Care Home: Fairways

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What the care home does well People have their individual and diverse needs well assessed in order to devise support plans and health care plans, but evidence beyond the actual care plans is not available to verify this. People have satisfactory plans of care and support plans in place that enable staff to meet their needs. Improvements in the effectiveness of care plans will be seen once person centred plans of care are implemented. People have good opportunities to make choices about everyday life and have risks greatly reduced where possible. People enjoy good opportunities to take part in appropriate activities and pastimes in the home and in the community. They make and enjoy appropriate relationships, are respected and exercise their rights, and they benefit from satisfactory and nutritious meals. People receive good personal care and support as they need it, have good, relevant health care plans in place to assist staff in meeting their needs and people benefit from robust and safe systems for handling medication. People have good systems in place to complain or make representations, and they are kept informed. There are good records maintained and staff understand how to pass on complaint information. There also appears to be good systems in place to protect people from abuse and to pass on referrals to the appropriate authorities on safeguarding, though these have not been tested for some time. People enjoy the benefit of a satisfactorily maintained environment that is appropriately equipped and furnished, and is clean, comfortable and safe. Some item will always need replacing or some area will always need redecorating, because of the high usage people in the home make of both private and communal areas. People benefit from sufficient numbers of staff on duty at most times to meet their needs, from satisfactorily recruited, qualified and trained staff. People benefit from an experienced and trained registered manager in post, that uses a quality monitoring system to determine the service performance. The home is well maintained and safe working practices prevail, and these are evidenced in certificates, monitoring checks on safety that are recorded. What has improved since the last inspection? The service now makes sure security checks are received before new staff begin working in the home, so people are protected from the risk of harm from staff that are not safe to care. What the care home could do better: The service could make all original and reviewed assessment of needs documents available for viewing, so people know their needs are properly assessed and can be met. The home`s assessment document should be resurrected and checked for relevance and be implemented when necessary. The service could make sure all person centred plans are implemented as soon as possible. The manager needs to come to a decision on consistency and ensure all people in the home have the same format for their documentation on support and action plans so staff are able to work more effectively with these documents and so people know their needs are met. The service could make sure all staff undertake full safeguarding training every three years and that it is recorded and then make sure they are all competence assessed each year on understanding and using the procedures. This also needs recording. This is so people are confident they are protected from harm at all times. The service could continue to make repairs to the environment and to replace furniture and equipment as necessary, and should consider the refurbishment of the kitchen, to ensure people live in a safe, comfortable home. The service could develop the quality assurance system to include surveying of relatives and other stakeholders at least on an annual basis and to produce an annual report on the findings of the system, so people are confident their views underpin any self monitoring and inform the service of future changes. The service could make sure a maintenance contract is taken out on the new bath hoist, so people are protected from the risk of harm due to an accident. The service could make sure monthly fire safety drills held are fully recorded in that they contain staff signatures as evidence they have completed the drills, so people are confident they are protected from the risk of harm from fire. Key inspection report Care homes for adults (18-65 years) Name: Address: Fairways 119 Cardigan Road Bridlington East Yorkshire YO15 3LP     The quality rating for this care home is:   two star good 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: Janet Lamb     Date: 1 6 0 9 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 Adults (18-65 years) Page 2 of 30 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 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 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 Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Fairways 119 Cardigan Road Bridlington East Yorkshire YO15 3LP 01262676804 01262676804 anne@franklinhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Franklin Homes Limited care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Fairways is a care home registered for twelve people with a learning disability, some of whom have complex needs. The home is situated on the outskirts of Bridlington and consists of a large house with accommodation provided on two floors. There are two lounge areas on the ground floor, one of which also serves as a dining room. The home has a dedicated arts and crafts activity room and people living in the home have access to the garden. The service has its own minibus to enable people living in the home to get out into the local community and for going out on trips. The senior in charge indicated that the current scale of charges are around £973.30 per person per week, with extra charges made for holidays and such as toiletries and magazines. Fairways provides information about the home to people in its Statement of Purpose and Service User Guide, upon request from the manager. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 12 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: two star good 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 peterchart Poor Adequate Good Excellent How we did our inspection: The Key Inspection of Fairways has taken place over a period of time and involved sending a request to complete an annual quality assurance assessment (AQAA) in June 2009, containing information about people who use the service and support workers and details of the homes policies, procedures and practices. The Commission received the requested information at the end of August 2009 and survey questionnaires were arranged to be sent to 10 people living in the home, to 6 health care professionals and 6 staff working there. These surveys were not issued in time before the site visit took place however and so replacement surveys were taken to the home on the day of the site visit. Two surveys were completed by people in the home and two by staff, but no health care professionals were actually given an opportunity to make comments. All of the information obtained about the home from notifications received and information already known from having had contact with the home since the last key inspection was used to suggest what it must be like living there. Care Homes for Adults (18-65 years) Page 5 of 30 Then on 16 September 2009 Janet Lamb made a site visit to the home to test these suggestions and to interview people, support workers, visitors and the home manager if available. Some documents were viewed with permission from those people they concern and some records were also looked at. The communal areas of the home were viewed along with five bedrooms. Only one of the people living at Fairways was formally spoken with but three others were given brief, informal opportunities to make their views known. The manager was unavailable for interview, but a senior in charge and one other staff were spoken with to seek information about the service. What was said was checked against the information obtained through questionnaires and details already known because of previous information gathering and contact with the home. Judgements were made using the information and some of the evidence used at the last inspection to say what it is like living in the home. This report shows those findings and judgements. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The service could make all original and reviewed assessment of needs documents available for viewing, so people know their needs are properly assessed and can be met. The homes assessment document should be resurrected and checked for relevance and be implemented when necessary. Care Homes for Adults (18-65 years) Page 7 of 30 The service could make sure all person centred plans are implemented as soon as possible. The manager needs to come to a decision on consistency and ensure all people in the home have the same format for their documentation on support and action plans so staff are able to work more effectively with these documents and so people know their needs are met. The service could make sure all staff undertake full safeguarding training every three years and that it is recorded and then make sure they are all competence assessed each year on understanding and using the procedures. This also needs recording. This is so people are confident they are protected from harm at all times. The service could continue to make repairs to the environment and to replace furniture and equipment as necessary, and should consider the refurbishment of the kitchen, to ensure people live in a safe, comfortable home. The service could develop the quality assurance system to include surveying of relatives and other stakeholders at least on an annual basis and to produce an annual report on the findings of the system, so people are confident their views underpin any self monitoring and inform the service of future changes. The service could make sure a maintenance contract is taken out on the new bath hoist, so people are protected from the risk of harm due to an accident. The service could make sure monthly fire safety drills held are fully recorded in that they contain staff signatures as evidence they have completed the drills, so people are confident they are protected from the risk of harm from fire. 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. Care Homes for Adults (18-65 years) Page 8 of 30 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 Care Homes for Adults (18-65 years) Page 9 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their individual and diverse needs well assessed in order to devise support plans and health care plans, but evidence beyond the actual care plans is not available to verify this. Evidence: Discussion with people in the home, the senior in charge and staff and viewing of documents with permission where possible, shows the home uses a combination of placing local authority community care assessment forms, its own assessment of needs forms and other information gathered from other sources, to determine what peoples needs are and if they can or cannot be met. Because people have been in the home some years all types of assessment forms have been archived and are unavailable for viewing. Evidence of East Riding of Yorkshire Council assessments is available for those people more recently admitted, but the homes documents are still unavailable. The manager needs to resurrect the homes assessment document, check it for relevance to admitting someone to the home today and review it if necessary. It should be available for viewing in blank Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: format or as completed for all people living in the home. Someone should also retrieve from the archives those assessments relating to people currently living at Fairways and place these on individuals files, as two files seen did not hold them, to show how and when their needs were determined. There should also be evidence of peoples needs being reassessed where drastic changes have taken place over time. A third file, relating to a person more recently admitted, was also viewed and it contains a pre-admission assessment report, though this is in the format of written statements of relevant information and not in the form of a specific assessment document. Recommendations are made in this report to ensure assessment forms are kept for viewing and follow a format that is consistent for everyone, showing at least all of the areas for assessment as listed in standard 2.3. People spoken to could not remember having had assessments done as it was too long ago. They were aware of their case files and had no objection to having them read. Care Homes for Adults (18-65 years) Page 11 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have satisfactory plans of care and support plans in place that enable staff to meet their needs. Improvements in the effectiveness of care plans will be seen once person centred plans of care are implemented. People have good opportunities to make choices about everyday life and have risks greatly reduced where possible. Evidence: Discussion with people in the home, the senior in charge and staff and viewing of case files with permission where possible, and observation of interactions between people and staff, shows there are improvements being made for people regarding their individual needs and choices. There are care plans in place but these are being reviewed and their format is being changed. The old type plan is in an old written format with risk assessment documents being intertwined amongst the action plans, but person centred plans of care are due to be set up. These have not yet been started though. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: There are also health action plans in place as separate documents, though again these have yet to be completed for everyone. There are also still some old individual personal plans in place that need to be reviewed and changed to the new format. Altogether there is a wealth of information in care plans and every area appears to be covered. However, the manager needs to come to a decision on consistency and ensure all people in the home have the same format for their documentation on support plans and action pans so staff are able to work more effectively with these documents. Individual support plans contain information on what support is needed for and who is responsible to support people with communication, behaviour and distress, medication administration, mobility, nutrition, oral hygiene, personal care, leisure and general wellbeing. Health action plans, when completed, will look at medications, physical and psychological support and also have such as health screening information. There are also risk assessment documents that relate to the support people need. Some people may also have a behaviour management plan in place, covering incidents, risk of violence and challenging behaviour. The intended new systems need to be completed as soon as possible to make sure all care needs are consistently, but more importantly are completely, addressed for each individual. Daily decision making is down to people as much as possible, but they often need guidance and information to be able to make informed decisions. Sometimes staff have to steer people towards a particular decision due to the disabilities they have. Observation of people on the day of the site visit shows they are encouraged to make decisions and choices in everyday life, such as what to do, when to bathe, what to wear, how to style their hair, what to eat, whether or not to spend time with each other, whether or not to go out to the shops, etc. People were observed listening to music, watching television, holding hands and sharing time together, enjoying their mid day meal and teasing one another over possessions. Staff try to encourage people to have more choice in their lives. Records in diary notes show what choices people make and how they are encouraged to make them. With choice comes risk and where possible all activities taken up have the risks involved reduced through clear risk management strategies and assessments. People will be discouraged from doing things if the risks are too high, but they will also be actively encouraged if risks are lower and can be reduced or eliminated. People engage in a large variety of pastimes, which are listed in the next section of this report. Where incidents may occur people are merely guided and removed from the situation and encouraged to try something different the next time. Changes may be made the next time to reduce the risk of further incidents. Care Homes for Adults (18-65 years) Page 13 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy good opportunities to take part in appropriate activities and pastimes in the home and in the community. They make and enjoy appropriate relationships, are respected and exercise their rights, and they benefit from satisfactory and nutritious meals. Evidence: Discussion with people in the home, the senior in charge and the staff and viewing of some records and documents with permission where possible shows the general lifestyles of people are improving and tend to be more personal to individuals. People now have better individual opportunities to do educational and occupational activities in the community. They all have a weekly activity plan and a record in place of activities held and places attended. People use the local area and especially Bridlington town for entertainment and pastimes. Each person has their own daily Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: diary that is completed by staff and shows personal care assisted with, activities, outings, appointments to health care professionals etc. Case files also hold records of weight monitored, health support, records of monthly updates on support plans and risk assessments, as well as general monthly reviews held. Information gathered shows people like to bake and cook, take walks, go swimming, visit air shows and the theatre, and go on outings to such as Goathland, Muston to see the scarecrow festival and Knowsley Safari Park. People also take an annual holiday in small groups and though staff are trying to encourage new and different places, such as the countryside, people always choose to go to Disney Paris. Relationships tend to be mainly those established within peoples home circles and those at such as centres and places of activity. People have good contact with family and friends and there are records of trips to visit and stay with them. Daily routines tend to be according to peoples choice and whatever they have planned for the day as part of their programme. Those that attend centres or colleges or are more able to make decisions on their own go out when they wish, enjoy different activities than the home offers and meet with different people as a consequence. Three people attend Priory View, one walks often and long and the rest tend to join in with pastimes in the home, though because the manager was on holiday and one staff had not been able to attend work at short notice, the staffing complement was short and therefore routines had been disrupted somewhat. No one was able to implement any activity on the day of the site visit because of the staffing shortage. Meal times tend to be hurried affairs with people constantly on the go before a meal and then in a rush to consume it once it has been served. People say they like the food very much, but one or two have very rigid likes and preferences and so their intake tends to be a little less healthy than staff would prefer it to be. Other people are encouraged to eat healthily and do eat the food prepared for them. The day of the site visit saw shepherds pie with mashed carrot and swede and gravy being served. The dessert provided was yoghurt. Menus are compiled in advance and usually have a set alternative, mainly sandwiches and salads, but what is actually produced tends to be one set dish per meal and this is usually according to choices of people on the day, and as near to the planned menu as possible, providing the ingredients are available. There were no adverse views expressed about the meals provided. Some effort needs to be made to try to obtain peoples views more often on food options and choices and to meet their requests. Care Homes for Adults (18-65 years) Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good personal care and support as they need it, have good, relevant health care plans in place to assist staff in meeting their needs and people benefit from robust and safe systems for handling medication. Evidence: Discussion with people in the home, the senior in charge and staff and viewing of peoples case files with permission where possible shows there are satisfactory systems in use for personal and health care support. Personal support is provided according to details written in peoples individual support plans, which show individuals assessed needs and how they are to be met in conjunction with risk assessments. Times for rising and going to bed, having meals etc. are flexible and meet peoples needs and routines. Choice of clothes, hair styles etc. are respected and how people are guided and supported is according to their preferences. Evidence is seen in diary notes and in key worker monthly reviews. Health action plans are being introduced but have not been completed for anyone yet. Franklin Homes is to liaise with peoples GPs to seek information and to seek health Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: screening for everyone in order to make sure the health action plans are produced and are current and relevant. Records are maintained of health practitioner visits, dental visit, who supports people with medication administration, with nutrition and with general wellbeing, as well as for recording weight, behaviour, mobility and food and fluid intake etc. Once everyone has a full health action plan in place their needs will be more easily monitored and met. People will also have a patient passport in place in the event they need to be admitted to hospital, which will contain all of their health details and needs. Health checks are carried out as necessary for general health, dental care, optical needs, and so on and all of these are recorded. Medication is handled satisfactorily. Medicines are receipted into the home, stored in a locked facility in a medication store and administered according to the prescription instructions. The home has a monitored dosage system in operation, called the clear advantage and stores cassettes in the medication cupboard. There is a control drugs register, storage facility and practice would be that two staff sign on administering these. No one takes any controlled drugs at the moment and no one ever selfmedicates. The medication administration system is supplied by Moss Chemist in Bridlington and only one seal is used on the dossette box. Some drugs are stored in boxes only. Any returns are sent back to the pharmacy, are recorded and signed for. Staff undertake medication administration training on a medications management course and after training undergo shadowing and competence assessing for a time. They are then considered capable of administering medications alone. Training records and training matrices evidence who is competent to handle medicines and when. Care Homes for Adults (18-65 years) Page 17 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good systems in place to complain or make representations, and they are kept informed. There are good records maintained and staff understand how to pass on complaint information. There also appears to be good systems in place to protect people from abuse and to pass on referrals to the appropriate authorities on safeguarding, though these have not been tested for some time. Evidence: Discussion with people in the home, the senior on duty and staff and viewing of some records and documents show there are still systems in place to deal with complaints and allegations, but that they have not been tested for some time. There is a new complaint procedure in place that is in an appropriate format for people to understand. It tells people how to make a complaint and encourages them to do so if they are dissatisfied with anything. Minor issues have been reported to the manager and dealt with fairly quickly according to the senior in charge. People in the home have spoken up for others who they feel are less capable of doing so. There is a complaint record held which shows there has been none made since before the last key inspection. People spoken with say they would go to the manager, one of the seniors or a relative if they are unhappy about anything and people were observed asking for support and guidance during the site visit. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Staff say they know how to pass on complaint information and try to resolve small issues immediately. There is a safeguarding adults policy and procedure in place that also includes a whistle blowing procedure. Staff undertake safeguarding adults training and this is evidenced in the training matrix and in training records. The manager should make sure all staff undertake full safeguarding training every three years and that it is recorded and then make sure they are all competence assessed each year on understanding and using the procedures. This also needs recording. Systems for making complaints and safeguarding referrals seem not to have been tested recently and so it is difficult to say if they are effective or not. There have been no concerns, complaints or allegations passed to the Care Quality Commission in the last two years and according to information in the AQAA there has been no referrals to local authority safeguarding teams. Care Homes for Adults (18-65 years) Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy the benefit of a satisfactorily maintained environment that is appropriately equipped and furnished, and is clean, comfortable and safe. Some item will always need replacing or some area will always need redecorating, because of the high usage people in the home make of both private and communal areas. Evidence: Discussion with people in the home, the senior in charge and staff and viewing of some private and all communal areas of the home show the environment continues to be satisfactorily maintained and meets peoples needs. Fairways has been registered and operating as a care home for many years and the premises are suitable for its stated purpose of providing care and accommodation to people with a learning disability. It is maintained in keeping with the rest of the local area, has public transport access immediately outside, and as far as is known meets the requirements of the local fire service and environmental health department. Much of the internal building and furnishings are very heavily used by people living there and so replacements and repairs are often needed. Some improvements since the last key inspection are the fitting of an en-suite toilet in one downstairs room, and redecoration of the hallway, stairs and landings. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: However, people tend to be heavy handed and damage to such as stoothing and some brick walls, and to doors and frames regularly takes place. Furniture in bedrooms and in communal areas is also heavily used and often needs replacing, and so the task to keep the home up to standard is a constant one. The new area manager has plans to improve the environment in the coming months and already has new carpets and suites on order. New dining furniture is being tested for robustness before any purchases are made. The home is clearly ready for some upgrading and a long term project ought to be refurbishment of the kitchen. Generally the lounge areas are comfortable and clean. Some bedrooms seen are personalised and homely, while others are sparsely furnished and stark, but they reflect the conditions of people in the home and to have them any other way could cause distress. Where possible alternatives to curtains that have been torn down should be tried out to find a more suitable window covering that gives people privacy when needed. The home is clean and hygienic and all areas seen are satisfactorily maintained in terms of cleanliness. Staff are very vigilant at mopping spills and clearing away after meals etc. and they encourage people to use sanitising hand spray on a regular basis to guard against spread of infection. Staff complete infection control training as evidenced on the training matrix and in staff files. There are policies on infection control and on maintaining good hygiene. The laundry and bathrooms meets the requirements of the Water Supply (Water Fittings) Regulations 1999. Care Homes for Adults (18-65 years) Page 21 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from sufficient numbers of staff on duty at most times to meet their needs, from satisfactorily recruited, qualified and trained staff. Evidence: Discussion with the senior in charge and staff and viewing of staff training files only with permission shows the systems for managing staffing levels, for safely recruiting new staff and for encouraging them to complete qualifications continue to be good. Systems for monitoring training and development have continued to be maintained over the last year or two. Staff undertake NVQ levels 2 and 3 where possible and information on the homes AQAA says there are now 12 from 17 staff with the minimum award, giving 71 of staff with the recommended qualifications. Staff present as an experienced group that has come to understand the particular needs and preferences and specific learning disability conditions of each individual living in the home. Staff speak firmly to people and clearly state to them what is expected from their behaviour particularly towards each other, staff and visitors. Staff encourage people to make their own choices wherever possible, but offer guidance and information to enable them to make informed decisions. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: There is a regular staff team that works to a roster, rotating over four weeks. Generally it is intended for there to be five or six staff on duty each morning shift and three or four each afternoon shift, with one sleeping and one waking staff through the night. On the day of the site visit there were five staff including one senior, as one person had been unable to turn in to work that day. Though this was sufficient staff to meet basic needs there was not enough on duty to provide anything beyond that, such as someone to take people out, to facilitate activities or to spend quality time with people. Staff in surveys say there are usually enough staff to meet peoples individual needs. There is a recruitment policy and procedure in place that meets the requirements of regulation 18 and 19 and schedule 2, and which are adhered to though this could not be properly verified, due to recruitment files being locked away and not available to the senior in charge. Information obtained and documentation seen at the last key inspection therefore informs this inspection. Staff training and development opportunities include all mandatory courses and any courses related to specific conditions of learning disability. Staff complete such as medication administration, safeguarding adults, first aid, deprivation of liberty, fire safety, moving and handling, health and safety,infection control etc., as well as dual diagnosis and psychosis, dementia awareness, autism and asphergers syndrome and sensory integration. They say they feel empowered through completing courses and learning about peoples needs. Care Homes for Adults (18-65 years) Page 23 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from an experienced and trained registered manager in post, that uses a quality monitoring system to determine the service performance. The home is well maintained and safe working practices prevail, and these are evidenced in certificates, monitoring checks on safety that are recorded etc. Evidence: Discussion with the senior in charge and staff and viewing of some of the homes records, documents and maintenance checks and certificates etc. shows there is a responsible, registered manager in post, there is a satisfactory quality assurance system in operation and there are good checks on systems and equipment to ensure the protection and promotion of the health, safety and welfare of people and staff. There is a registered manager in post who is qualified and expereinced to do the job. She was not on duty on the day of the site visit and could not therefore be interviewed, so the senior in charge provided all of the information she was able to, and showed us around the home. The home is run by a qualified and competent person as determined at the last key inspection. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: There is a quality assurance system in operation that consults people in the home via surveys and carries out quality audits on such as care plans and training etc. The home also keeps complaint and compliment forms for completion to inform the service of its performance. The quality assurance system needs to develop further to involve relatives and other stakeholders in completing surveys on at least an annual basis, and then an annual report on the findings of the systems needs to be published for people and stakeholders to view and this is a recommendation of this report. There are some areas of the health and safety checks and maintenance that were sampled in order to determine whether or not the home is promoting and protecting peoples and staff health, safety and welfare. These were fire safety, gas and electrical safety, water temperature and legionella testing, and if risk assessments are carried out on the premises and health issues within the home. There is a fire safety system in operation in the home and it is checked each quarter by HR Fire & Safety. The last visits were made in February, May and August 2009. There is a fire risk assessment document in place last reviewed 07/07/09 and the extinguishers were last maintained in February 2009. There is a weekly fire safety audit carried out on lights, alarms etc. and there are monthly fire safety drills held, though the record needs to contain staff signatures as evidence they have completed the drills. This is a recommendation of this report. Evacuation drills are carried out every three months and everyone exits the building. Annual fire safety training is provided and this is due shortly. The last Humberside Fire and Rescue Service inspection was announced in a letter to the home, to be done in April 2007, but there is no evidence of the visit being made. The landlords gas safety certificate dated 28/05/09 and completed by P. Blakeston plumbing is available for viewing, while the last electrical hard wiring certificated from BB Electricals is dated 29/03/09. Hot water outlets are fitted with thermostatic control valves and water temperatures are tested and recorded, while a legionella certificate provided by Bodycote is dated 26/09/08. There are risk assessments carried out on the premises and all activities within the home, as well as on individuals activities and pastimes etc. One newly purchased bath hoist, in June 2009, seen in the home is not yet under a contractual arrangement for servicing and this needs to be set up, and is a recommendation of this report. It has been portable appliance tested already though under the contract for such testing Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: done by the company L Broardbent. There is sufficient information to establish that the registered provider, registered manager and staff ensure the health safety and welfare of everyone in the home is satisfactorily promoted and protected. Care Homes for Adults (18-65 years) Page 26 of 30 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 Adults (18-65 years) Page 27 of 30 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 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 2 The registered provider should make all original and reviewed assessment of needs documents available for viewing, so people know their needs are properly assessed and can be met. The homes assessment document should be resurrected and checked for relevance and be implemented when necessary. The registered provider should make sure all person centred plans are implemented as soon as possible and the manager needs to come to a decision on consistency and ensure all people in the home have the same format for their documentation on support and action plans so staff are able to work more effectively with these documents and so people know their needs are met. The registered provider should make sure all staff undertake full safeguarding training every three years and that it is recorded and then make sure they are all competence assessed each year on understanding and using the procedures. This also needs recording. This is so people are confident they are protected from harm at all times. The registered provider should continue to make repairs to Page 28 of 30 2 6 3 23 4 24 Care Homes for Adults (18-65 years) 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 the environment and to replace furniture and equipment as necessary, and should consider the refurbishment of the kitchen, to ensure people live in a safe, comfortable home. 5 39 The registered provider should develop the quality assurance system to include surveying of relatives and other stakeholders at least on an annual basis and to produce an annual report on the findings of the system, so people are confident their views underpin any self monitoring and inform the service of future changes etc. The registered provider should make sure monthly fire safety drills held are fully recorded in that they contain staff signatures as evidence they have completed the drills, so people are confident they are protected from the risk of harm from fire. The registered provider should make sure a maintenance contract is taken out on the new bath hoist, so people are protected from the risk of harm due to an accident. 6 42 7 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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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