Care Home: Fairview House

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What the care home does well People are generally happy with the service offered at Fairview House. Positive comments were received such as, “Fairview is a lovely home. The managers Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 and care staff are polite helpful and courteous,” and “I am very happy here and everything is fine.” People said that they liked the food provided and were offered choices about what they ate. People are able to welcome their visitors at any time, and there are regular opportunities for families to enjoy time together at events put on by the home. Staff have a kind and caring approach to residents. The home has a friendly atmosphere and staff and residents get on well together. What has improved since the last inspection? A new permanent manager has recently been appointed. They will hopefully continue to make improvements at Fairview House. Since the previous inspection redecoration and refurbishment has continued. This means that people are living in a home where the environment is gradually improving and they have better facilities. Equipment to help people in their daily lives such as recliner chairs, hoists, and specialist beds have been provided. Opportunities for activities are more varied as more activity equipment and games are available. A minibus is now also available for the home use so that people are able to have occasional trips out. Although staffing has been an issue at the home with a high turnover and a high level of agency staff used at one stage; things now seem to have settled down. People are benefiting from having permanent staff to care for them. Staff training has been ongoing to ensure that staff have a good level of core skills and care for people in a safe way. When staff start work at the home they now have a better induction. This will help them to understand the job and develop good skills from the start of their employment. Other systems and procedures such as medication rounds, and when people return from a stay in hospital, have been reviewed and changes made to benefit residents. What the care home could do better: Fairview HouseDS0000015435.V377005.R01.S.docVersion 5.2Care planning at the home has improved, but people still cannot be sure that all of their individual needs will be identified, assessed, planned for and carried out in practice. Some staffing issues, such as numbers of staff and the level of hours worked by staff, need to be kept under review to ensure that people always have sufficient and competent staff caring for them. Key inspection report CARE HOMES FOR OLDER PEOPLE Fairview House 14 Fairview Drive Westcliff On Sea Essex SS0 0NY Lead Inspector Ms Vicky Dutton Key Unannounced Inspection 26th August 2009 09:00 DS0000015435.V377005.R01.S.do c 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 homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Fairview House DS0000015435.V377005.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 House DS0000015435.V377005.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fairview House Address 14 Fairview Drive Westcliff On Sea Essex SS0 0NY 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) 01702 437555 01702 432835 fairview14@tiscali.co.uk www.southendcare.com Strathmore Care Manager post vacant Care Home 55 Category(ies) of Dementia - over 65 years of age (55), Old age, registration, with number not falling within any other category (55) of places Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The number of service users for whom personal care can be provided shall not exceed 55. (Total number not to exceed fifty five). Personal care is to be provided to service users who are over the age of 65. (Total number not to exceed fifty five). Personal care to be provided to no more than 55 service users with dementia over the age of 65. (Total number not to exceed fifty five). 28th August 2008 Date of last inspection Brief Description of the Service: Fairview House is a large purpose built home situated in a residential area of Westcliff on Sea. Accommodation is provided on three floors for 55 residents in 49 single bedrooms and 3 shared bedrooms, 28 of which have en suite facilities. A passenger lift provides access to all three floors. Communal facilities are situated throughout the home with the main dining and lounge area being located on the ground floor. Fairview House is within easy reach of local shops and a bus route. There is ample parking space and gardens to the front and rear of the property. The home is registered for older people and older people who have dementia. On the day of the inspection the cost for accommodation at Fairview House ranged from £395.00 to £553.00 per week. The home has a Statement of Purpose and Service User Guide in place. A copy of the last CSCI inspection report was available in the entrance hall. Fairview House DS0000015435.V377005.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent eight hours at Fairview House. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. We also spoke to one visitor during the site visit. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us. The AQAA is a self assessment that providers are required by Law to complete. It was received by the due date, was fully completed, and outlined how management feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from four residents, six relatives, two visiting professionals and four staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager, the care standards manager for the Company and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: People are generally happy with the service offered at Fairview House. Positive comments were received such as, “Fairview is a lovely home. The managers Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 6 and care staff are polite helpful and courteous,” and “I am very happy here and everything is fine.” People said that they liked the food provided and were offered choices about what they ate. People are able to welcome their visitors at any time, and there are regular opportunities for families to enjoy time together at events put on by the home. Staff have a kind and caring approach to residents. The home has a friendly atmosphere and staff and residents get on well together. What has improved since the last inspection? What they could do better: Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 7 Care planning at the home has improved, but people still cannot be sure that all of their individual needs will be identified, assessed, planned for and carried out in practice. Some staffing issues, such as numbers of staff and the level of hours worked by staff, need to be kept under review to ensure that people always have sufficient and competent staff caring for them. 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 House DS0000015435.V377005.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 House DS0000015435.V377005.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. 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 wishing to move into Fairview House can feel confident that assessments carried out will ensure that the home is suitable to meet their needs. EVIDENCE: We saw that copies of the homes Statement of Purpose and Service Users Guide were available in the entrance area of the home. These had been updated in May 2009. The Service Users Guide contained good information about the home. People living at Fairview House also had access to copies of ‘Residents Guides’ in their rooms. As admission enquiries and pre-admission assessments are largely organised through the Company’s head office the manager was unsure about what information people are given about the service. They said that sometimes Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 10 they have a brochure. If prospective residents, or more usually their families, visit the home they are given verbal information to help their decision making. This system may not provide people with sufficient information about the service to help them make an informed decision about the home. On five surveys returned three people felt that they had received sufficient information about the home and one that they had not. One person was not sure. We looked at the files of two people who had most recently moved into the home. We saw pre-admission assessments had been undertaken by an admissions co-ordinator that the Company employs. One assessment had taken place on the day of admission so the home had not had much notice. Assessments were completed using a set format to a satisfactory standard. Currently the manager at the home is not involved in assessing the suitability of people moving into Fairview House. They did feel however that admissions were discussed with them, and that they would be able to have a say in whether the placement was suitable. A positive development is that now if people are admitted to hospital from the home, when they are ready to return someone from Fairview House will visit them. This is to ensure that the home is still able to meet their needs. Fairview House DS0000015435.V377005.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. 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. People will receive care and medical support to meet their general needs. EVIDENCE: At the site visit people looked comfortable and well cared for. Comments from people about the care provided were positive, for example: “Fairview House looks after my needs very well,” and, “Keeps me clean, keep me well fed, keeps me well.” Relatives said: “The service is very good. They care for the individuals needs very well. They also keep the family informed about changes that may occur. The clients always look clean and tidy,” “They provide a good care package for my [relative]”, and, “The service attends to my relatives needs very well, everything is taken care of.” Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 12 When people needed assistance during the day staff carried this out in a caring manner. Staff spoken with had a good general understanding of people’s care needs and individual personalities. To see how well peoples care is planned for and arranged so that staff are aware of peoples detailed needs and meet them in an individual way we looked at three care files in detail, and three others for specific issues. Each person living at the home has a care file in place containing assessments, care plans, risk assessments, daily records and ongoing care information. For a person with complex care needs admitted a few days prior to the site visit we saw that their care plan was still being compiled, with staff working from pre-admission assessment information. Staff have worked hard to establish and maintain a reasonable standard of care planning, and to develop a person centred approach. For example, ‘X will need full assistance with shaving, X wants to be shaved every other day.’ Others care plans however lacked person centred details. For example, ‘Needs assistance with both dressing and undressing to ensure that they are given choice.’ From care documentation viewed, and observations, there remain a number of issues that need to be addressed in order for people to feel confident that they will receive good, consistent and person centred care. We saw that care plans or people’s wishes are not always carried out in practice. For example one person’s care plan said that they felt the cold. They liked to wear a cardigan and should always have a blanket provided for their legs. The person was not wearing a cardigan and only had a blanket given when the activity co-ordinator came on shift. A relative said that they had asked that the person always wear socks. They were not doing so, and the relevant care plan did not mention this. A member of staff said that they thought the person could not wear socks because of problems that this might cause. There was no mention of this in care planning either. When one person with dementia was admitted it was established and recorded that they liked to be called by a certain name. This had not happened, records and most staff were still using their given name, and not the one they were used to and preferred. Where people had behavioural issues, what they did, and the best ways for staff to address the behaviours were not well identified in care planning. The manger said that records to monitor and record any incidents and behaviours were in place. These were held separately to, and not referred to in care plans. Staff may not therefore know about the need to maintain these records, or the best way to manage any incidents. When compiling care files the home use a set format risk assessment for different aspects of care. These are put in place whether this is specifically relevant to the person’s needs or not. This is not an individual and person centred approach. Where risk assessments are relevant, the information contained in them might be better highlighted in the persons care plan. For example a relative said that a person had been prone to mouth ulcers. Their care plan did not highlight this. A standard format risk assessment was in place said ‘Teeth/dentures to be cleaned and observe for any mouth Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 13 ulcer/thrush.’ The relative showed us that the person did in fact have quite a nasty mouth ulcer. This had not been picked up by staff. Where people have short term needs, care plans are not put in place to ensure that staff are aware of these needs and tailor care accordingly. For example one person had recently attended hospital for a procedure that subsequently required district nursing input and caused a few issues. No care plan was in place relating to this. A number of people at the home are cared for in bed. More organised and better records are now maintained of these people’s care but inconsistencies remain. For example one person fluid chart having no entries from 14.30 to 21.00 on one day then no entry from 17.00 on another day. Both the manager and area manager felt strongly that people had received the care but staff had not recorded their input. The AQAA recognised that there were issues around care. It said under plans for improvement in the next twelve months, “To provide more effective leadership to the team by building on existing strengths of the senior team, to oversee the performance of staff more closely to produce more person centred care for residents.” We received positive feedback from a visiting professional who said, “There is excellent communication between care staff and community nursing to ensure that the residents receive the appropriate nursing care. Care staff are always on hand to assist community nurses on out visit days.” Records showed that people access different healthcare professionals to meet their needs, such as doctors, district nurses, psychiatric support, chiropodist and opticians. We saw that a number of people still have their own teeth. The manager said that the community dental service visit when required. On surveys people said that they ‘always’ received the medical support that they needed. Across the staff team some staff have had training in areas such as pressure area care, diabetes, nutrition, catheter care and continence care to enhance their knowledge and practice. A professional said “It would be helpful for the care home as a whole to receive teaching sessions on pressure ulcers, equipment etc. so that when the residents require input the care staff feel empowered and confident to deal with these issues.” We saw that nutritional assessments are undertaken, but that where a heightened risk is identified that this is not then carried forward into care planning to make staff aware of additional actions or care required. Apart from one person who was highlighted to the manager, generally peoples weight is monitored so that any problems are identified. This process has been helped through the provision of roll on/roll off scales. This enables people who are not mobile to more easily have their weight monitored. One person had been recently admitted to the home with a pressure sore. The manager said that the district nurse had commented that this was ‘Already looking better’ with improved care and nutrition. One relative however pointed out that they have trouble ensuring comfort and pressure relief. “They could ensure that my [relative] always has their cushion in their wheelchair every time they are put in it. Most of the time it is missing.” Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 14 We viewed medication records and systems to see how this aspect of people’s care was managed. Generally we found that good practices were maintained but that some attention to detail was needed. For example sometimes boxed/bottled medicines were dated when commenced to provide a good audit trail, and sometimes not. Where medicines are handwritten onto the medication administration records these were not signed by two people to show that instructions etc. had been checked and verified. Protocols were mostly in place relating to medicines to be used as and when required (PRN), but not for one person who was prescribed PRN medication to help manage behaviours. This means that staff may not use the medicine in a consistent manner. One person had a cream in their room that had been prescribed for another person. A number of rooms had pots of unlabeled Sudo cream in. The manager said that staff were no longer supposed to be using this cream with residents. Although medication training was not a subject identified on the core training matrix the manager said, and staff spoken with confirmed, that in house training in medication had been undertaken. The manager said that she also observes people to monitor their competence. Since the previous inspection the morning medication round is now normally undertaken by two people to ensure that people receive their medicines in a timely manner. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. Although staff have undertaken recent dignity and respect training, they do need to think about what they are doing to ensure that people’s dignity is maintained. One gentleman who had awareness was noted to be wearing a flowery patterned bib all day, even after its use was pointed out to the manager. As pointed out at the previous inspection the communal toilets off the lounge area cannot be locked to ensure people’s privacy. Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. 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 will have a lifestyle that will meet their needs through access to basic activities, being able to welcome visitors and enjoying good food. EVIDENCE: On five residents surveys completed everyone said that there were ‘always’ activities arranged that they can take part in. An activities co-ordinator works at the home on two days each week. During the site visit they were on duty and provided entertainment and activity for people. Both they and care staff also spent time with people who were less able to participate in group activities. When the activity co-ordinator is not on duty care staff are expected to provide activities for people. A timetable is provided for this, although this did not seem to tie up with the activities that had been recorded on individual activity records. Activities such as bingo, board games sing along, seated exercise and skittles are undertaken. Each month one big event such as barbeques, parties or entertainments are planned. Photographs in the lobby Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 16 area showed recent activities that have been enjoyed by people. The manager is aware that activities continually need to be developed, particularly so that opportunities for stimulation and occupation relevant to people who have dementia are provided. Under plans for improvement in the next 12 months the AQAA said, ‘Plan to improve the programme of activity. Create an activities team to assist the activity co-ordinator in preparing activities throughout the year.’ Since the previous inspection the provider has purchased different activities equipment and games for the home. Also since the previous inspection a minibus is now available enabling people to get out and about more easily and spontaneously. Peoples care files viewed identified to a degree their previous and potential interests. People living at Fairview House are able to have visitors at any time. A visitor spoken with during the site visit said that they were always made welcome by staff. Staff were respectful of peoples wishes and they were able to go where they wished in the home. Information on advocacy services was available so that people know where they can go for independent support and advice. A tour of the premises showed that people are able to bring in their own possessions in order to make their rooms homely. The home operates a four weekly rotating menu. This provides choice and is adapted to meet individual needs and preferences as required. At lunchtime we saw that people had been offered choices other that what was on the menu to accommodate their individual needs. People are able to choose on the day what they will have for lunch. The manager said that they are hoping to develop pictorial menus for those with communication difficulties. People spoken with seemed happy with the food provided. They said, “I like the food,” “The food here is generally good,” “They give me too much” and, “More fresh fruit would be nice.” On surveys four out of five people said that they ‘always’ enjoyed the food. Although the day’s menu was written up on a white board people said, “We never know what’s for lunch.” The lunchtime meal looked well presented and people who needed assistance were helped in a sensitive manner. Equipment such as plate guards and cutlery grips were available to assist people in maintaining their independence. We did notice that a number of people ate both their breakfast and lunch from over-bed style tables whilst remaining in their armchairs. Seventeen people ate their lunch in this way. The current layout provides insufficient dining table space should everyone wish to sit at a dining table. Whilst people’s choices should of course be respected, management also need to consider the potential wellbeing consequences of people remaining in the same place for many hours without moving, or having a change of scene, and of eating when in a less upright position. Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. 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 are protected through procedures and practice in the home. EVIDENCE: We saw that there was a complaints process in place that was on display for people to refer to. The complaints information in the service user’s guide identified ‘useful contacts’ for people and provided contact details for Essex and Southend Local Authorities where people could raise concerns. However the procedure on display did not provide this information so that it is easily accessible. On surveys all residents and relatives said that they knew who to speak to, and knew how to make a complaint. On staff surveys people said that they knew what to do if someone raised concerns with them. When we looked at the home’s complaints records we saw that two complaints had been made about the home since the previous inspection. One had been made through Social Services who had asked the home to investigate. Both complaints had been responded to appropriately by the home. No concerns about the home have been raised with us (CQC.) Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 18 The homes training matrix, staff files and discussion with staff showed that training in safeguarding people had taken place. Local guidelines relating to safeguarding practice were available, with information about actions to be taken and contact details on display on an inside cupboard door in the office. We also saw that since the previous inspection the home’s own policies and procedures in relation to safeguarding have been reviewed. These now provide good information for staff including guidance on completing relevant forms for making a referral. No safeguarding referrals have been made by or about the service since the previous inspection. Although not currently a major issue, some records viewed, and discussion with the manager indicated that the home does accommodate people who can display behaviour that challenges staff. The training matrix indicated that training in this area in relation to dementia had taken place. As previously mentioned in relation to care planning, the manager is aware of the need to record and monitor behaviours, but care plans are not currently robust enough in ensuring that staffs’ response to behaviours will be appropriate and consistent. Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 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 live in a comfortable and improving home. EVIDENCE: As part of this inspection we undertook a partial tour of the premises. Since the previous inspection the gradual refurbishment of the home has continued to improve the environment for people and bring the home up to a good standard. Further bedrooms have been redecorated, some have had new carpets. A number of new beds, chairs and other equipment have been provided. This work needs to continue so that everyone has good quality furnishings and equipment available to them. People seemed generally happy with the accommodation provided, but one person commented that their relative’s room was, “Pretty basic.” One resident Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 20 was in a room where the window had obscured glass to the front aspect so they could not see out. They were complaining of being hot but could not open their window as this required negotiating a boxed in area. They said, “I did try it once but skinned my knees. I have to wait for one of the staff to climb up there.” People should be able to control their own ventilation where they are able, and be able to see out of their bedroom windows. There is outdoor space for people to enjoy with a patio and places to sit. Signage in the home has been further developed with most people now having their photographs/names on their doors and a sign to identify who their key workers are. Management do need to check if this information is helpful for people as print sizes used are quite small and not everyone would find the information usable. To give the home a more welcoming feel and help people to feel more orientated various areas of the home have now been given the names of flowers, for example ‘Snowdrop wing.’ On the day of the site visit the home appeared generally clean. Training records showed that staff had received training in infection control. The laundry area was suitable to meet the needs of the home. The member of staff in the laundry had received appropriate training and was knowledgeable about correct procedures. Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 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. People are looked after by staff who are caring, safely recruited and adequately trained EVIDENCE: During the day we saw that residents and staff had a good rapport with one another. People told us that they liked the staff and got on well with them. We received positive comments about staff working at Fairview House from relatives: “The staff are kind, courteous and attentive and make every effort to make my [relative] comfortable,” “The carers at Fairview generally do a fine job and are very helpful,” and, “The staff all seem to be happy and caring people and do a very good job under difficult circumstances” were some comments made. The AQAA indicated that staff turnover at Fairview House had been high and that eleven staff had left within the last year. The AQAA, which was completed at the end of June, said that in the preceding three months 248 shifts had been covered by agency or temporary staff. This will not have provided people with consistent care from people that they knew. Since that time however the home Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 22 has recruited a number of new staff. The manager said that there were no current vacancies and that agency staff are not used. On the day of inspection 49 people were being accommodated at Fairview House. Rotas showed us that staffing levels have continued to be maintained at eight staff between 08.00 and 14.20. (Usually includes two senior staff) Seven staff between 14.00 and 20.20 (Includes one or two senior staff.) and four waking night staff between 20.00 and 08.20. The manager has limited supernumerary time and is often working as part of the shift. This may limit opportunities for service and staff development. The manager felt that current staffing levels were sufficient to meet people’s needs. This needs to be monitored however as the home continues to use a tool for assessing people’s level of dependency that does not fully relate the level of needs to level of dependency. So, for example someone requiring total care of two people with all aspects of daily living might be categorised as ‘medium’ dependency. Someone who is physically able but has a high level of needs due to dementia might be categorised as ‘low’ dependency. No one currently living at the home is said to be ‘high dependency.’ This does not tally with evidence seen on the day of the site visit. Using this tool management risk having insufficient staff to meet people’s holistic needs. During the site visit there were generally staff around in the communal areas to interact with, and assist people. On surveys three people felt that there were ‘always’ staff available when they needed them and two that there ‘usually’ were. Relatives made no particular comments about staffing levels. Staff however felt that staffing could be improved. On four staff surveys only one person felt that there were ‘always’ enough staff to meet the individual needs of people. Two felt that there ‘sometimes’ were and one that there ‘never’ was. A number of comments were made about staffing including, “I feel the only downside is the lack of staff at times.” In spite of it being said that the home was ‘fully staffed’, When we looked at rotas we saw that care staff are still working frequent twelve hour shifts from 08:00 to 20:20 with one day off each week. Some night staff are covering five nights each week totalling nearly 62 hours per week. This is not good practice as staff practice and competence may become compromised if they are working long hours and tired. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. The rota identified that currently 23 care or trainee/senior care staff are employed at the home. Information provided on the AQAA and at the site visit indicated that of these five have an NVQ at level two or above, and a further five staff are working towards this. Some staff who have NVQ at level two are also working towards their level three. The home have not yet reached the 50 basic target. Staff are recruited centrally by the organisation. Management, staff or people living at the home have no input into the recruitment process. This means that potentially the staff recruited may not meet the needs of the home or fit Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 23 in with the existing staff team. The manager felt that this was an area that they would like to be more involved with. We looked at the files of two members of staff who had been most recently started work at Fairview House to ensure that recruitment procedures protect people living in the home. Files viewed were mostly satisfactory and showed that proper checks such as POVA first, references taken up, proof of identification sought and health declaration had been undertaken. Neither file had a Criminal Records Bureau check in place. These were faxed over from head office for us to view. Both were dated after the persons start date. This is not best practice. On four staff surveys everyone said that their recruitment was carried out fairly and thoroughly. On staff surveys one person said that their induction had covered everything very well and three said that it had mostly covered everything. Two new members of staff spoken with said that their induction had been very good. They were enthusiastic about the training they had undertaken. The staff files of new members of staff looked at showed that a good induction process was in place. A detailed initial induction had been undertaken. This was being followed up by a Skills for Care Common Induction Standards workbook being completed. On surveys staff all made positive responses to the questions about training saying that training offered gave them the skills that they needed. The Company has a designated training co-ordinator to identify training needs and arrange training for staff. Staff spoken with during the day identified that they had undertaken a good level of basic training. A training plan is in place for 2009 which identifies training coming up in dementia/challenging behaviour, Bereavement and grief, diabetes and medication. From surveys and people spoken with, staff felt supported in their role. The manager agreed however that staff supervision needed development to reach the recommended frequency. Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. 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 live in a safe and well managed home where their views are listened to. EVIDENCE: A new manager only started at the home in July this year. Their ability to manage the home effectively cannot therefore yet be fully assessed. The manager has appropriate experience and is currently undertaking their Leadership and Management Award. This is a recognised qualification for those managing care homes. Prior to the new manager starting the deputy manager and senior staff were being supported to manage the home by a Care Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 25 Standards manager in the organisation. This arrangement has seen the home make good progress since the previous inspection. Fairview House had a friendly open atmosphere and people seemed comfortable and at ease with staff. People have opportunities to express their views at residents meetings. These were recorded, and showed that peoples views are listened to and acted on. The new manager said that they plan to hold their first residents’ meeting soon. We saw that staff meetings also take place where practice and other issues are discussed. The provider employs an external agency to undertake quality reviews of their services. At Fairview House a quality review last took place in May 2007. The manager confirmed however that this process is now underway again and that surveys have been sent out. Monthly visits to review the service are required by Regulation. We saw that these are being undertaken by a Consultant to the organisation. The visits include talking to people about the service. The AQAA was completed by the deputy manager. It was briefly but fully completed and gave us the information that we had asked for. It recognised areas where the home needs to continue with improvements. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. We could not check money balances on this occasion as the keys were not available. However good records were maintained and receipts in place for all transactions. We saw that the system and residents’ monies had recently been audited by the Company. The AQAA completed identified that systems and services are monitored and maintained. A sample of records looked at confirmed this. A partial tour of the premises showed that the home seemed well organised, and no particular health and safety issues were identified. The fire service visited the home in April this year and found everything to be in order. A fire risk assessment was seen to be in place. Fire records were well maintained. Systems are tested weekly, and regular fire drills are carried out to ensure that staff know what to do in an emergency. The last environmental health officer’s visit last year found standards of food hygiene to be satisfactory with only some minor issues to rectify. A three star ‘Good’ rating was awarded. A training matrix and discussion with staff showed that training in core areas such as moving and handling, fire awareness, health and safety and basic first aid is kept up to date. Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 26 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement So that people can feel confident that they will receive consistent care that meets their individual assessed needs, care plans and care documentation must continue to be reviewed and developed. Care plans and documentation must provide a person centred and holistic approach that identifies all of people’s care needs and gives staff clear guidance about how to meet these. Care plans must be carried out in practice so that people receive the care agreed. Timescale for action 30/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 28 No. 1. Refer to Standard OP1 Good Practice Recommendations People should have good information about the home before they make a decision about moving in, a copy of the Service Users Guide should be provided to them. People should be assured of privacy by being able to lock communal toilets. Management should continue to develop an approach to activity and occupation that meets the needs of people who have dementia. So that people receive care from a skilled workforce 50 of care staff should be trained to NVQ level 2 or above. So that an adequate number of staff are always available to people, management should use an effective tool in assessing dependency levels and staffing numbers needed to meet their level of need. The provider should consider the provision of a dishwasher to ensure the effective and regular sterilisation of crockery and cutlery. 2. OP12 3. OP16 4. OP28 5. OP27 6. OP38 Fairview House DS0000015435.V377005.R01.S.doc Version 5.2 Page 29 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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). 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. 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