Care Home: Fairview

What the care home does well The home provides a specialised service for people with learning disabilities who also have mental health problems. People living at the home feel settled and have good relationships between themselves at the home. They speak positively about the support provided to them by staff. One resident who has since moved out of the home, advised "this place has given me so much self confidence and really taught me to stand up for myself". People living at the home attend a number of social groups and clubs and are encouraged to form networks outside of the home. They have the opportunity to go on holiday with others from the home every year.FairviewDS0000062524.V374949.R01.S.docVersion 5.2Admission and care planning processes are appropriate for the home. Care plans are in place for all residents and their progress in meeting goals set is reviewed regularly. They are encouraged to develop independence skills so that they can move on to more independent living settings. People living at the home are encouraged to be involved in all aspects of home life and a group of residents take pride in maintaining the home`s garden. The home is inspected at least monthly by a responsible individual on behalf of the provider organisation to ensure that it continues to meet a high measurable standard. What has improved since the last inspection? Appropriate repairs have been made to the hot water system within the home so that it is fully functioning across the home. Regular residents meetings are being held to ensure that the needs and views of people living at the home are taken into account regarding the way the home is run. There is greater inclusion of residents in the interviewing process for prospective staff members for the home. The home is commended for the physical and emotional support provided to a resident diagnosed with a terminal illness, who was able to remain at the home until they passed away, in line with their wishes. What the care home could do better: Key inspection report CARE HOME ADULTS 18-65 Fairview 33 Bridgend Road Enfield Middlesex EN1 4PD Lead Inspector Susan Shamash Unannounced Inspection 16th – 17th March 2009 01:30 Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 2 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 Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairview Address 33 Bridgend Road Enfield Middlesex EN1 4PD 019 9271 1693 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) Avon Lodge UK Ltd Needyanand Raya Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th April 2007 Brief Description of the Service: Fairview is a care home registered to provide care for ten adults, aged 18 to 65, who have a learning disability. A private provider owns the home. Fairview is situated in a large purpose built care home, which also houses a care home for older people. The two homes are separated by a fire door. There are ten single bedrooms, including one en suite room. The home is situated close to a busy road, Bullsmoor Lane in Enfield. The amenities of Enfield Town are a bus ride away. Weekly fees are £1000 - £1400 according to needs as of March 2009. Residents purchase their own toiletries, travel fares, hairdressing etc. and contribute towards holidays. CQC inspection reports are made available to residents in the dining area and they are informed when a new report has been received. Fairview DS0000062524.V374949.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection was a routine visit to the home in order to check on compliance with requirements made at the last inspection. The visit lasted approximately seven hours. The manager was available throughout the inspection, and I also had the opportunity to speak to two staff members during the visit. Two residents had moved out since the previous inspection, into more independent accommodation, and one new resident had moved into the home. Sadly one long time resident of the home had passed away since the last inspection visit, but was supported to remain within the home as their health deteriorated, in line with their expressed wishes. I met with four residents independently during the inspection, and observed routines and interactions within the home. A tour of the building was conducted, although some residents’ rooms could not be inspected in their absence, as their permission could not be obtained. Residents’ records, staff files and maintenance records for the home were also inspected. Information provided in the most recent Annual Quality Assurance Assessment for the home was also taken into account as part of this inspection. What the service does well: The home provides a specialised service for people with learning disabilities who also have mental health problems. People living at the home feel settled and have good relationships between themselves at the home. They speak positively about the support provided to them by staff. One resident who has since moved out of the home, advised “this place has given me so much self confidence and really taught me to stand up for myself”. People living at the home attend a number of social groups and clubs and are encouraged to form networks outside of the home. They have the opportunity to go on holiday with others from the home every year. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 6 Admission and care planning processes are appropriate for the home. Care plans are in place for all residents and their progress in meeting goals set is reviewed regularly. They are encouraged to develop independence skills so that they can move on to more independent living settings. People living at the home are encouraged to be involved in all aspects of home life and a group of residents take pride in maintaining the home’s garden. The home is inspected at least monthly by a responsible individual on behalf of the provider organisation to ensure that it continues to meet a high measurable standard. What has improved since the last inspection? What they could do better: There is room for improvement in storage facilities available for documents relating to people living at the home, in order to ensure their confidentiality. A small number of issues need to be addressed within the home environment for the safety and comfort of residents. The newest staff member must be provided with all relevant mandatory training without delay, and all staff must receive annual appraisals to ensure that they continue to develop their skills in line with best practice. An improvement needs to be made regarding the management of a resident’s finances, to ensure that they are protected from financial abuse as far as possible. Reports of monthly visits by the provider organisation need to be available within the home promptly so that any requirements can be met without delay. The fire risk assessment must be updated on a six-monthly basis. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 7 It is strongly recommended that care plans and other documents be made available in easy read – pictorial formats, in line with best practice, to be accessible to people living at the home. Other recommendations are made regarding medication recording, archiving records, procuring a computer/s, and further staff training. 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. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate system is in place to assess people’s needs and goals effectively and ensure that these can be met. EVIDENCE: Three people’s files were inspected and each included a detailed assessments of their needs. Residents spoken to advised that they were involved in the assessment process and that their needs were being met appropriately. One new resident had moved into the home since the last inspection, and I had the opportunity to speak with them during the visit. They confirmed that they had had the opportunity to visit the home for meals, overnight and weekend stays prior to moving into the home. This was also confirmed by staff spoken to, and inspection of their care file, which included detailed assessment information obtained prior to their moving into the home. The newest resident indicated that they had settled well and advised “I like it here – I don’t want to go anywhere else.” Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ needs and goals are assessed and responded to effectively ensuring that they are met according to their choices. Risks are recorded appropriately with strategies in place to ensure that people are protected as far as possible, whilst being encouraged to develop independence skills. There is room for improvement in confidentiality procedures in the place to protect the rights of staff and residents. EVIDENCE: Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 11 People living at the home that I spoke with advised that they remained free to come and go and make their own decisions with support from staff as needed. They also advised that regular residents meetings continue to be held, to discuss the way in which the home is run. I saw evidence of this in the form of meeting minutes. Staff noted that residents are encouraged to be involved in the food shopping for the home, and this was confirmed by residents spoken to. During the visit I observed residents coming and going from the home freely according to their choices, to carry out activities within the local community. Care plans included evidence of support provided to meet people’s goals as well as limitations placed on individual residents, where needed, following detailed risk assessments. Residents’ signatures evidenced that they had been consulted about the content of their care plans, and those that I spoke to confirmed that this was the case. These documents had been reviewed within the last six months as appropriate. Three care plans were inspected and were found to be satisfactory including regular reviews, records of some one-to-one sessions with residents and risk assessments clearly detailing control measures. However none of these are currently made available in pictorial or other more accessible formats for easier access to people living at the home. This should be given serious consideration in line with best practice. Since the previous key inspection two residents had moved out into more independent accommodation. Sadly one resident who had lived in the home for many years, passed away in the winter, following diagnosis of a terminal illness. I saw evidence that the home had updated care plans appropriately in order to manage this person’s changing needs as their health deteriorated, liaising with relevant medical practitioners including Macmillan nurses. The home is commended for enabling this person to remain within their own home over this difficult period, and for the sensitive support shown so that this person was able to spend their last days amongst their friends and family. Evidence was available that each person’s needs were being reviewed at lease six monthly, with social worker reviews being undertaken at least annually. A filing cabinet is used within the home’s dining room, for the storage of daily records including key working notes and other working documents relating to people living at the home. However I was concerned to learn that this cabinet is not lockable, and therefore does not fully protect the confidentiality of residents. The use of a ‘bath book’ for the home, appears to be a remnant from a more institutionalised regime. If such a record is deemed to be necessary, records Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 12 of people’s baths/showers should be recorded on separate sheets for each individual, to protect each person’s confidentiality. Staff advised that the office is not always kept locked when not in use, however discussion with management indicated that there are insufficient lockable filing cabinets for the storage of all documents relating to service users. This situation must be addressed, to ensure confidential storage of all documents relating to residents as far as possible. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17 People using the 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 have varied lifestyles with access to meaningful activities both in the community and at home and are supported to maintain links with their friends and families. They are encouraged to take responsibility for the running of the home and to develop independent living skills, and their dietary needs are catered for with a varied selection of food. EVIDENCE: Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 14 Staff and residents that I spoke to confirmed that people are encouraged to go out and follow their individual interests. Most go out independently, and are involved in activities including various clubs in Enfield, Edmonton and Palmers Green, playing pool, going to the cinema, shopping and meeting friends. Several residents are involved in planting and tending to vegetables and flowers in the garden and keeping it tidy. Two residents attend college courses and various social activities within the local community. Residents have recently started playing badminton at a local sports centre, and continue to visit the local library, and local shopping areas independently. They also confirmed that they are supported to maintain contact with their relatives and attend places of worship of their choosing if they so wish. Residents also remain in contact with some people who previously lived at the home, and staff advised that some of them come to visit from time to time. The most recently admitted resident requires support to go out, but advised “I go out when I want to” and indicated that they went to places of interest to them such as garden centres. Residents usually go on an annual holiday with the home, and the manager advised that he was looking into the possibility of a holiday abroad for residents this year. However there was some delay due to the need to obtain passports for several residents. It remains recommended that books specifically written for adults with learning disabilities should be sourced, and that advocacy groups should be contacted to further support the rights of people living in the home. Residents spoken to said that the food provision in the home was generally good. Residents were seen helping themselves to foods from the kitchen. Stocks of food available to residents in the home included some fresh fruit and vegetables with some foods reflecting cultural diversity as reflected in the menus. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the 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 receive appropriate physical and emotional support in accordance with their needs and choices. Appropriate medication procedures are in place to protect residents from harm. EVIDENCE: People living at the home advised that they were able to choose when to go to bed, get up, take meals etc. Records indicated that the home seeks specialist support from external agencies where needed, to meet peoples’ needs. The home is commended for the support given to a resident who was diagnosed with a terminal illness, and was enabled to live at the home until the end of their life, in accordance with their expressed wishes. Records showed close work in partnerships with relevant medical professionals including Macmillan nurses, and sensitive involvement of this person’s family members. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 16 Appropriate records were in place to evidence that each resident was prompted and supported to attend routine health care appointments including dentist, chiropodist and optician appointments. Medication procedures were also found to be satisfactory, with appropriate records of medicines brought into the home and disposed of, and no gaps found in the medication administration records. No residents were selfmedicating. Written guidelines were in place for prescribed PRN (as and when) medications, and when these medicines should be administered. An alternative refrigerator is available for medication that requires refrigeration, however there was no such medication prescribed for any residents at the time of the inspection. The local pharmacy continues to carry out periodic inspections of the home’s medication arrangements and I was able to view the most recent pharmacy report. It is recommended that medicines carried forward from previous months should be recorded on the medication administration records (MAR sheets) and that the medication profile for each person should be brought up to date. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure to ensure that the concerns of residents are acted upon effectively. Procedures and appropriate training are in place to ensure the protection of residents from abuse. EVIDENCE: The home had appropriate procedures for investigating complaints and addressing adult protection and whistle blowing. No new complaints, disclosures or allegations had been received since the previous inspection. All but the newest member of staff had current Safeguarding Adults training, with certificates within staff files to evidence this. The home has a copy of the local authority’s Safeguarding Adults policy in addition to its own policies and procedures in this area. All but this staff member had also been provided with external training in the management of challenging behaviour and an appropriate policy was in place on managing challenging behaviour. Staff members confirmed that they had undertaken this training and found it useful. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant improvements had been made to the environment over the last few inspections, which has led to an improvement in the quality of life for people living at the home. There is a sufficient standard of cleanliness and provision of hand-washing and drying facilities throughout the home to ensure appropriate hygiene for people living at the home. EVIDENCE: Ten single bedrooms are provided in the home, along with five toilets, three bathrooms, an en suite shower room and adequate communal space. Over the last few years, the kitchen had been refurbished with new cupboards and working tops presenting more space and providing a less institutional feel. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 19 New curtains and lampshades had been provided in residents’ rooms according to their preferences. New dining room chairs and tables had been provided, and the lounge had been refurbished, including provision of a new pool table. Staff and residents spoken to confirmed that all equipment was in good working order, and residents advised that they were happy with the décor and furnishings in their bedrooms, and communal areas of the home. On the day of the current inspection visit, the cleanliness within the home was found to be of a satisfactory standard. There had been no recent problems with security experienced by people living at the home from young people in the neighbourhood following advice sought from the local police. Staff and residents confirmed that problems with hot water in some parts of the home as noted at the time of the previous inspection had been rectified. Following observation of the home’s records, and discussion with management, staff and residents, it is recommended that a computer/computers with internet access be provided within the office for the use of staff and management in recording care plans and other documents for the home. A computer would be invaluable in enabling care plans and other documents to be made more user friendly including photographs and pictorial formats, in order to develop ‘person centred’ plans. Computer access would also be valuable for the learning and development of people living at the home. At the time of the inspection a number of items (mostly furnishings to be discarded) were temporarily stored under the stairwell of the home. These should be disposed of without delay, as they present a fire risk. Discussion with the manager indicated that there were plans to replace/reupholster the home’s sofas, the carpet on the stairways and to replace the home’s payphone (which was out of order at the time of the visit). A schedule should be provided for these improvements, to ensure that they are prioritised appropriately for the comfort of people living at the home. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A key group of experienced staff members support people living at the home. Recruitment procedures are appropriate to safeguard residents. Staff members are generally well trained to ensure that the needs of residents at the home are met. However insufficient training provided to one staff member may place residents at risk. EVIDENCE: One new staff had commenced employment at the home since the previous inspection. Staff files for four staff employed at the home, including the most recently recruited staff member, were inspected. They were found to include the necessary documentation as required under the Care Homes Regulations 2001 Schedule 4 as appropriate. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 21 Two staff members were spoken to, and appeared to be knowledgeable about their role and responsibilities at the home and cultural needs of residents accommodated. They advised that they were receiving sufficient support and supervision from management at the home. Records indicated that regular supervision sessions are occurring between management and staff members. However no staff members had had appraisals within the last year and this is required. Residents spoken to advised that staff working in the home continue to be supportive and meet their needs appropriately whilst encouraging them to be as independent as possible. As required, induction records were available for all staff members. The manager advised that there was greater involvement of residents in interviewing prospective staff members, and this was confirmed by staff and residents spoken to. Inspection of staff training certificates indicated that all but the newest staff member had undertaken training in safeguarding adults, addressing challenging behaviour, first aid, food hygiene, fire safety, medication administration, epilepsy awareness, health and safety, autism and infection control. However I was concerned to learn that the newest staff member had not yet undertaken any mandatory staff training despite being in post for approximately nine months, and despite being involved in supporting residents out in the community, and being involved in food preparation within the home. It remains recommended that informal training be provided to the staff team in working with residents who have mental health problems. As required previously, more than fifty percent of the staff team had an appropriate NVQ level 2 qualification or above. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run with a suitably qualified and experienced manager in place at the home. There is consultation with staff and residents regarding the way in which the home is run to ensure that high standards are maintained. Residents’ health and safety is protected appropriately. EVIDENCE: Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 23 The registered manager has been in post for many years, and I was satisfied that the home is generally managed effectively and competently with the best interest of residents in mind. Staff and residents spoken to advised that they were consulted with regard to their views about the home at regular meetings. Records of residents and staff meetings also confirmed their consultation about the way the home is run. The area manager conducts monthly visits to the home as required under the Care Homes Regulations 2001. However although staff confirmed that these were happening, I was concerned to note that the most up to date reports were not yet available within the home. The most recent report available related to a visit undertaken in December 2008. The Annual Quality Assurance Assessment had been completed for the home as appropriate, indicating that the home is proactive in identifying areas for improvement in the provision of support to residents. The provider organisation also continues to conduct quality assurance audits. Monies stored on behalf of two residents for safekeeping was inspected and records were found to be accurate and up to date as appropriate. However I was concerned to learn that the manager had access to the pin number for a resident’s bank/building society card, which was kept for safekeeping within the home. This presents a risk of financial abuse to the resident, and this practice must therefore cease without delay. Discussion with the manager took place regarding other ways that this resident could access their monies if they were unable to remember (and keep secret) the security pin number. The home’s policy regarding supporting service users with their finances should also be updated accordingly. At previous inspections access to current records maintained in the manager’s office was hindered by the presence of many years worth of records for each resident. It was therefore required that outdated information be archived. Although some material had been archived, I noted that there remains a great deal more information that can be archived. There were appropriate records of fire extinguisher and fire alarm servicing, fire alarm testing and drills at the home. Up to date insurance, gas and electrical wiring and portable appliances testing safety certificates were available. Current risk assessments were available for the home as appropriate including a fire risk assessment. However this had not been updated within the last six months. Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X 2 3 X Version 5.2 Page 25 Fairview DS0000062524.V374949.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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 YA10 Regulation 12(4) Requirement The registered persons must ensure that a lockable filing cabinet is provided for storage of key working notes and other working documents pertaining to people living at the home that are kept downstairs in the home. Records of people’s baths/showers should be recorded on separate sheets for each individual, and The office must either be kept locked when not in use, or lockable filing cabinets must be provided for the storage of all documents relating to service users in order to protect their confidentiality as far as possible. The registered persons must 15/05/09 ensure that items temporarily stored under the stairwell are disposed of, as they may present a fire risk. A schedule should be prepared for the replacement or reupholstering of the home’s sofas, replacement of the carpet Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 26 Timescale for action 15/05/09 2. YA24 23(2) 3. YA35 18(1ci) 4. YA36 18(2) 5. YA39 26 6. YA41 17(2) Sched 4(9) on the stairways and repair or replacement of the home’s payphone, for the comfort of people living at the home. The registered persons must ensure that the most recently recruited staff member undertakes all mandatory and other relevant training without delay, to ensure that people’s needs are met safely and in line with best practice. The registered persons must ensure that all staff members are provided with an annual appraisal for their personal development, and to ensure that they continue to improve their practice in addressing people’s needs effectively. The registered persons must ensure that reports of monthly unannounced visits to the home on behalf of the provider organisation are provided to the home without delay, so that action can be taken to address shortfalls, to ensure that a high standard of quality control is in place in meeting people’s needs. The registered persons must ensure that no staff member or manager has access to the pin number for any resident’s bank/building society card, including those held for safekeeping within the home, to ensure that people are protected from financial abuse as far as possible. The home’s policy regarding supporting service users with their finances should also be updated accordingly. The registered persons must ensure that the fire risk assessment for the home is DS0000062524.V374949.R01.S.doc 10/07/09 12/06/09 15/05/09 15/05/09 7. YA42 23(4) 15/05/09 Fairview Version 5.2 Page 27 reviewed at least six-monthly for the safety of people living and working at the home. 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. Refer to Standard YA12 Good Practice Recommendations It remains recommended that books specifically written for adults with learning disabilities should be sourced, and that advocacy groups should be contacted to further support the rights of people living in the home. It is recommended that medicines carried forward from previous months should be recorded on the medication administration records (MAR sheets) and that the medication profile for each person should be brought up to date. It is recommended that a computer/computers with internet access be provided within the office for the use of staff and management in recording care plans and other documents in pictorial and other ‘user-friendly’ formats, for accessing relevant professional websites, and for the learning and development of people living at the home. It remains recommended that informal training be provided to the staff team in working with people who have mental health problems. Staff training should also be updated to include the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. It remains recommended that further outdated information maintained on residents’ files should be archived, so that important information can be easily accessed. 2. YA20 3. YA24 4. YA35 5. YA41 Fairview DS0000062524.V374949.R01.S.doc Version 5.2 Page 28 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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). 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