must be continually kept under review to ensure that adequate numbers of staff are on duty to meet the care needs of the residents. A robust recruitment procedure needs to be in place to ensure residents are in safe hands at all times. Training is being facilitated to ensure that care workers are being provided with the required training to meet the care needs of the residents. Evidence: The AQQA detailed that the staffing levels are appropriate. That the home is managed to ensure that care staffing levels are maintained at a higher level than recommended and the Manager provides thirty-seven hours supernumerary cover throughout the week. The Manager stated she is currently looking to recruit a deputy manager to support her. Three care workers were on duty in the home during the waking day and at night the home deploys two waking night, staff. The Manager had left the home for a meeting with Mr Patel and returned during the day to help facilitate the inspection. Staff spoken with during the inspection and the sample rotas viewed also confirmed the staffing levels in place. Four residents were in their bedroom at the start of the inspection, situated on all floors of the home. One of these residents was unwell and the Inspectors were not informed of this at the start of the inspection but ascertained this during the inspection. The AQAA details that all the residents need assistance with washing, dressing/undressing and bathing, nine residents need assistance with toileting, three residents require two care staff to provide their care, Care Homes for Older People Page 23 of 30 Evidence: and five residents need supervision and prompting with eating their meals, which are not all eaten in the dining room. This can leave periods during the day when other residents are not supervised. Residents were observed to be left unsupervised in the lounge for periods during the inspection. The sample of staff rotas viewed on occasions did not record that staffing levels are maintained when staff are on training. Feedback received stated that there is not always adequate staff on duty to meet all the care needs of the residents. This is an outstanding Requirement following the last inspection. The AQAA detailed that of the twelve care workers working in the home eleven hold an NVQ Level 2 in care. The documentation was viewed for the two new members of staff, who had been recruited since the last inspection. These demonstrated the completion of an application form, one had two written references in place prior to commencing work and one had only one written reference, and a record of a Criminal Records Bureau (CRB)/and a Protection of Vulnerable Adults (POVA First) check which had been received. The recruitment information detailed that one of the member of staff had been given information on the General Social Care Council Code of Conduct. The Manager stated that induction training for new members of staff is now in place and that this meets the requirements of the General Skills for Care induction standards. The AQAA details that eleven of the staff have completed the induction training described and recommended by Skills for Care. The Manager stated she had taken had taken all the care workers through the induction glossary and a training analysis has been completed to identify individual care workers training needs. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fairlight Manor is run in a friendly manner. The current management arrangements have enabled significant work to address issues highlighted, but there are still shortfalls in respect staff recruitment, staffing levels and the health, safety and welfare of residents and staff are not well protected in all areas. Systems have been developed to monitor the quality of care provided. Residents financial interests are safeguarded. Evidence: Although Mr Patel is the Registered Manager of the home it was clear from feedback with staff and records viewed that he is not in the home very often and the responsibility of the day to day management continues to be allocated to the Manager. A new Manager has been appointed since the last inspection to undertake the day to day management. Observation and feedback confirmed that the Manager had a good rapport with staff, residents and relatives. The CQC have received an application for a new Registered Manager for the home. Care Homes for Older People Page 25 of 30 Evidence: The Manager stated she has attended training on the Mental Capacity Act and the Deprivation of Liberty, and that guidance is in the process of being sought as to a potential application to be made under the Deprivation of Liberty. Again this inspection visit has identified a number of shortfalls in respect of the management for example the recruitment and staffing and health and safety practice in the home. The AAQA detailed a quality assurance system is in place and that the results from the feedback received is recorded in the Statement of Purpose. The Manager stated that feedback has been sought during November using surveys and has still to be collated. The AQQA detailed policies and procedures are in place, which had recently been reviewed. That over the next twelve months it is planned to continue to improve the homes policies and procedures. The Manager stated that Mr Patel visits the home to meet the requirements of Regulation 26. The records of these visits should be available to view for any further visits. That further quality systems have been put in place to monitor the care provided in the home including a quality group which has been started as detailed under Standard seven. The Manager confirmed that the home has no dealings with residents monies and that any extras costs incurred are paid by the home and then individually invoiced on a three monthly basis. The AQAA detailed that regular supervision and team meetings are facilitated to meet requirements, and this has been an area of improvement over the last twelve months. Staff spoken with a sample records viewed confirmed these forums occurred. Records viewed were limited and would benefit from further development to protect all staff. This was discussed with the Manager who agreed to address this Training records were viewed, but were still in the process of being updated. The Manager stated that a training audit for each member of staff has been completed and had identified that staff had not all received the required training. The Manager has booked or was booking courses for staff to attend. The Manager stated that she is also looking at training to ensure there are sufficient fully qualified first aiders working in the home. One new care worker was observed moving and handling a resident and had not received moving and handling training. This was discussed with the Manager who stated she would discuss this again with staff to protect residents and staff. So a Requirement has not been made on this occasion. Following staff changes in the home it was not clear who would be undertaking any moving and handling risk assessments. This was discussed with the Manager who stated this would be addressed. So a Care Homes for Older People Page 26 of 30 Evidence: Requirement has not been made on this occasion. Risk assessments of the environment had been completed, and were viewed. The Manager was aware these needed to be reviewed and stated that this would be addressed. The AQAA did not detail and evidence that the maintenance of equipment and services in the home had all been carried out. The Manager was able to provide some further detail of maintenance undertaken during the inspection but there was not evidence that all the maintenance had been undertaken as required. This is an outstanding Requirement from the last inspection. A fire risk assessment is in place which recorded had been reviewed in October 2009. Records were viewed of regular weekly and monthly checks undertaken in the home. Records were viewed that evidenced that some staff had attended fire training facilitated in the home this year. The Manager stated that a member of staff is also booked to attend fire warden training. A sample of the recording was viewed of incidents and accidents. Records detail that there have been a high level of falls in the home. The Manager stated that a new falls risk assessment has been put in place and guidance and advice is being sought from the falls risk assessment service. The training records viewed recorded that staff have also been attending falls prevention training. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 27 18 That staffing levels are kept under review to ensure adequate staffing is in place to meet residents care needs. To protect residents and staff. 30/06/2009 2 38 13 That up-to-date records are 30/06/2009 available to view of the maintenance of services and equipment in the home. To protect residents and staff. Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 That staff will not commence 06/01/2010 working in the home until two written references are received. To protect residents. 2 37 17 That all the required records 31/01/2010 are maintained at the home and available to view. To protect residents and staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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