Care Home: Fairmount

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What the care home does well Survey respondents consider areas in which the home does well are as follows `I am very pleased with all aspects of the home, particularly the many activities and the high level of cleanliness, my [relative] is very happy at Fairmount.` `The home is fresh and clean and the staff are attentive and pleasant. The garden is superb.` `It is kept very clean. The food is excellent. The standard of accommodation is excellent.` `I`m impressed by the number and variety of activities available. Fairmount always looks welcoming, clean and is a very pleasant environment with lovely gardens.` `My relative has been resident at Fairmount since February 2008 and has been very happy and contented. [They] always says how good the food is. Medically [they] have [their] needs met. I think the love and attention [they] have received, thus far, has been excellent. My thanks to the manager and her team.` `The home is run very well, the food looks very good and they have plenty of entertainment and activities for the residents. They are all very caring.` `I spend quite a lot of time at the home and do take notice of how the staff deal with the residents, but cannot comment on the night care.` `Keep everyone cheerful and feeling safe. Very clean. Social events that involve family.` Staff respond `on every occasion.` `It cares in every way for our [relative] plus it gives us great satisfaction that we chose the home in its entirety.` `Care is good; food is nice, nice atmosphere, comfortable and pleasant room. Entertainment.` What has improved since the last inspection? At the previous key inspection in 2007 requirements were made relating to health and safety within the home. These issues have now been addressed. An anonymous complaint that was received by CQC concerning care in the home. We could find no evidence of issues with care provided. What the care home could do better: Areas in which survey respondents thought the home could improve `Changes in resident and sometime staff do cause some disruption from time to time but that reflects life anyway. [My relative] is generally very well looked after.` `Nothing other than maintain their high standard.` `Cannot think of anything.` `Maybe organise days out for those able to participate.` `Nothing that I can think of.` Key inspection report Care homes for older people Name: Address: Fairmount Mottingham Lane Mottingham London SE9 4RT     The quality rating for this care home is:   two star good 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: Janet Pitt     Date: 2 8 0 7 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 26 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 26 Information about the care home Name of care home: Address: Fairmount Mottingham Lane Mottingham London SE9 4RT 02088571064 02084027401 info@fairmount-of-mottingham.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Harold South,Mrs Jenny South care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 38 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Learning Disability Code LD (maximum number of places:1) Date of last inspection Brief description of the care home Fairmount is a large detached house set in its own landscaped grounds. It is a Grade 2 listed building, having been the home of W.G. Grace the noted cricket player. The home provides care and accommodation for older persons including those with dementia. The home caters for up to 38 people and there are bedrooms on all three floors accessed by two passenger lifts. There are various lounges and sitting areas, and Care Homes for Older People Page 4 of 26 Over 65 0 0 38 38 1 0 Brief description of the care home all public areas of the home are accessible to everyone. There are grab and handrails in the passageways, stairs, toilets, showers and bathrooms. Specialised bathing and toilet equipment and lifting aids are available. All toilets, showers, bathrooms and bedrooms have lockable doors, which can be accessed from the outside, in case of an emergency. The home has been extended with furnishings and facilities to a high standard. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of the service is 2 star. This means the people who use this service experience good outcomes. One inspector undertook this unannounced inspection. The home provided us with an Annual Quality Assurance Assessment [AQAA], information from this was used to inform this report. We sent surveys to people that live in the home and their relatives. We also looked at information held by us such as notifications, complaints and our Annual Service Review. A site visit was made that totalled four and a half hours. During this time we looked at staff files, care records and policies an procedures. A tour of the premises was undertaken and we spoke with people that live in the home, their visitors and staff members. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Areas in which survey respondents thought the home could improve Changes in resident and sometime staff do cause some disruption from time to time but that reflects life anyway. [My relative] is generally very well looked after. Care Homes for Older People Page 7 of 26 Nothing other than maintain their high standard. Cannot think of anything. Maybe organise days out for those able to participate. Nothing that I can think of. 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 8 of 26 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 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are able to make informed choices about whether they want to live at Fairmount. An assessment of need is undertaken and the person is involved in this process. Contracts detail what is provided in the fee. Evidence: The homes AQAA stated that thorough and in depth pre-admission assessments are carried out on all new residents. If a person choses to live in the home, then they are able to have a months trial before making a decision whether to stay permanently. During our site visit we looked at the assessments of individuals. We found that the documents covered the persons abilities and indicated where they may need assistance. Areas such as mobility, communication and sleeping were included. One persons assessment showed that they were a light sleeper, [liked their] light on in [their] room at night. Care Homes for Older People Page 10 of 26 Evidence: Other aspects of need that were assessed included personal hygiene, behaviour, hobbies and interests. There was information on medication and an individuals past medical history. Risk assessments for falls and moving and handling were in place. Plans contained good details for example may need prompting at times with eating and drinking. All survey respondents stated that they had received sufficient information in order to make a choice about moving into the home. All had contracts that detailed terms and conditions. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their assessed needs will be planned for. Care plans indicate how the person wants to be treated and this is evidenced by the daily records. Medications are handled and administered safely, protecting people from harm. People are treated with respect and their privacy and dignity is maintained. Evidence: During our site visit we looked at care plans. We found that these documents lead from the assessment of need. Each plan had a photograph of the person and details of their next of kin. Spiritual, social and occupational interests had been noted, but there was limited information on sexuality. For example one plan detailed that the individual like knitting, watching television and going out in the care, but the section on sexuality stated it was non applicable. Staff should make sure that all aspects of a persons needs are addressed within the care plan. There were records of visits by other health professionals, such as the general Care Homes for Older People Page 12 of 26 Evidence: practitioner and chiropodist. each person had a record of their body weight and no issues were found regarding weight loss. Family and friends had provided information on peoples life history when needed. Each person had had a Deprivation of Liberty and Mental Capacity assessment on file. This showed whether they were able to make informed choices and recorded if there were restrictions on their activities to safe guard the individual. No one was subject to Deprivation of Liberty at the time of the site visit. Each person or their representative had signed to indicate that they had been involved in the care planning process. Plans contained good detail of how needs should be met. We found that care had been taken with the language used to protect a persons dignity. For example, sometimes needs prompting. Keyworkers undertake one to one sessions with an individual to review their plan. One person had recorded loves [their] bath and talk[ed] about hobbies. Another example was [The person] was telling me about her family life how [they] looked after [their] mother and father. This demonstrated to us that people are at the centre of the care given to them. We found that plans had been reviewed regularly and amended if needed. Daily records generally recorded how need had been met. However, staff should make sure that if painkillers are given, then the effectiveness of the medication should be recorded. The AQAA states A robust medication policy is in place and all staff are fully aware of the contents. Some residents self medicate, this is individually reviewed monthly and is covered by the medication policy. We observed a medication round and saw that medicines were handled and administered safely. The medications were stored properly and records kept, this evidenced an audit trail into and out of the home. Surveys we received stated that they were satisfied with the care given. One comment was I have always found the staff to be courteous, helpful and friendly. They also have time to listen and to talk with the people in their care. The home said in its AQAA that they wish to improve the way in which we record residents choice in care plans - we have become more determined to organise choice of End of Life, which has in the past been a difficult subject and sometimes avoided by Care Homes for Older People Page 13 of 26 Evidence: relatives when asked. Dignity is maintained for dying residents and all physical, mental and spiritual needs and rites are provided by the staff and relevant professionals. The families are kept fully informed and any wishes they or the resident has are complied with. Pain relief is planned by the GP and District Nurses and any alterations are swiftly implemented by the staff. This work on providing end of life care is in progress and monitored routinely by the home. All survey respondents indicated that they received care and support when needed and medical attention. Care Homes for Older People Page 14 of 26 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. People who live in Fairmount are able to continue with their hobbies and interests. The home has an activities programme which reflects individual choice. A persons privacy and dignity is protected and staff treat individuals with respect. Mealtimes are a social occasion and there is a choice of food and drink available. Evidence: Fairmount states in its AQAA, as follows We have increased the number of external outings available to residents. We now have an activity officer 5 days a week. We have installed a Polytunnell in our garden so residents can with the help of our Gardener enjoy pottering in a more comfortable environment for most of the year. Expand the range of activities available to residents. We are intending to create a shop in the grounds so residents are able to go shopping for personal items and gifts. We are planning to introduce life stories for all residents. This has not happened this year but we will try and implement this in the next financial year. Some people commented on surveys that they would like more outings into the community which may or may not involved family members. However, the majority of respondents were satisfied with activities provided. Comments included I am impressed by the number and variety of activities available. Fairmount always looks Care Homes for Older People Page 15 of 26 Evidence: welcoming, clean and is a very pleasant environment with lovely gardens. During our site visit we saw a group of people participating in a reminiscence session. They were discussing characteristics they had inherited from their fathers. Some other people were listening to music in one of the three lounges. In the garden lounge individuals were sitting with their visitors enjoying tea and cakes. The manager told us that they engage outside entertainers and recently the people that live in the home enjoyed a performance of 1950s and 1960s music. The manager said this was very popular and she plans to ask the entertainer back again for another show. There are plans for a garden party at the end of September 2009 with music. People are able to continue to practise their spiritual or religious beliefs if they chose. Evidence in the care plans shows that support is given to attend services. We observed supper during the site visit. Individuals had particular places that they liked to sit for their meal. the atmosphere was relaxed and unhurried. There were choices for the main meal and dessert. Condiments and beverages were available. Staff members interacted well with people and showed they were knowledgeable about likes and dislikes. Assistance was given with eating when needed in a discreet manner. All staff were noted to speak calmly and kindly to the people that live at Fairmount. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to access a clear complaints procedures. All complaints or concerns are recorded and action taken if needed. People are protected from harm by the Safeguarding arrangements in place. Evidence: We when did an Annual Service Review earlier this year we were concerned as we had received two anonymous complaints relating to not respecting a persons dignity, standards of hygiene being poor and lack of care over individuals dress. The laundry was inspected during the site visit and found to be well organised. People we saw in the home were well presented and looked clean. We did not find any evidence of people being treated disrespectfully. The AQAA states that A clear complaints procedure is displayed, any complaints are responded to promptly. If necessary residents are encouraged to use the services of an advocate. Survey respondents indicated that they knew how to raise a complaint or concern either formally or informally. The home reported that staff have received training in Safeguarding Adults and are able to access up to date policies and procedures. There have been no safeguarding investigations in relation to Fairmount since the previous inspection. Care Homes for Older People Page 17 of 26 Evidence: Fairmount does not manage any persons finances as stated in its AQAA The home does not hold any money for residents, services that are chargeable (newspapers, hairdressing etc) are paid for by the home and re-charged quarterly. Care Homes for Older People Page 18 of 26 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. Popele live in a home that is celan and tidy. They have access to suitable private and communal areas. Individuals are able to bring in significant personal possessions for their rooms. Evidence: Fairmount considers that The home is maintained to an extremely high standard with the best available equipment, fixtures and fittings being used. It is always clean with no persistent smells, furniture and fabrics are replaced when necessary and there is a clear commitment to maintaining and improving standards wherever possible. All rooms are now fully ensuite. We looked around the home during our site visit. All areas were clean and tidy and there were no unpleasant odours. People had been able to personalise their rooms and bring in their own possessions. Survey respondents considered that the home is always fresh and clean. The garden is accessible and there are doors from the garden lounge to enable people to use the area easily. Benches are provided for individuals to sit on and there are a variety of plants to see. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Fairmount are supported by trained and competent staff. Employees undergo a clear recruitment procedure prior to commencing work. All necessary checks are carries out to make sure that individuals are fit to work in the home. Evidence: We looked at staff files during our site visit. Information contained in the files consisted of staff recruitment, staff training and supervision. Staff files were selected at random. Generally they contained all the information needed by the Standards. There was an application form, Criminal Records Bureau checks, proof of identity and permission to work. Potential employees had been asked about any previous cautions or convictions. There was a record of the persons full employment history. One file did not have a job description or photograph in it, we were told that this would be rectified. Each person is given a contract and a copy is kept in their file. Records of supervision Care Homes for Older People Page 20 of 26 Evidence: and training were current and maintained. Fairmount states in its AQAA that One area identified for improvement is implementing staff training given. The home offers all mandatory training and has accessed dementia care training for staff. As a result of a requirement at the key inspection in 2007, the number of staff available on nights has been increased to three. Survey respondents all agreed that staff were Always quick to respond and available when needed. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in their best interests. Their views are actively sought and listened to. The buildings provide a safe environment in which to live. Evidence: During our site visit the manager said that the residents guide how the home is run. The manager considers that she is open and approachable to staff. People we spoke with during the site visit confirmed this. Visitors and people that live at Fairmount said they were asked for their views and thought that these views were listened to and acted upon. We did not find any issues relating to health and safety during the site visit. All areas of the home were safe and maintained. The AQAA indicated that there are appropriate procedures in place for monitoring and checking health and safety. For example staff have received fire training and routine checks of the premises are carried out and recorded. Care Homes for Older People Page 22 of 26 Evidence: The home continues to undertake an Annual Quality Assurance survey. Information is collated from this and made available. The home then incorporates any suggestions into its improvement plan to action. Survey respondents considered that they were involved in the running of the home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 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 1 2 7 9 Staff should be provided with training on sexuality and how this can be addressed sensitively. Staff should make sure that when painkillers are given their effectiveness is recorded. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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