Care Home: Fairview Court

Similar services:

• Fairfields Country Rest Home
• Fairfax House
• Claremont Nursing Home
• Doveridge Care Home
• Dunmore
• Chatsworth
• Dunraven Lodge
• Eastleigh Care Homes, South Molton

What the care home does well The manager stated in the Annual Quality Assurance Assessment that all potential residents are assessed at their home or in hospital before admission to the home and in some cases new equipment is purchased to ensure that the home is able to meet their need. Care plans are comprehensive and are kept up to date at least every month. All new residents are assessed by the home`s Social Therapist for likes and dislikes, their cognitive awareness and previous hobbies. The information obtained in this way would be used to plan activities suitable for this individual. Individuals living at the home are encouraged to bring in the personal items to make their rooms a more homely environment. Staff receive appropriate training to ensure that they are able to meet the needs of the service users. The home has a robust complaint procedure to ensure that people are listened to and that complaints are looked at and responded to appropriately.Generally the home was found warm, clean, tidy and free from offensive odour. Individuals living in the home were found relaxed in their homely environment and looked well cared for. The home follows robust recruitment practices to ensure that appropriate staff are employed at the home. What has improved since the last inspection? There is an ongoing redecoration of the building to provide the service users with a homely and more comfortable environment. The home has provided raised flowerbeds in the garden for residents to work in. The home has purchased a new dishwasher in the kitchen to enhance the principles of infection control. A new bath has been installed to enhance the residents` personal care. It was pleasing to note that the home has made efforts to ensure that the requirements made at the last inspection were met. Some recommendations about medicines made in the last inspection have been followed. A homely remedy policy for treating minor ailments has been agreed with the doctor. A medication policy specific to Fairview Court is now available to provide guidance for staff about safe handling of medicines in the home. Copies of the patient information leaflets for the medicines used in the home are obtained from the pharmacy. These provide useful information about the safe use of medicines for both residents and staff. What the care home could do better: To ensure that care needs of identified individuals are met it would be better to provide appropriate care plans for identified service users` needs. Whilst touring the building we noted that two individuals had long nails digging into their palms that could cause potential injury to the individuals concerned. We have issued a requirement for these identified individuals` personal care plan to be reviewed to meet this need. We have received information from the home that above concerns have been remedied. The requirement has been withdrawn. In addition it could be better if two individuals with incontinence were regularly monitored to reduce unpleasant odour and uphold their dignity and respect.Residents would be better protected if identified staff receive training update on manual handling and appropriate equipment is provided for handling this person in order to prevent injury. We have received information from the home that the above requirements have been met. To enable us to determine how the people living in the home are being treated and how staff felt about their roles and responsibilities, we started this visit at seven o`clock in the morning. At this visit we spoke to night staff and residents we met in the lounges. We also spoke to day staff and relatives. Comments we received from these sources led us to believe that the home should review the staffing notice to ensure that residents` needs are appropriately met. The Group manager reassured us that the organisation has considered employing a second registered nurse on the first floor to enhance the staffing level on both first and second floors. We are satisfied with this arrangement and would be monitoring the staffing level and issue a requirement as necessary. Whilst we noted that the kitchen was clean we recommend that a periodic deep cleaning of the kitchen to provide added protection to the residents staff and visitors. If a medicine has a variable dose, the amount given must be recorded. If regular medicines are not given a reason must be recorded. To make sure that medicines are given safely: -Information about crushing medicines before giving them must be up to date and supported by the person`s care plan. -Guidance must be available for staff about the use of "When required" medicines. It is recommended that action be taken to make sure that rarely used medicines can be audited so that staff can check that they have been given correctly. CARE HOMES FOR OLDER PEOPLE Fairview Court 42 Hill Street Kingswood South Glos BS15 4ES Lead Inspector Grace Agu Key Unannounced Inspection 20th & 22nd May 2008 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairview Court Address 42 Hill Street Kingswood South Glos BS15 4ES 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) 0117 935 3800 sheenahelyer@btconnect.com Linksmax Ltd Mrs Sheena McNeil Helyer Care Home 49 Category(ies) of Dementia - over 65 years of age (49) registration, with number of places Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 34 Persons over the age of 65 with dementia requiring nursing care May accommodate up to 15 persons over the age of 65 with dementia requiring personal care 14th March 2007 Date of last inspection Brief Description of the Service: Condition of registration: The Home will care for people with Dementia aged over 65 years. The Home is registered to accommodate up to forty-nine four older people with dementia. Each of the single bedrooms has a wash hand basin and en-suite facility. The property is arranged over three floors with shared space on each floor. There is a central courtyard, which is pleasantly laid out with flower and plant containers and exterior furnishings. In addition to the courtyard, the home has a large and attractive garden with suitable garden furniture and shelter from the sun. The Home is close to shops, amenities and bus routes. The philosophy of the home is to ensure that all the service users have enjoyable lives and make the most of their potential while they are at Fairview Court. The home has competent registered and care staff to ensure that needs of people living at the home is met. Fairview Court provides 24-hour service. The fees that are charged for staying at the Home are around £550 a week. There are extra charges for chiropodist, and hairdresser services. Fairview Court DS0000067811.V360995.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 was an unannounced visit that was undertaken by two inspectors over two days to review medication and other requirements made at the last key visit and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The pharmacy inspector reviewed the home’s medication and her report can be found in the body of the report under Standard 9. The visit also followed up complaints raised by a concerned person regarding an individual living at the home. We met with the manager Sheena Helyer and the Group Manager, Gill Evans. A tour of the building was undertaken and a number of records were viewed. Thirty-five service users, thirteen staff members and six relatives were spoken with on the day. What the service does well: The manager stated in the Annual Quality Assurance Assessment that all potential residents are assessed at their home or in hospital before admission to the home and in some cases new equipment is purchased to ensure that the home is able to meet their need. Care plans are comprehensive and are kept up to date at least every month. All new residents are assessed by the home’s Social Therapist for likes and dislikes, their cognitive awareness and previous hobbies. The information obtained in this way would be used to plan activities suitable for this individual. Individuals living at the home are encouraged to bring in the personal items to make their rooms a more homely environment. Staff receive appropriate training to ensure that they are able to meet the needs of the service users. The home has a robust complaint procedure to ensure that people are listened to and that complaints are looked at and responded to appropriately. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 6 Generally the home was found warm, clean, tidy and free from offensive odour. Individuals living in the home were found relaxed in their homely environment and looked well cared for. The home follows robust recruitment practices to ensure that appropriate staff are employed at the home. What has improved since the last inspection? What they could do better: To ensure that care needs of identified individuals are met it would be better to provide appropriate care plans for identified service users’ needs. Whilst touring the building we noted that two individuals had long nails digging into their palms that could cause potential injury to the individuals concerned. We have issued a requirement for these identified individuals’ personal care plan to be reviewed to meet this need. We have received information from the home that above concerns have been remedied. The requirement has been withdrawn. In addition it could be better if two individuals with incontinence were regularly monitored to reduce unpleasant odour and uphold their dignity and respect. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 7 Residents would be better protected if identified staff receive training update on manual handling and appropriate equipment is provided for handling this person in order to prevent injury. We have received information from the home that the above requirements have been met. To enable us to determine how the people living in the home are being treated and how staff felt about their roles and responsibilities, we started this visit at seven o’clock in the morning. At this visit we spoke to night staff and residents we met in the lounges. We also spoke to day staff and relatives. Comments we received from these sources led us to believe that the home should review the staffing notice to ensure that residents’ needs are appropriately met. The Group manager reassured us that the organisation has considered employing a second registered nurse on the first floor to enhance the staffing level on both first and second floors. We are satisfied with this arrangement and would be monitoring the staffing level and issue a requirement as necessary. Whilst we noted that the kitchen was clean we recommend that a periodic deep cleaning of the kitchen to provide added protection to the residents staff and visitors. If a medicine has a variable dose, the amount given must be recorded. If regular medicines are not given a reason must be recorded. To make sure that medicines are given safely: -Information about crushing medicines before giving them must be up to date and supported by the person’s care plan. -Guidance must be available for staff about the use of When required medicines. It is recommended that action be taken to make sure that rarely used medicines can be audited so that staff can check that they have been given correctly. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12345 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users needs are assessed on admission and they are informed of the homes ability to meet their needs. EVIDENCE: The Home’s Statement of Purpose and Service User’s Guide remains in place and provides information to prospective residents in relation to services provided to enable them to make a decision about the Home. The manager stated that both documents are to be reviewed. We expect the updated copies to be forwarded to the Commission. Inspection of the care record of one recent admission to the home showed that there was a Care Management assessment from the social services which was given to the home on contact to enable the home to deternime it’s ability to meet the residents needs. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 10 The relatives of the individual met on the day confirmed that the manager, before admission to the home, assessed the person in hospital. The manager usually confirms in writing the ability of the home to meet the assessed needs to the resident or their representative. Another relative stated at a conversation that their person was assessed before admission to the home; they were offered a trial visit and also given a contract detailing the fees to be paid and what service users can expect from the home. Staff demonstrated that they had a good understanding of the needs of the older people. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers care and support to residents by reviewing their health, personal and social care needs; their right to be treated with respect and privacy is upheld. However, some action is needed to ensure that aspecific care plan is in place for an identified resident’s need. Medicines are looked after safely in the home. Improvements in the information available to staff about some medicines could further protect resident’s health. EVIDENCE: At this visit ten care files was reviewed. Each care file evidenced that pre admission assessment took place before the residents were admitted to enable the home to determine its suitability to meet the individuals’ needs. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 12 The home’s capacity to meet the assessed needs of the residents relies on the skills of the staff and their relevant and effective training. It was evident from discussions and the training records that relevant training is undertaken and that care plans are developed to ensure that the service users needs are met. Examples of training are First Aid and Food Hygiene. Medication Administration Protection of Vulnerable Adults from Abuse, Diabetes Care and specialist (Peg Feeding procedures). The home also has a responsibility to provide the appropriate facilities and aids to support residents’ independence. There was information in relation to risk assessment, manual handling, and wound-care assessment and pressure sore prevention using the ‘Waterlow’ Score also nutritional needs assessments. All of the above were regularly reviewed and updated in line with change in need. There was a daily record maintained for each service user whose records were seen. The records detailed the service users’ daily health and welfare. Evidence of wishes in the event of death was noted in the care files viewed. Staff spoken with were aware of the importance of ensuring that all information about residents is to be kept confidential. Staff were also aware of the relevant policies and procedures and where to access them if required. However, whilst there was evidence of different care plans in place to meet a resident’s various needs, and there was regular doctors visits, there was no care plan to enable the staff to support an identified individual with a specific way of communication as identified at the social service review on 15/02/07. This was discussed with the manager and a requirement was made for this to be put in place. One care file of a resident with a medical condition and some challenging behaviour was reviewed and discussed with the manager. It was noted that the home is monitoring the individual’s behaviour. The individual had regular visits from the General Practitioner (GP) and input from the Consultant to review the medication and other health professionals to support the home in order to meet the person’s need. The care file contained strategies developed by the home to be followed by staff to ensure that the resident’s need is met. The manager stated that these strategies had not been entirely successful, as the individual remains challenging at times. Residents spoken with stated that staff supported and treated them with dignity and respect. Staff were noted knocking at the doors and waiting for an Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 13 answer before going in to assist residents with personal care. One resident stated, “I get up when I want and go to bed when I want to.” However we noted whilst touring the building that two service users met in the dining area had unpleasant odours due to their medical condition. This we believe compromises their dignity. We discussed this with the manager and issued a requirement to ensure that they are adequately monitored to ensure that these persons were clean and comfortable at all times. We received information from the home after the visit that one of the individuals is reluctant to accept personal care and that this is documented in the care plan. Whilst we accept that some individuals may be reluctant to receive personal care, we believe that the home must ensure that appropriate strategies and monitoring are in place to support people in order to meet their specific needs. We also noted that one service user’s personal care in relation to regular hair wash was unsatisfactory. We observed that this person had very greasy hair and seemed unwashed for a period of time. Records indicated that the individual had a bath on 20/04/08. At a discussion with the manager we noted that there was a difference in the bath records on the unit and entry on the daily records in regards to bathing and hair wash on 20/05/08 May. We were led to believe that the individual had a bath however the entry stated ‘ washed and dressed’. The manager sent us information after the inspection that staff had noted that the individual had sever dandruff and it was reported to the doctor and medication had been prescribed to be used when the wound sustained during a recent fall was healed. The manager stated that a care plan has been put in place. We are satisfied with the action taken after the visit in regards to two individuals noted with long nails digging into their palms with a potential risk of injury. The pharmacist inspector looked at the handling of medication in Fairview Court. Medication is supplied by a local pharmacy using a monthly blister pack system. Someone from the pharmacy has recently visited the home and given advice to staff about the safe handing of medicines. The manager said that they are waiting for a report from this visit. This helps to make sure medicines are well looked after in the home. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 14 None of the people using this service are able to look after their own medicines so all medicines are looked after by staff. The home has a clear medicine policy to make sure that medicines are looked after safely. This includes a policy, approved by the doctor, for the use of homely remedies to treat minor ailments. Most of the people living in the home are registered with a local doctor who visits the home regularly. Staff said that the doctor and pharmacist had reviewed everyone’s medication six months ago. This helps to make sure that people are taking the correct medicines. Care plans showed that the doctor and other relevant health care professionals come and see residents in the home. Each floor of the home has safe and secure storage for medication. A medicine fridge is kept on the first floor; the temperature is recorded daily and is in the safe range for keeping medicines. Suitable storage for medicines needing extra security is also available. The pharmacy provides printed medicines administration record sheets each month for staff to complete as medicines are given. Handwritten additions by staff to the medicines administration record sheet when new medicines are prescribed had been signed, dated and checked by staff. This is good practice to reduce the risks of mistakes being made. We saw some medicines being given at lunchtime and the administration record was completed as the medicines were given. Records are kept of the receipt of medicines and the safe disposal of unwanted medicines. On the ground floor care staff give out the medication. Training has been provided for care staff involved with medication administration. The administration records had been completed, showing that medicines had been given as prescribed by the doctor. For some medicines prescribed with a variable dose it was not clear how much had been given and this must always be clear from the records. A requirement concerning this was made at a previous inspection. Some people are prescribed medicines to be given When required. Most had clear dosage instructions to make sure they are given appropriately. However for one person, prescribed two medicines to be used When required, we found that there was no information for staff about when the medicines should be used or the dose of medicine that should be given. Records showed that these medicines had not been given. Action is needed to make sure that clear guidance is available for staff about the use of When required medicines, especially if these are used to modify a person’s Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 15 behaviour. This is to make sure that these medicines are always used safely and appropriately. We also recommended that staff take some action to make sure that they can audit the stock of these medicines and check that they have been given correctly. Qualified nurses give the medication on both the first and second floors of the home. Several gaps in the administration chart for one person were seen although the medicines were missing from the blister pack. It was not clear whether these had been taken. If regular medicines are not given a reason must be noted on the medicines administration record sheet. Several people receiving nursing care have sheets, signed by the doctor, authorising listed medication to be crushed and/or disguised before it is given. In some cases the medicines prescribed had changed so the agreed list was not completely accurate. This could mean that staff crush medicines that have not been agreed as safe to crush. In other cases staff said the person could swallow their medicines without difficulty and the agreement to crush medicines was just in case they had a difficulty. This could mean that staff who do not know the residents well could crush or disguise their medicines unnecessarily. Action should be taken to make sure that information about how medicines are to be given are up to date and supported by the person’s care plan. This is to make sure medicines are always given in the safest and most appropriate way. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home enables residents to maintain contact with family and friends and local community. It also provides meaningful activities and choice in respect of meals and meal times. EVIDENCE: Evidence of discussion with residents, staff and entries in the visitors’ book showed that the Home actively supports the residents to maintain contact with families, friends and advocates. One service user spoken with told us that her family visits very regularly and that the Home would contact her family anytime she wanted them to. One relative spoken with on the day stated that there are no restrictions to time of visiting and that they visit their relative almost everyday. They are satisfied with the Home and the services provided, “staff are very welcoming, I cannot fault them. The home provides meaningful activities for the people living in the home. The manager told us in the Annual Quality Assurance Assessment that residents Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 17 are assessed on an individual basis to enable the home to plan activities tailored to individual residents. The activities organiser consults with the resident/relatives on admission to obtain information on the activities preferences and regularly undertakes reviews to ensure it is still appropriate. The families also complete a social history form to enable the activities coordinator to plann activities suited for the individual. Whilst walking round the building we observed that there were a group of service users participating in flower arranging activities in one of the lounges individuals that were able to engage in conversation told us that they were very happy and that they enjoyed what they were doing. One individual told the inspector that she enjoyed the company of other people living in the home and that the poem she learnt as a youngster has helped them to adapt to any situation or environment that she found herself in. The individual proudly stated, “ Life is too short to quarrel, heart too precious to break, shake hands, be brothers and friends for old time sake”. The manager stated that the home has employed a Social Therapist and two Activity Coordinators. All new residents are assessed by the homes Social Therapist for example likes and dislikes, their cognitive awareness and previous hobbies. The information obtained in this way would be used to plan activities suitable for this individual. The Social Therapist and the Activities Coordinators recently attended a study day on 26/03/08 in relation to activities for older people and are booked to undertake a longer course on Activities Planning. The course covers developing activities for individuals living in the home, Dementia and Reminiscence. Each section has duration of four days training leading to a national professional qualification. During a discussion, the activities organiser stated that there are “activities for everyone”. There is a list of monthly activities for special events, weekly planned activities that include outings and trips. The activities book contained lists of all the residents and activities they had participated in. This is to enable the home to monitor participation and to plan other ways to encourage those who are reluctant to participate in any activity. Activities recorded in each resident’s file include music entertainment, Holy Communion and flower arranging. There were also records of interaction on an individual basis with residents who prefer to be in their rooms or declined or were unable to attend to the general planned activities. In the Annual Quality Assurance Assessment the manager stated that the home has a wide range of equipment to suit a variety of tastes. For example, Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 18 Sensory equipment had been purchased for those who are highly dependent and have limited communication skills. The home has constructed raised flowerbeds to encourage residents who are able to participate in gardening activity. Residents are encouraged to join in household chores such as laying tables, peeling vegetables and dusting. One resident was observed dusting the doors on the ground floor on the day of this visit. The Social Therapist stated that there is an activities folder on each floor and an activities coordinator to ensure that everyone benefit from any activity on offer. To ensure that equality and diversity is promoted at the home there is a service of Christian Worship and a visit from the Catholic priest once a month for those who are interested in Christian faith. For those who are not interested in Christian activities they are offered one to one interaction or any other activity within their capability. The Social Therapist told us that she uses her training and experience to offer bible study and counselling to residents that requested for it. We were informed that a session took place on 6/06/08. There was evidence of personal possessions in the rooms viewed. One relative stated in the survey returned to us “This care home is light, fresh smelling and warm. The rooms are large and spacious with appropriate furniture and because pictures photos, plants and flowers are allowed to be placed around the rooms look personalised. The menu on the day contained a choice of two nutritional meals and a choice of pudding. One of the puddings tasted by the inspector was delicious. The meal was relaxed and residents were given the meals based on the choices they made after consultation on the meals available to them. Service users who were unable to feed themselves were given appropriate support; staff approached the residents in a sensitive manner and treated them with dignity and respect. All service users spoken with after lunch stated that they enjoyed their food. The kitchen was found clean and tidy. The chef stated that staff working in the kitchen have attended basic food hygiene training and Control of Substances Hazardous to Health (COSHH) Training. Some certificates were displayed in the kitchen area. There was a regular record of the fridge and freezer temperatures. The food in the fridge was noted to be labelled. The chef also stated that the home was inspected by the South Gloucestershire Council Environmental Services on 5/01/08 and was awarded Five Star rating Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 19 on food safety. It was agreed that periodic deep cleaning of the kitchen would be beneficial in order to maintain a cleaner environment. Laundry staff spoken with confirmed that they have attended COSHH Training and that two industrial machines and two industrial tumble dryers were available to provide better laundry services for the residents at the home. The laundry person also showed us the four special trolleys recently purchased to enable staff to deliver and collect laundry from the floors. The individual showed an in-depth knowledge of the role and responsibility and was passionate about ensuring that the home is free from any form of infection epidemic. The staff member stated, “You need to have a good rapport with residents to be a good carer or domestic. I am very passionate about making sure that the home has no outbreak of infections. I am one of the few people that were not affected the last time we had sickness here”. There are risk assessments of both laundry and kitchen. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are confident that their complaint will be listened to. Practices at the Home ensure protection of residents from harm and abuse. EVIDENCE: The Home has appropriate procedures in place for management of complaints. The complaints procedure was noted displayed at the entrance as well as in each resident’s care file. This document contains information about the Commission for Social Care Inspection to enable individuals to contact the Commission if they were not satisfied with the outcome of their complaint to the organisation. There were five recorded complaints since the last inspection. These complaints were in relation to care provided to individuals living at the home the way two individuals were transferred from the home and a service users agitation observed by a member of the public. Records indicate that the appropriate procedure was followed and that the complaints were satisfactorily responded to. The home is waiting to receive confirmation that the complainants are satisfied with the outcome of their complaints after investigation. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 21 Relatives responses noted on the comment card evidenced that people are aware of whom to complain to. One relative stated, “We have no reason to raise any concerns”. Staff are aware of the Whistle Blowing policy and would report any bad practices to the Manager without fear of reprisal. There is evidence of staff training in relation to Protection of Vulnerable Adults from Abuse. We noted a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidents of abuse occur. Records of recently employed staff members were viewed and contained personal information and record of identity. There was evidence of statutory information to include two satisfactory references, record of previous employment, and satisfactory Criminal Record Bureau disclosures to ensure that service users are adequately protected. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals living at the home enjoy a pleasant, safe and homely environment with a good standard of hygiene. EVIDENCE: The Home is registered to accommodate up to forty-nine older people with dementia. Each of the single bedrooms has a wash hand basin and en-suite facility. The property is arranged over three floors with shared space on each floor. There is a central courtyard, which is pleasantly laid out with flower and plant containers and exterior furnishings. The Home is close to shops, amenities and bus routes. Whilst touring the building, the units were found to be generally clean, warm, well lit and free from unpleasant odours and suitable for its stated purpose. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 23 Each unit is the size of a small community and has its own kitchenette, dining and living area. Residents sitting in the lounges, looked relaxed, well cared for and enjoying each other’s company. Some service users spoken with in the lounges stated that they felt safe at the home and that they have access to the garden. To ensure added security the home has installed a second key pad lock on the external front door Staff were noted well presented in uniform and wearing disposable aprons and gloves and more importantly washing their hands after attending to individual residents. This demonstrated that infection control and principles of hygiene are of paramount importance to the home. Laundry facilities have been discussed previously. The home’s maintenance book was viewed and was found up to date. The maintenance man was noted dealing with issues entered in the maintenance book on that day and previously. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The recruitment procedure of the Home is robust and offers protection to residents at the Home. Staffing levels need to improve following comments from staff members and relatives. EVIDENCE: There is a robust recruitment policy and procedure in place at the Home to ensure that only appropriate and well-qualified staff are recruited at the Home. Records of two recently appointed staff members contained required information to include CRB disclosures, two satisfactory references, record of previous employment and proof of identity. All staff have job descriptions in the files and staff spoken with demonstrated knowledge of their roles and responsibility in relation to meeting the needs of individuals living in the home. There is evidence of a detailed induction programme for all new staff to ensure that staff are competent before working independently with service users. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 25 Evidence from the staff-training file showed that twenty care staff have NVQ Level 2 certificates; fourteen care staff are working towards NVQ level 2 and ten care staff are undertaking NVQ level 3 with City of Bristol College and JHP training organisation. The unit manager on the ground floor is currently undertaking NVQ level 4 in Care Management. Other training courses attended by staff included supervision training for three senior carers, the house-keeper and the chef to enable them to supervise staff in their department. There was evidence of training on, dementia awareness using the Mulberry House approach including a teaching session on managing the behaviour from the In-Reach Team. Staff have also attended First Aid, Protection of Vulnerable Adults from abuse Manual Handling, Basic Food Hygiene and Infection Control updates. All staff have attended Fire Awareness training updates, night staff attend more frequently. The manager told us that four staff members also attended training on assessing nutrition in the elderly, PEG feeding training to enable senior cares to administer PEG feed. Senior carers on the ground floor have also attended Safe Handling of Medicines from City of Bath College. Registered Nurses have attended training on venepuncture, wound care update Male and Supra Pubic Catheterization update. The manager also stated and there is evidence of this that fifteen staff attend training delivered by theHuntington’s Disease nurse to support staff with caring for service users suffering from the illness living at the home. One feedback we received from a relative states “ I feel that the staff at the care home are capable, caring, friendly always polite, cheerful and sympathetic, polite people who understand the needs of all the service users. I commend them all and would never hesitate to recommend the home to future residents”. Another comment card states “ the full time staff have an excellent personal relationship with each of the residents and in my experience having witnessed it myself, I feel very reassured that my relative is very well looked after”. To enable us to determine if the staffing level is satisfactory with the level of dependency and the category of the service users at the home, this visit started at 0700. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 26 We met with the night staff and at a discussion most of the staff told us that the staff level on night shift could improve on the first and second floor due to the dependency of the service users on those floors. We also had discussion with the day staff, service users and relatives and the general comment was mostly of inadequate staffing levels. For example staff stated that they find it difficult to meet the service users needs at meal times especially at supper times due the number of service users that require assistance with feeding. Staff also told us that they are unable to spend quality time with the service users due to heavy workload and less staff. Some of the feedback we received from relatives in relation to staffing at Fairview Court includes “ Staff work to the best of their ability! But there are not enough carers to help those that really need help. The residents who are able to walk around and help themselves do not need the attention like others. Where food is concerned they are able to sit to the table and enjoy food of their choice. But when you have someone who is placed to the table in a wheelchair and cannot help themselves. I think a carer should be on hand to help not leave the meal in front and then returning it untouched what a waste! This is not a one off it happens all the time. No one can expect quality work and care unless there are enough carers for residents who are really in need”. We discussed our findings and comments with the manager and Group Manager and the Group manager stated that the organisation believes that the home has adequate numbers of staff to meet the needs of residents at the home however, it had decided to employ a second registered nurse to work on the middle floor to enhance the staffing level on first and second floors. The Commission is satisfied with this arrangement and would continue to monitor the situation and would issue a requirement as appropriate. In addition to the care staff, the Home also employs a social therapist two activities organisers, a part time administrator, chef, kitchen assistants domestic, laundry staff and a handyman. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home benefits from good leadership and management, its practices have offered protection to the health and safety of residents. EVIDENCE: An experienced and well-qualified home manager manages Fairview Court Nursing Home. The registered manager is a Registered General Nurse and has attended many training courses to enhance her knowledge and skills to enable her to provide quality care for the individuals living at the home. The manager has achieved National Vocational Qualification (NVQ) level 4 in management. The atmosphere at the Home on the day of inspection was positive and welcoming. Staff were noted interacting with residents in an informal and friendly manner. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 28 Staff said that they work as a team and that the Manager has good leadership qualities. These have enabled staff to provide quality care and to support the residents. One staff member stated that she gets on well with the manager and that the manager is very good and very approachable. Service users and relatives spoken with on the day of this visit commented positively and highly of the Manager’s ability to manage the Home. Three relatives comments cards received before the inspection contained evidence of satisfaction with the care to the people who use the service. One-comment card states “Home seems to be well organised. Staff all seem to be friendly and kind”. Another comment card stated “They try hard to keep everything clean, the staff are very friendly, I always find the manager Sheena very approachable”. Staff supervision was reviewed. Evidence from the records viewed showed that staff have received group supervision as well as individual supervision. Staff spoken with confirmed that they have received supervision and that they benefited from the exercise. However one trained staff member stated the it would be better if they received more individual supervision to afford them the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to residents’ care. There was evidence that the home ensures so far as is reasonably practicable. The health and safety of resident’s staff and visitors. The home has robust policies and procedures in relation to aspects of health and safety. Records relating to health and safety were clearly written and accessible to staff. There was evidence that the home takes the health and safety of residents, staff and visitors seriously whilst maximising residents’ independence. For example the home had completed a fire risk assessment. In response to the concerns raised by the Environmental Health Officer at the visit on 21/09/07 the manager stated that all the risk assessments requested at the visit had been put in place for example risk of legionella from showerheads. In regards to two recommendations made by the Environmental Health Officer, the manager stated and confirmed in writing that the installers of the gas appliances are satisfied that no carbon monoxide detection is necessary because there are safety cut out systems which stop the flow of gas when the extractor fans are not working. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 29 Also the kitchen ducting is cleaned regularly from below by the handy man. More extensive cleaning of this and the laundry ducting will be carried out every 2 years. The system is less than 2years old. The fire logbook is well maintained. Records showed that fire detection and alarms system were serviced, accidents were accurately recorded. There was evidence of health and safety checks to include water, food, fridge and freezer temperatures. The maintenace book was up to date. The home employs a maintenance person twice a week. All maintenance work is recorded including when the task is completed. The records of accidents to residents were clearly written and showed a high recorded number of accidents including serious injuries since the last inspection. The manager stated more attention is focused on review of risk assessments and care plans to minimise accidents to residents in line with change in need. In relation to Quality Assurance the manager stated at a discussion that the home has an open door policy and residents and their families take advantage of this to discuss any of their concerns at any time. Other methods used to monitor the quality of it’s sevices include relatives meetings the last meeting was on 7/05/08, staff meetings, review of the dependency levels on each unit, wound audit, monthly accident audit, statutory providers monthly visits (Regulation 26), Social Services reviews and the organisation’s questionaires to residents and their families for a fedback on the services provided at the home. The home has policies and procedures to include Protection of Vulnerable Adults from Abuse, Complaints, First Aid, Missing Persons, Medication, Whistle Blowing, Manual Handling and Infection Control. These have recently been updated. Other residents’ documented information was securely locked away. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Ensure that care plans are in place for one individual’s identified needs. Ensure that two individuals with incontinence were regularly monitored to reduce unpleasant odour and uphold their dignity and respect. To make sure that medicines are given safely: -Information about crushing medicines before giving them must be up to date and supported by the person’s care plan -Guidance must be available for staff about the use of When required medicines. If a medicine has a variable dose, the amount given must be recorded. If regular medicines are not given a reason must be recorded. Timescale for action 22/06/08 2 OP10 12 22/06/08 3 OP9 13.2 22/06/08 4 OP9 13.2 22/06/08 Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP26 Good Practice Recommendations It is recommended that action be taken to make sure that rarely used medicines can be audited so that staff can check that they have been given correctly It is recommended that the kitchen is periodically deep cleaned to ensure adequate protection of service users staff and visitors. Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fairview Court DS0000067811.V360995.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!