Care Home: Fairview Lodge

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Fairview Lodge 6 Knowles Hill Road Fairview Lodge Newton Abbot Devon TQ12 2PL three star excellent service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judy Hill Date: 1 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Fairview Lodge 6 Knowles Hill Road Fairview Lodge Newton Abbot Devon TQ12 2PL 01626362001 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Peninsula Autism Services & Support Limited Name of registered manager (if applicable) Miss Emma Jane Holman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary cae needs on admission to the home are within the following category: Learning disability - Code LD The maximum number of service users who can be accommodated is 5. Date of last inspection A bit about the care home Fairview Lodge is registered to provide accommodation and care for a maximum of five people in the registration category of Learning Disability and specialises in providing a service for adults who have autistic spectrum disorder. The home is situated within half a mile of the town centre, which is served by bus and mainline railway services. Private transport facilities are made available for the service users. Information about the service is available on request from the Home in the form of a Statement of Purpose. Inspection reports will also be made available from the Home or can be accessed on the CQC Website. Fees will be based on the individually assessed needs of the people who use the service. For the people currently using the service this ranges from 2487.78 pounds a week to 3820.00 pounds a week. Extra charges are made for car mileage (46p a mile), professional hairdressing, chiropody, clothing and other items of a personal nature. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home An unannounced site visit was carried out by one regulatory inspector on 12th March 2009. During this visit we met the people who live at Fairview Lodge and some of the people who work there. We also had a look around the house and garden and spent time with the registered manager looking at records, including the residents needs assessments and care plans and the staff recruitment and training records. To produce this key inspection report we used information from the site visit and information that we had received since the last key inspection. This includes an Annual Quality Assurance Assessment that had been completed by the Emma Holman, who is the registered manager, surveys completed by some of the staff and surveys completed by the people who live at the home, with help from their families or key workers. Additional information was taken from the homes Statement of Purpose, Service Users Guide, the last inspection report and notifications provided by the home to keep us informed about some of the things that happen at the home. What the care home does well The people who use the service and their representatives have the information they need to choose a home that will meet their needs. Individuals are involved in decisions about their lives and play an active role in planning the care and support they receive. People who use the service are able to make choices about their lifestyle and are supported to develop their life skills. Social, occupational and recreational activities enable the people who use the service to enjoy a better quality of life. The personal care that people receive is based on their assessed needs and the principles of respect, dignity and privacy are put into practice. Concerns and complaints are taken seriously, listened to and acted upon. The home has been adapted to meet the specific needs of the people who live there. This means that people have both the private and the communal space that they need. Safe staff recruitment practises are used to ensure that unsuitable people are not employed to work with the residents. The staff are well trained, well managed and work together as a team to provide a high standard of care for the people who use the service. The registered manager is well qualified and highly competent. She has good senior management support from Peninsular Autism and Support Services Limited. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Judy Hill 33 Greycoat Street London SW1P 2QF 02079792000 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 set out 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 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service and their representatives have the information they need to choose a home that will meet their needs. Evidence: A copy of the homes Statement of Purpose was made available on request. This document is clearly written and provides current and prospective residents and their representatives with an accurate picture of the service that the home offers. Each of the people who use the service has an individualised Service Users Guide that is written in an easy read format and illustrated with photographs. There is a Service User Agreement and this contains the terms and conditions of residency. No new person will be offered a place at the home until a comprehensive assessment of their individual needs has been carried out. This process involves the prospective resident, their families and people working with them in a professional capacity. As part of the initial assessment process the manager and staff spend time getting to know the prospective resident and he or she will be invited to spend time at the home to familiarise themselves with the surroundings and to get to know the other residents. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individuals are involved in decisions about their lives and play an active role in planning the care and support they need. Evidence: Person centred care planning is used to ensure that the management and staff involve the people who use the service in planning their care and take into account their wishes and needs of the individual resident. The approach used recognise the importance of structure and routine for the people who use the service, all of whom have very complex needs, but by focussing on the individual avoid providing an institutional service. Good use is made of risk assessments and risk management plans. Good use is also made of the traffic light system to identify the individuals different moods and to enable the staff to respond appropriately to defuse situations that could lead to behaviour that can be challenging or lead to self harm. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are able to make choices about their lifestyle and supported to develop their social skills. Evidence: Regularly reviewed personal development plans enable the residents, with help from the management and staff, to set and monitor personal goals. We were told that this had been used to help a resident who had needed physical assistance with her personal care to become fully independent with only minimal supervision over a twelve month period. All three residents have complex needs and have been assessed as needing constant one to one or two to one attention to ensure that they receive enough support to reduce their anxieties or agitation. This is provided by care staff who have been trained to use individually developed behaviour management programmes which enable them to assess the residents moods and plan activities accordingly. This flexible approach has enabled the residents to develop their social skills and to increase their participation in social, occupational and recreational activities both within and outside their home environment. The manager and staff have helped the residents to maintain close links with their families and families are encouraged to be involved in the care planning and review processes. Visitors are welcome at any time, although notice of visits is preferred. We were told that this is to enable all of the residents to be told that visitors are expected Evidence: as they can become agitated or anxious when people they do not know enter their home. Healthy eating is encouraged but this does not prevent the residents being offered a choice of meals and the snacks they enjoy. One of the people who use the service requires a dairy free diet and the home is able to cater for his needs. A professional cook is employed and the care staff who assist with the preparation of meals have received training related to infection control, food hygiene and Safer Food Better Business. The residents can eat their meals together, or separately if they prefer. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The health and personal care that people receive is based on their individual needs. The principles of autonomy, respect and dignity are put into practice. Evidence: The staff provide sensitive and flexible support to enable the residents to meet their personal hygiene needs. Because of the good staffing levels that are maintained, the residents are able determine the time and pace at which assistance or supervision is provided and set their own timetables according to their mood at any given time. Peoples healthcare needs are monitored and, along with regular appointments with a specialist dentist and a chiropodist, the home maintains contact with the residents GPs and other healthcare professionals including the learning disability liaison nurse, consultant psychologist, occupational therapist, physiotherapist and speech and language therapist. One of the residents had recently been very ill and needed to be admitted into a general hospital. The staff continued to provide care for the resident throughout his stay in hospital, working in shifts to ensure that a member of staff was always with him. The residents medication is administered by trained staff. Medication is suitably stored and detailed up to date records, which are regularly audited, are kept to ensure that the medication is administered safely. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Allegations, complaints and concerns will be listened to and taken seriously. This means that the residents are protected from the threat of abuse and their rights are protected. Evidence: The Complaints Procedure is provided in an easy read format for the residents. Feedback from residents and the staff indicates that they would know what to do if a resident made a complaint or expressed any concerns about the service provided. The manager has a system for recording complaints and how the issues raised should be dealt with. Only one complaint had been recorded and was made by a neighbour who complained about the height of a garden fence. The planning department at Teignbridge District Council was consulted and he agreed that the height of the fence was necessary on the grounds of safety and accessibility for the residents. All of the policies and procedures relating to adult protection and safeguarding are kept at the home and accessible to the staff. All of the staff have received safeguarding training. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The way that the home is being used enables the residents to live in a safe, spacious and comfortable environment that meets their individual needs. Evidence: Fairview Lodge is a detached house that is situated within walking distance of the town centre. Limited off street parking is available. Although Fairview Lodge is registered to accommodate a maximum of five people, because the three people currently living at the home can find it difficult to mix with other people, there are no immediate plans to accommodate more than three people. One of the residents has his own flat, which has a bedroom, a sitting room, a bathroom, entrance hall and front door. He showed us around his flat, which clearly reflected his personality and interests. One resident has his own bedroom and sitting room. The staff sleeping in room is next to his bedroom and so the staff sleeping in share his bathroom facilities with him. The third resident has her own bedroom and bathroom. There is a large communal lounge with a communal dining room off it. The kitchen is kept locked but the residents are able to use it with staff supervision. This restriction is imposed for reasons of safety, which are recorded. The laundry facilities are accessible through the kitchen and accessible to the residents with staff supervision. The registered manager has an office which is accessible from the back of house, but Evidence: also has an entrance from the drive which means that people can access the office without disturbing the residents. Although the home is detached and set in its own gardens to all four sides, most of it is very steep and not accessible to the residents for safety reasons. A level area of garden to the front of the house has been fenced and provides a safe outdoor area for the people who live at the home. Overall the premises were found to be in a good state of repair. The roof over one of the bathrooms had been leaking but repairs had been made. The bathroom ceiling was damaged by the leak but we were told that arrangements had been made to refurbish the bathroom. The standard of cleanliness and hygiene maintained within the home is good. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff in the home are well trained, skilled and sufficient in numbers to support the people who use the service. Evidence: All three of the people who use the service have been assessed as having complex needs and needing a high level of staff supervision. The staffing levels are maintained at a level that enables two of the residents to receive a minimum of one to one care throughout the day and evening and the third to receive a minimum of two to one care. An additional support worker is usually on hand to provide additional assistance if a resident chooses to go out. Overnight cover is provided by one support worker on waking duty, one sleeping in and one on call. The records of staff training and feedback from the staff tell us that the provision of staff training in both health and safety related areas and specialist training based on the individually assessed needs of the people who use the service is good. Nine of the support staff have achieved a National Vocational Qualification in care and a further four are currently working towards gaining a qualification. Records of staff recruitment were seen and these told us that safe practices had been used to ensure that unsuitable staff are not employed to work with the residents. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who use this service benefit from living in a well managed home. Evidence: The registered manager has completed her National Vocational Qualification in Care at Level 4 and her Registered Managers Award. She also has a University Certificate in Autistic Spectrum Disorders and has completed a number of courses in health and safety related topics, some at a trainers level, and specialist training to meet the needs of the people in her care. The registered service providers, Peninsula Autism Services and Support Ltd, have system in place to oversee the management of the home and to ensure that the care provided meets the needs of the people who use the service and a copy of the most recent Annual Service Development Plan is kept at the home. Both this document and the completed Annual Quality Assurance Assessment demonstrate that the service providers are not complacent, but are continually looking at ways in which the service and therefore the quality of life of the people who use the service, can be improved. All of the required and recommended policies and procedures for the safe running of the home are in place and kept accessible to the staff. The staff are required to read these documents and to record when they have read them. An open management approach and more formal staff meetings and supervision enable the staff to discuss any issues in the policies and procedures that they are unsure about. The importance of maintaining a safe working environment for the staff and a safe living environment for the residents is very clearly understood by the service providers. Evidence: Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 03000 616161 or Textphone : or 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) Commission for Social Care Inspection (CSCI). 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. 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