Care Home: Fairview House

What the care home does well Residents living in the home are offered a comfortable and homely environment with attractive communal areas that provide fine views across the garden to Carisbrooke Castle. Effort has been made to provide communal areas and bedrooms that are well furnished, comfortable, and individually decorated. People are encouraged to bring their own possessions when they move in to make their rooms as personal and homely as possible. Visitors to the home made positive comments about their experience of being in the home. One person told us: `I was overall, impressed with the quality of care that I saw and the attitude of staff was excellent`. Other people told us: `I am satisfied with all areas of the service as far as my relative is concerned. ` Fairview is a very clean and friendly home.` What has improved since the last inspection? Not applicable What the care home could do better: The service must ensure that all aspects of practice in the home are regularly monitored and assessed for compliance with legal requirements. For example, some aspects of medication practice such as the dispensing of prescribed creams have not been efficiently monitored. Medicine that is prescribed to be given as and when required does not have a specific care plan. This means that staff do not have clear guidance and people may be at risk of not getting their medicine when they need it. The lack of a staff training and development plan means that not all of the staff have the skills and qualifications for the work they do. Failure to arrange regular staff supervision means that practice in the home is not monitored and staff may not consistently follow the home`s policies and procedures for good practice. This puts residents at risk if care is not provided consistently and safely. Individual plans of care do not provide provide sufficient detail about personal and individual choices and preferences about how they wish to receive their care. Comments confirm that the manager and staff think and work in a person centred way. This must be reflected in the care records. A recent inspection has highlighted that the home is not compliant with relevant health and safety legislation and action is being taken to address all areas of concern, such as health and safety risk assessments, fire safety procedures and other procedures to promote safe working practice. The home must develop effective monitoring systems to make sure they are compliant with all legal requirements and to regularly review the quality of the service they are providing. Key inspection report Care homes for older people Name: Address: Fairview House 37 Clatterford Road Newport Isle Of Wight PO30 1PA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 0 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Fairview House 37 Clatterford Road Newport Isle Of Wight PO30 1PA 0000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Fairview Care Home Ltd Name of registered manager (if applicable) Mrs Tracey Anne Sansom Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 24 The registered person may provide the following category of service only : Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Fairview is a newly registered care home located on the outskirts of Newport. The converted period building enjoys views of Carisbrooke Castle and has gardens at the rear of the building and limited parking space at the front. Some of the bedrooms are en-suite and there is one double room for people who choose to share. There is a passenger lift to access the upper floors, a large lounge/dining room and an outside Care Homes for Older People Page 4 of 34 Over 65 0 24 24 0 Brief description of the care home patio area. The building is accessible. Fees vary and there are some additional charges - information is available from the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first inspection visit to Fairview House since being registered with the Care Quality Commission in August 2009. An unannounced visit took place on 3 December 2009 with one inspector. Over a period of five hours, two of the residents, three members of staff, two visitors, the registered manager, the responsible individual and another representative of the registered providers, were involved in the visit. We were shown around the building by the registered manager and the responsible individual and the manager was available to provide access to all of the records. We looked at some of the care records, medication records, staff recruitment and training records, and the statement of purpose for the home. Before the visit we sent surveys to the home to distribute to 10 residents, 5 relatives/carers, 5 members of staff and 3 health and social care professionals. The surveys were sent with stamped, addressed envelopes to ensure confidentiality. Surveys were returned to us from 4 members of staff, 2 relatives/carers, and two Care Homes for Older People Page 6 of 34 health care professionals. Feedback about the service is positive. We did not receive the Annual Quality Assurance Assessment (AQAA) from the home. This is a self-assessment document that provides us with a picture of the current situation in the service and gives us useful information about the homes plans for improvement, staffing numbers and staff qualifications. The home did not receive the AQAA request and following the inspection visit we sent another AQAA for completion but this had not been received at the time of writing this report. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 34 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home have access to information about the services provided, this is available in a standard written format but some of the information has not been updated. Prospective residents can expect to have their care needs assessed before they move into the home. However, staff do not have all of the skills, knowledge and qualifications for the work they do and to provide specialist dementia care and this may put people at risk of their care needs not being consistently met. Evidence: We looked at the available information about the home including a small brochure with photos of the home and a more detailed statement of purpose for the home. The statement of purpose sets out the aims and objectives of the service with a statement promoting privacy, dignity, choice and independence and includes details of staff, what is included in the fees and other relevant information such as the complaints procedure. Some of the information is out of date: for example, the complaints procedure refers to the Commission for Social Care Inspection (This is now the Care Care Homes for Older People Page 11 of 34 Evidence: Quality Commission) and there are two different addresses and phone numbers given, one of which is incorrect. People using the service should have the correct title, address and phone number for the commission in the event they need to contact the commission. The information is available in a standard written format, this may not be suitable for the needs of all prospective residents. We received surveys from two relatives of people living in the home and responses to the question do you and your relative get enough information about the care service to help you make decisions? was sometimes and usually. As a new service, the home was asked to ensure that information about the one double room included information that this room is intended for couples or people who choose to share a room, this has not yet been amended to reflect this. The manager told us that the home also offers day respite care to two people, but does not provide intermediate or specific rehabilitative care. The home has an admissions policy and the statement of purpose tells us that the registered manager carries out an initial assessment of peoples needs and people are encouraged to visit the home as many times as they wish before they make the decision to move into the home. We spoke to a service user and their relative and they confirmed that they had visited the home before making the decision to move in. Another person told us they had chosen their bedroom because they liked the colours and furnishings of the bedroom and the location of the room. The statement of purpose tells us that all staff in the home are expected to be trained and proficient in skills related to care and including dementia awareness. At the moment, the training programme for care staff is aimed at making sure that staff have the basic skills and knowledge in care and not all of the staff have competed training in dementia awareness. The manager told us that the home is planning to develop a dementia strategy to ensure that people receive specialist dementia care to meet their specific care needs. We were told that the home plans to ensure that all staff have received relevant specialist training in the near future, to include dementia care and training in the mental capacity act and how this may affect people living in the care home. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of the residents are monitored and appropriate action and intervention taken. However, details of residents specific choices and preferences about how they wish to receive their care are not recorded. Medication record keeping does not confirm that all medicines have been given to residents and this puts people at risk of not receiving their medication, as prescribed, at all times. Staff are aware of the need to treat individuals with respect and to consider dignity when delivering personal care. Evidence: We looked at the individual care records for three residents. Each resident has a care plan that covers all aspects of health care needs. One care plan contained a risk assessment for someone who is at risk of developing pressure sores. However, the risk assessment did not include the residents weight and staff told us they were having to estimate this. The registered manager told us that the home will be purchasing sit on scales for residents who are unable to stand on weighing scales. A falls risk assessment and moving and handling assessment were also in place. Care Homes for Older People Page 13 of 34 Evidence: We saw evidence that equipment is available for assisting people with mobility when this has been assessed as appropriate for individual residents. Care plans contained evidence of contact with GPs and other health care services. We were told that all but three of the staff team have completed updates in their training in safe practice in manual handling. The registered manager has sought specialist advice from the community dementia care team and we spoke to someone from the team who was visiting the home. The health care professional told us that the home is working with NHS specialist services to support identified residents who may benefit from additional interventions. The care plans that we looked at did not contain specific detail of individual and personal preferences and choices, for example, whether people preferred to receive care from a male of female carer, details of how and when people prefer to receive their care, what people like to do for themselves, when and what time they like to receive a bath. Although it was evident that staff are working in a person centred and individual way, this needs to be clearly recorded in the plan of care to ensure people receive care in a consistent way, from different carers. The plan of care did not contain evidence of consultation with residents and/or their representatives and the care plans had not been signed to indicate agreement. The manager told us that this would be actioned. The manager told us that it was planned to consult with residents and their representatives to draw up a personal history for each resident with the aim of further personalising the delivery of care. Comments and feedback from residents and visitors indicated that people are happy with the way that staff deliver their care and respect their dignity and rights. For example, interactions between staff and residents were discreet and appropriate and staff ensured privacy when people were using toilets and bathrooms. Residents medication is stored in a large room on the ground floor. Medication is taken to the residents in a locked medication trolley. There is suitable storage for any controlled drugs and these are recorded in a controlled drugs register. The medication storage fridge contained prescribed liquids for one resident. However, these were not recorded in the residents plan of care and were not on the medication administration records. Staff said they would check with the residents GP if these were still being prescribed and needed to be in the care plan, to be taken. Some medication is received in pharmacy filled blister packs and some medication is Care Homes for Older People Page 14 of 34 Evidence: received in the original pharmacy supplied container. Some medicines were not printed onto the medication record sheets and had been written on by hand by staff, but had not been signed and witnessed by someone suitably qualified to do this. This means that the records had not been checked to ensure that the quantities and prescribing instructions were correct. This puts people at risk if they do not receive their medication according to the prescribers instructions. The registered manager told us that no-one has been assessed as being able to manage their own medication although the service user guide states that residents would be supported to do this wherever possible. The records of medication confirm that people have received their medication, however, we found one exception: prescribed creams for one resident had been overlooked on the medication records and there was no record that these had been dispensed as prescribed. The creams had been left in the bedroom and were being stored on top of the radiator cover at higher than the recommended temperature for storage. This means that we were not able to confirm if the prescribed creams had been dispensed or not and this may put the resident at risk of not getting the medication they need. Some residents had been prescribed medication to be taken as and when required. These medicines were recorded in a general care plan but did not contain specific guidance for care staff on the circumstances for when and why these medicines should be offered, or if residents were able to ask for them or required prompting. Lack of clear guidance puts people at risk of not receiving as required medicines when they need them. We spoke to two members of staff who confirmed that they had completed training in the safe administration of medication. The manager told us that all senior staff have received appropriate training in medication procedures. Some staff have received additional training in the dispensing of eye drops. Staff who dispense medicines also need to have specific training in checking blood sugar levels. However, the manager told us that not all of the staff are up to date with this training. We were told that updates of training will be arranged. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are given the opportunity to take part in a variety of activities. Further development is planned to engage people in meaningful occupations that promote and support individual well being. Residents are encouraged to enjoy attractive and nutritious meals in a pleasant setting. Visitors to the home are always made welcome. Evidence: The service user guide/statement of purpose says that a range of activities are available to residents on a daily basis such as games, music and sing along, manicures, outings and bingo, and residents are supported to take part in religious worship if they choose. In the sitting room a resident and a visitor told us they liked the music and reminiscence sessions. We were told that a local arts group visits the home regularly to co-ordinate music and other entertainment with the residents. During our visit, we observed a member of staff organise a sing along with the residents. The manager told us that she recognises that not all of the residents are able to choose or participate in organised activities and advice is being sought from health Care Homes for Older People Page 16 of 34 Evidence: care professionals on effective ways to engage people in meaningful occupations to support their well being. We spoke to a health care professional from a multi-disciplinary dementia care team who was visiting the home. This person told us: The manager and staff are keen to develop further ideas to support person centred interventions at a level that enables engagement. The manager told us she plans to also seek professional advice on ways to make the building more user friendly for people in the home. For example, to seek best practice guidance on door nameplates, clocks and calendars, notice boards and other aids to support residents who experience confusion and memory loss. We observed most of the residents enjoying a freshly prepared and attractive meal at lunchtime, in the dining room. Staff were seen to sit with those residents who needed support with eating their meal. The cook told us that importance was placed on providing home-cooked and nutritious meals for the residents. This was confirmed when we spoke to a resident and a visitor to the home. We were told that the food is very good and the portions are very generous. Home made cake was available later in the day for the residents, at tea-time and we were told that drinks and snacks are always available. The dining area is homely and attractive to provide residents with a pleasant place to take their meals. We received positive feedback from three people who visit their relatives in the home. One person told us: you are made welcome when you visit and part of the team in looking after your relative. Another person told us: Fairview is a very clean and friendly home and my relative seems to be very happy here. In the surveys we asked people what the service could do better: one person told us: perhaps more things for the residents to do and get them to take part. Another person did not think there was anything the home could do better and told us: I find the manager and staff very caring and am more than satisfied with the care and attention they give to my relative who is well looked after. Care Homes for Older People Page 17 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure but the information is not up to date. There are policies and procedures for safeguarding people in the home. However staff are caring for vulnerable people without having the appropriate training in safeguarding procedures and awareness. Evidence: The home has a formal complaints procedure that is available in the service user guide/statement of purpose. We have already identified that some of this information is out of date with regard to contacting the Care Quality Commission. In the surveys we received from visitors one person told us they know how to make a complaint about the service provided and another person told us they did not. However, two people told us that they would feel confident about speaking to the manager if they had any concerns about anything in the home. We have not received any complaints or concerns about the service and the manager told us that the home has not received any complaints. The manager told us that the aim of the home is to ensure that all staff have covered all of their basic training in the next few months. This training includes knowledge and awareness of safeguarding policies and procedures. However, at the moment, not all of the staff have completed this training. This means that practice may be inconsistent Care Homes for Older People Page 18 of 34 Evidence: because some staff have had training and others may have limited understanding about how they must protect vulnerable people in the home. In addition, only three of the staff have completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards. This means that staff in the home have limited understanding on how the new legislation aims to protect people who do not have the capacity to make important decisions about their lives, in practice. This means that people living in the home do not have their needs and interests protected and promoted by staff who have the knowledge and training for the work they do. The manager told us that training in safeguarding and the Mental Capacity Act will be arranged in early 2010 for all staff who have not done this training. However, this is not yet part of a planned programme of staff development and training to ensure that staff have the skills and qualifications for the work they do. Care Homes for Older People Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have access to a clean, warmly heated and attractive, homely environment. As a new service, work is ongoing to develop parts of the building. However, prompt action has not been taken to ensure that all parts of the home are safe for the residents and this has the potential to put people at risk of harm. Infection control procedures are not thorough enough to ensure that residents are adequately protected from the risk of infection or cross infection. Evidence: Fairview House is newly registered as a care home and started to admit new residents in September 2009. We were told that prior to opening, bedrooms and communal rooms were newly furnished and we noted that care has been taken to provide coordinated and individual colour schemes in the bedrooms and comfortable and matching furniture in the communal rooms. Residents are encouraged to bring their own personal possessions when they move in and during our visit a member of staff was helping a new resident to hang pictures and place items of furniture in their bedroom. The communal area on the ground floor is a large L shaped open plan area that provides a quiet area for residents, a sitting area with a television, and a dining area. The sitting room opens onto an outside patio area with views of the garden and Carisbrooke Castle. The registered providers told us that there are plans to develop a Care Homes for Older People Page 20 of 34 Evidence: conservatory. Also to make the patio safer for residents and develop safer and better access to the garden. We were told that there are plans to introduce closed circuit television cameras to improve security and safety in the home. The registered providers told us that this would be only be introduced with the full understanding and agreement of all stakeholders in the service (residents, relatives and staff). We were told that all of the rooms except two currently have a lockable drawer for people to use and all of the bedrooms and bathrooms have easy to use locks for privacy; with a facility for staff to over ride the locks in the event of an emergency. In some of the bedrooms we found prescribed creams and lotions were being stored on top of the radiator cover and residents did not have a lockable cabinet to store toiletries and other items. One bedroom had denture cleaning tablets left out. The heat from the radiator will have a detrimental effect on some creams and lotions. Toiletries and medication that are not locked away present a potential risk to residents who are confused because residents do not lock their bedroom doors. The manager was made aware and we were told that an assessment of risk to residents will be undertaken and action taken to protect people in the home. Residents have access to an alarm call system. However, in one bathroom, the alarm pull cord had been tied out of the way making it difficult to use in an emergency. This was rectified by the manager. In some bedrooms, the alarm pull cord needs to be moved and sited next to beds for easy access by residents as the room arrangements had changed. The laundry facilities have a lockable door, washable floor and a washing machine with settings suitable for maintaining infection control. Cleaning products are safely stored in a locked cupboard in the laundry room. However, one en-suite bathroom contained cleaning products that had been left out. The manager was made aware and we were told that an assessment of potential risks to other residents is to be carried out. A room on the ground floor houses the heating boilers and at the moment, the freezers are also stored in this room. This room does not have a lock and this could be a potential risk to residents who are confused. We were told that this would be addressed. One part of the ground floor corridor has a low step. Currently, people are alerted to the risk of tripping, with hazard tape. The manager told us that a warning sign will be Care Homes for Older People Page 21 of 34 Evidence: be installed but this had not yet been done. The ground floor toilet and bathroom next to the dining room had suitable facilities for people to wash their hands, liquid soap, towels and hand gel. However, other toilets and bathrooms on the upper floors did not have any soap, paper towels or antibacterial gel. The manager told us that this would be rectified. The home does not have a sluice and the procedures for emptying and cleaning commodes mean that they are emptied in shared toilets and sprayed with disinfectant. There are no facilities for pans to be immersed and cleaned. There are no facilities upstairs to ensure that staff are able to wash their hands easily. The manager has not sought specialist advice from an infection control/health care professional about infection control procedures in the home. This means that people may be at risk from poor practice in infection control. Staff confirmed that they always have access to gloves and aprons when required. There are two bathrooms on the upper floors and currently one is awaiting a new bath seat. All of the bathrooms have assisted baths. We looked at all areas of the building and we found the home to be clean and tidy with no unpleasant odours. Comments from residents and relatives confirmed that the home is always clean and fresh. The home employs staff to clean and maintain the building and these staff were working in the home when we visited. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team do not have all of the necessary skills and qualifications for the work they do. Generally there are staff recruitment checks in place to demonstrate that staff are suitable to work in the home. The gaps in training and supervision means that staff are not supported, trained and supervised to develop the skills they need to meet peoples needs. Evidence: We did not receive the Annual Quality Assurance Assessment from the home. This would have provided us with information about staffing numbers and staff qualifications and training before we visited the home. The manager told us that some staff transferred to Fairview from another home where she had previously been the registered manager, and some staff have been recruited since Fairview opened in September 2009. The staff rota shows that there are usually three care staff on duty between 8am and 8pm. In addition there is a cleaner, cook, and the registered manager. The maintenance person works full time between Fairview and another home in Ryde. There are two wakeful staff on duty at night and the manager told us that the home plans to increase this to three people. Care Homes for Older People Page 23 of 34 Evidence: We received surveys from three members of staff and also spoke with two staff during our visit. Staff told us that there are usually enough staff to meet the individual needs of people living in the home. Comments received from residents, relatives and visitors described the staff in the home as warm and friendly and very caring. Two of the staff that we spoke to confirmed that they are up to date with all of their basic training and had also completed an NVQ (National Vocational Qualification) in care at level 2 and 3. We were not able to confirm that all of the staff have completed basic training because the home did not have an easily accessible record of staff training, or training matrix. The manager told us that the ongoing training plan is to ensure that all staff have covered all basic training as soon as possible. The manager has also identified additional training needs such as dementia care, Mental Capacity Act and other training related to the specific needs of the residents such as blood sugar testing, and diabetes care. We were told that staff who work in the kitchen need to update their qualification in food hygiene and this was being arranged. We received positive comments about the care staff in the home from relatives and health and social care professionals: one person told us: the attitude of the staff is excellent. Another person told us: staff work in a person centred and holistic way and are warm and professional. However, the lack of training and supervision means that practice in the home may be inconsistent and people may be at risk of receiving different care from different carers. The manager told us that due to pressure of work staff supervision has been overlooked and has not been taking place on a regular basis. The manager has not undertaken training in being a supervisor and has identified this as part of her own training needs. On the day that we visited, the registered providers were in the home to start doing staff appraisals. We looked at the records of staff recruitment for three new members of staff. Records Care Homes for Older People Page 24 of 34 Evidence: for three people showed that satisfactory checks were in place before people started work. We were told that new staff follow a three day introduction to the home and work with more experienced staff before starting on a 12 week induction programme that follows nationally agreed standards in care. The manager told us that new staff are supervised and monitored, however, there was no signed record of this. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for monitoring practice, compliance with policies and procedures and legal requirements are not yet in place. This means that the health and safety of residents and staff is not consistently promoted and protected and puts people at risk. Evidence: We did not receive the Annual Quality Assurance Assessment (AQAA) when we asked for it. The home told us that they did not receive the request for the assessment to be completed. Following the inspection visit we sent another AQAA to be completed but we have not received this. This means that we have not been able to look at the information that would be submitted by the service, to give us a picture of the current situation in the service, for example, about planned improvements, staffing information, policies and procedures and evidence to support how it is planning to carry out improvements. The registered manager has previous experience managing another care home in Ryde and has the relevant qualifications in care and management. Care Homes for Older People Page 26 of 34 Evidence: Observation and comments from residents, staff and visitors tell us that the manager has an open and positive approach to managing the home and is accessible and available for people to consult with. The manager was open and honest and told us about areas of running the home that require improvement, particularly systems for monitoring compliance with relevant health and safety legislation. We were told that a recent contract monitoring visit by the Local Authority had identified a number of areas where the home is not meeting health and safety requirements. For example, the service has to re-write the health and safety policy for the home, ensure risk assessments are more comprehensive, review and update the fire risk assessment and ensure there is a comprehensive evacuation plan and that fire drills are carried out. The home has been recommended to ensure that water temperatures are checked weekly and to carry out other recommended actions with regard to health and safety. The manager told us that all of these issues of concern are being addressed. However, the service does not have systems in place to regularly monitor and confirm that the home is complying with all legal requirements. Failure to do this has the potential to place the health and safety of the residents and staff at risk. The front door of the building is currently secured with a lock and key. We were told that this is being changed to ensure that people are safe and secure and the security of the home meets fire safety regulations. However, this had not yet been done. We have made regulatory requirements where we have found that practice in the home does not meet legal requirements and puts people in the home at risk of their health care needs not being met or not being met consistently. For example, medication practice must be reviewed to ensure that residents receive their medication safely and as prescribed. Individual care plans need more detail about personal choices and preferences and how people wish to receive their care. The service must seek specialist advice on their procedures for reducing the risk of infection or cross infection. The home does not have a training and development plan or a training matrix to demonstrate what training has been completed. There is no training plan to ensure that staff have all of the skills, knowledge and qualifications for the work they do and to meet the specific needs of the residents. The manager told us that training was being arranged in 2010. However, the planned training will cover basic areas of safe working practice. Staff have not received specific training in dementia care to meet Care Homes for Older People Page 27 of 34 Evidence: the specialist needs of people living in the home. In addition, only three people have received any training in the mental capacity act and deprivation of liberty safeguards. This means that staff may not be aware of how the legislation may affect people who live in the home and who may lack capacity to make important decisions about their lives. Systems for monitoring the quality of the service and how well the home is providing a good service are not yet in place. The manager told us that there are plans to develop quality assurance systems including satisfaction surveys to residents, staff and visitors. The feedback and comments about the care provided are positive from residents and their relatives. We have also received positive comments from health and social care professionals who visit the home. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The service user guide/statement of purpose must include a summary of the complaints procedure and the address and telephone number for the Care Quality Commission. People must have correct information about how to contact the Commission if and when required as part of the homes complaints procedures. The information for prospective residents should clearly indicate that double rooms are for occupation by couples or people who choose to share. 29/01/2010 2 9 13 The registered person must 29/01/2010 make suitable arrangements for the recording, handling, safekeeping and disposal of medicines received into the care home. Records must confirm that Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action people receive all medication as prescribed, including prescribed creams and ointments. Staff must have clear and written guidance to ensure people receive as required medicines when they need them. 3 18 13 The registered person must make arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. Residents must be protected from the risk of harm or abuse by staff who are trained and knowledgeable about safeguarding policies and procedures, in practice. 4 26 13 The registered person must 29/01/2010 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Practice in the home with regard to sluicing procedures and hand washing facilities must meet current good practice guidelines for the protection of residents and staff. 29/01/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 30 18 The registered person must 26/02/2010 ensure that staff working in the home receive training appropriate to the work they do. In the interests of meeting the specific and individual needs of people living in the home, staff must have the skills and qualifications to do this, including knowledge of dementia care. 6 33 24 The registered person must establish and maintain a system for reviewing the quality of care provided at the care home. A report of the quality review should be made available to demonstrate improvement. 26/02/2010 7 38 12 The registered person must 29/01/2010 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the residents. In the interests of protecting the health, safety and welfare of residents and staff, the service must demonstrate compliance with all relevant health and safety legislation. Systems Care Homes for Older People Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to monitor compliance must be in place. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 In the interests of people receiving the correct medication, it is recommended that hand written entries on the medication administration record be signed and witnessed to ensure that quantities and prescribing instructions are correctly transcribed from the original pharmacy supplied packaging onto the record chart. The medication policy and procedures should be reviewed in line with good practice guidance for Care Homes produced by The Royal Pharmaceutical Society of Great Britain. The guidance is available to download from the Commission website. 2 9 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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