Care Home: Fairways Retirement Home

What the care home does well The service is managed pro-actively and run in the best interest of the people who live there. The Manager is able to demonstrate that she has the skills and abilities to make sure that all of the residents have their individual care needs met, in a safe and caring environment. The Manager goes to meet people before they move into the home. She talks to the prospective resident, their families and any one else who is involved with the person. This is to find out the type of support and care they will need if they decide to come and stay at Fairways. She also gives them information about the home and the services that are provided, she invites them to come and visit the home. This means that the home can decide whether or not they can look after the person in the way that is best for them. And the prospective resident can make an informed decision about whether or not Fairways is the right place for them. People receive the care that they need in the way that suits them best. The home keeps them as safe as possible while encouraging people to be independent and make decisions about their life`s. People are supported to stay in good health. This includes keeping an eye on how everyone is and then calling doctors and nurses as soon as they are needed. There are activities and things for people to do if they want to. Fairways provides a friendly, homely and comfortable environment for people to live in. There is good atmosphere and residents, staff and management all said that they get on well together. The majority of people living there appeared relaxed and content in their environment. This is what some people told us, `I did not want to leave my home but coming here was the best thing I did. The staff are always available and are very accommodating. It was a good decision`. `It could not be better. The staff are kind and caring`. `You can more or less do what you want. There are things going on, but you don`t have to join in if you don`t want to. I do have choices about what I do`. People know that any concerns or complaints that they have will be taken seriously and they are protected from abuse. This means that they can feel safe and secure in the home. The service is continually renewing and up-grading different areas of the homes` environment. This is to make sure that people have a safe, comfortable, clean and well maintained place to live.The registered manager and provider are continually looking at the ways they are doing things and how they could improve. They ask the people in the home what they could do better and act on what they say. What has improved since the last inspection? The owner has purchased a new assessment tools and care planning system to make sure they are identifying and meeting all the needs of the people who live at the home. The owner continues to invest in the home and improve the homes environment. They have re-decorated and put new carpets in bedrooms and communal areas. The kitchen has been refurbished and new equipment has been bought including a range cooker. They have almost completely double glazed the building and plan to complete this work next year. They have installed a new fire alarm and call system. There is a new medication trolley to make sure people`s medication is stored and administered safely. What the care home could do better: The Registered Manager/Provider need to review and up-date their Statement of Purpose and Service User Guide to make sure people have all the information they need about the service. All people living at the home need to know what they are getting for the fees that are being paid. All of the residents support plans need to contain all the information needed so they can be supported and cared for in the way that suits them best. This should happen when the new care planning system is up and running effectively. The staff need to keep a record to evidence that topical creams which have been prescribed by the doctor are applied as directed. All complaints /concerns need to be logged separately. The staff files could be better organised and audited to make sure all the necessary information has been obtained. There needs to be an up to date photograph of staff on their files. The AQAA could contain more information about how the service has improved and how it plans to improve in the future.We are confident that the registered manager will address these issues. Key inspection report Care homes for older people Name: Address: Fairways Retirement Home Madeira Road Littlestone New Romney Kent TN28 8QX     The quality rating for this care home is:   three star excellent 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: Mary Cochrane     Date: 2 5 1 1 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 32 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 32 Information about the care home Name of care home: Address: Fairways Retirement Home Madeira Road Littlestone New Romney Kent TN28 8QX 01797362336 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr David James care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 28 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 category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Fairways is registered to provide personal care, support and accommodation to a maximum of 28 older people. The home is owned by Mr David James and is managed, on a day to day basis, by Mrs Alison Yarnley. The home is close to the beach at Littlestone on Sea, and backs onto a busy golf course. Care Homes for Older People Page 4 of 32 Over 65 28 0 Brief description of the care home It is a large Victorian detached property set in its own secluded grounds. There is a regular bus route approximately 10 minutes walk away. The property has had several extensions to the original building which has provided seven extra bedrooms with ensuite facilities. One of the rooms is a double bedroom. Bedrooms are only shared by individual consent and as a positive choice. Two of the five communal bathrooms have fitted hoists, and seven communal toilets are well placed throughout the home. Several ground floor bedrooms have patio doors opening onto the garden. Interesting views are available from every window in the home. The offices are on the top floor, and a training room with separate wc is available. A range of in house activities is provided each week for people to access if they wish. The fees for this service range between £328.65 and £494.00 per week with additional charges for newspapers, chiropody and hairdressing. Information about the home can be found in the Statement of Purpose and Service Users Guide. The latest CQC report is available. All of these are available in the entrance hall of the home. Care Homes for Older People Page 5 of 32 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 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: The quality rating for this Service is 3 Star. This means that the people who use this service experience excellent quality outcomes. We arrived unannounced at the home at 10:30 and we were there for about six hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Manager and Provider in the self assessment. This is called the Annual Quality Assurance Assessment. (AQAA). We received this on time and it contained most of the information we needed to assist us with the inspection. We looked at any other information that we have received about the Service in the past twelve months. We did our last Key Inspection on 30th January 2007. In the intervening period we have also done an Annual Service Review. We completed this on 21st November 2008. Care Homes for Older People Page 6 of 32 This was an office based activity when we reviewed all of the information that we had gathered since the last Key Inspection. During the visit, we spoke with five of the people who currently live in the home. We also observed and looked at what people were doing in the communal areas and had a general chat with them. We spoke with the Registered Manager and the Provider. We also spoke with three care staff. We looked around parts of the accommodation. We also looked at a selection of records and documents. These included things like the individual written plans of care, medication records, the activities plan, the menu, complaints documents, the staff roster, staff training records, financial records and the quality assurance systems used by the service. Care Homes for Older People Page 7 of 32 What the care home does well: The service is managed pro-actively and run in the best interest of the people who live there. The Manager is able to demonstrate that she has the skills and abilities to make sure that all of the residents have their individual care needs met, in a safe and caring environment. The Manager goes to meet people before they move into the home. She talks to the prospective resident, their families and any one else who is involved with the person. This is to find out the type of support and care they will need if they decide to come and stay at Fairways. She also gives them information about the home and the services that are provided, she invites them to come and visit the home. This means that the home can decide whether or not they can look after the person in the way that is best for them. And the prospective resident can make an informed decision about whether or not Fairways is the right place for them. People receive the care that they need in the way that suits them best. The home keeps them as safe as possible while encouraging people to be independent and make decisions about their lifes. People are supported to stay in good health. This includes keeping an eye on how everyone is and then calling doctors and nurses as soon as they are needed. There are activities and things for people to do if they want to. Fairways provides a friendly, homely and comfortable environment for people to live in. There is good atmosphere and residents, staff and management all said that they get on well together. The majority of people living there appeared relaxed and content in their environment. This is what some people told us, I did not want to leave my home but coming here was the best thing I did. The staff are always available and are very accommodating. It was a good decision. It could not be better. The staff are kind and caring. You can more or less do what you want. There are things going on, but you dont have to join in if you dont want to. I do have choices about what I do. People know that any concerns or complaints that they have will be taken seriously and they are protected from abuse. This means that they can feel safe and secure in the home. The service is continually renewing and up-grading different areas of the homes environment. This is to make sure that people have a safe, comfortable, clean and well maintained place to live. Care Homes for Older People Page 8 of 32 The registered manager and provider are continually looking at the ways they are doing things and how they could improve. They ask the people in the home what they could do better and act on what they say. What has improved since the last inspection? What they could do better: The Registered Manager/Provider need to review and up-date their Statement of Purpose and Service User Guide to make sure people have all the information they need about the service. All people living at the home need to know what they are getting for the fees that are being paid. All of the residents support plans need to contain all the information needed so they can be supported and cared for in the way that suits them best. This should happen when the new care planning system is up and running effectively. The staff need to keep a record to evidence that topical creams which have been prescribed by the doctor are applied as directed. All complaints /concerns need to be logged separately. The staff files could be better organised and audited to make sure all the necessary information has been obtained. There needs to be an up to date photograph of staff on their files. The AQAA could contain more information about how the service has improved and how it plans to improve in the future. Care Homes for Older People Page 9 of 32 We are confident that the registered manager will address these issues. 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 Older People Page 10 of 32 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 11 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People might not be aware of what services the home has on offer and how their places are protected. People who are thinking of moving in are asked about what care and support they need and how they want this to be done. They are encouraged to visit the service to get a first hand feeling of what it is like. Evidence: The home has a Statement of Purpose and a Service Users Guide. The AQAA told us that a Fairways Prospectus is available on request and is a comprehensive pack comprising of the Statement of Purpose, Philosophy of Care, Residents Personal Finance Policy, Meal Times, Telephone details, Visiting Times, Sample Breakfast/Lunch/Tea Menus and Residents Contract. We were unable to see this at the time of the inspection Care Homes for Older People Page 12 of 32 Evidence: We saw that some of the Statement of Purpose was on display in the homes hallway. This told people the objectives of the service and the philosophy of care. People do get a leaflet about the home but this not written in a format that is easy to read and it does not tell people all about the services and support and care they will receive. The Provider and the Registered Manager said that they are going to review and update both these documents so they contain all the information needed for people. This will make sure people and their representatives can make an informed choice about whether or not Fairways is the right place for them. The home has a pre-admission assessment procedure. We looked at three assessments of the most recent people to move to Fairways. We saw that the registered manager visits prospective residents in their own home, in hospital, or in their existing placement to carry out a pre-admission assessment. This helps the service decide on whether they will be able to offer the person the support and care that they need. The assessment looks at the prospective residents physical and mental health, personal care and social needs. It also looks at cultural and religious needs. The home will not accept any resident unless they are confident that they can give the care and support that they need. Prospective service users and their representatives are given a guided tour of the home and meet the other residents before they decide if Fairways is the right place for them. There is a 28 day trial period so people can decide if they have made the right decision about moving to the home. Some people have a contract with the service these are the people who are privately funded. People who are funded by social services do not have information about the terms and conditions of the service. This means that some people might not know what they are paying for. The provider told us he would make sure that everyone does have this information so that they know what services the home provides for the fees paid what the extra costs are. The home does not offer intermediate care. Care Homes for Older People Page 13 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the personal and health care they need and are supported by a multi-disciplinary health care team. The ethos of care ensures that residents are treated equally and with kindness and respect. Evidence: At the time of the visit the Registered Manager identified the need to further develop and improve the care planning system. The service have purchased new documentation and a new format to help them identify all the care and support needs of the residents. This will eventually help them develop more robust plans to make sure all the residents needs are being met. The Registered Manager had identified some shortfalls in the new tool and was working out the best way to use the old and the new together to make sure everyone gets the care and support that they need. When the assessments and plans are fully completed and brought together they should contain all the information needed to assist staff in looking after people in a way that suits them best while keeping them as safe as possible. Each person at the home has a care plan. We looked at three of these in detail and at Care Homes for Older People Page 14 of 32 Evidence: specific things in another two. The plans contain information on daily living needs like nutrition, personal care, skin integrity, mobility, health and social needs. If risks are identified then a risk assessment is developed. The home looks at ways in which people can be kept as safe as possible while at The Fairways. There are risk assessments in the individual care plans. This means that they have looked at areas which might present a risk and have taken steps to reduce this. The plans do give an account on the support and care people need with regards their personal care and who needs to do what and why. They did reflect what people can do for themselves. For example they explained that a person could wash and get dressed independently but needed some assistance when having a bath. The risk assessment then explained what assistance was needed. The plans are being developed to promote independence and maximise peoples abilities. Some of the plans identified goals and aspirations. One person was being encouraged and supported to mobilise with a walking aid. The aim was to walk a little further each day until she reached her target of the front gate. The person said that they felt they had something to aim for and achieve. The next step was too able to get into a car without having to rely on a wheelchair. Health care needs of people are identified and they are incorporated into the plans but it is difficult to trail and find out how these needs are being supported and met. The manager has already identified this shortfall. She is working on ways to improve the system so that health care information is easy to assess and monitor. This means that any health problems existing or new problems will be quickly identified and the appropriate action can then be taken. We found that some of the plans had not been updated to reflect the changing conditions of residents. We found that one person was recently prescribed a cream for a pressure area. But the care plans had not been updated to reflect this and no record was being kept that the cream was being applied. The registered manager said that this would addressed immediately. We also found that a plan identified a person as being aggressive but there were no guidelines in place to tell staff how to deal with this situation if it should arise. We did see some accurate and precise care planning about a person who is a diabetic and who was giving their own insulin. There was step-by-step guidance in place for staff about what to do if the blood sugars went too high or too low. There was also a robust risk assessment place to make sure the person was giving their insulin at the right dose and at the right time. Care Homes for Older People Page 15 of 32 Evidence: People also have the aids that they need to help them get around and access facilities independently. We spoke to care workers and they were able to explain about the support and care they give to people and how they do this in a way that best suits that person. We saw evidence that they did this according to the individuals care plan. The people we spoke to told us that the staff are very good and attentive. They said the staff will do what ever you want and are always around to help. The records show that people are receiving the medical care they need. This includes seeing professionals such as their doctor as and when they are needed. They also see specialist doctors and nurses who give advice to the service about how best to look after people who have more complex care needs. Staff keep a daily record of what people do during the day. More information could be put in these so there is a better picture of how people spend their time and what significant events have happened. The AQAA told us that care plans are reviewed on a monthly basis. The residents have regular appointments with opticians, a chiropodist and dentists. All staff who administer medication have received training. We saw no evidence to show that their competencies are checked at regular intervals. The prescription sheets were all signed and no gaps were identified. Medication policies and procedures are in place. The medication being used is stored safely and at the correct temperatures. A lot of the peoples medication is given by using blister packs which are made up at the pharmacy. This system reduces the risks of errors when giving out medication. Some of the residents are prescribed topical creams but there was no record kept to show these had been applied. The staff did tell us that they did apply the creams and sometimes the residents did their own. There is no system in place to make sure people are receiving the prescribed treatment. The registered manager said this would be addressed. Controlled drugs are stored safely and correctly. The system used for monitoring the drugs was confusing but the manager said this would be rectified. People told us that the staff are very respectful and they are treated with dignity. One person told us, Some of the staff are young but they always listen to what I say. They Care Homes for Older People Page 16 of 32 Evidence: take into consideration how I am feeling. We saw that the staff are polite courteous and attentive to the residents. Staff spoke quietly and politely to people. They were discreet when supporting people from the lounge to the bathroom. We saw that they knocked on doors before entering peoples rooms and they explained to people what they were going to do and why. Care Homes for Older People Page 17 of 32 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 can take part in social activities if they want. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: We looked at what was happening in the home to make sure people are supported to do what they want and are encouraged to live fulfilling lifes. We regarded activities not only as those that were laid on by staff, such as quizzes or arts and crafts , but being happily occupied, such as speaking with other residents or enjoying listening to music. We found that staff were friendly and attentive. We saw that most of the residents had some opportunity to have quality contact with staff and other residents. People told us that there is a friendly, relaxed and welcoming atmosphere at the home. They said they could join in organised activities if they wanted to but they are given the choice. Some people told us they preferred to stay in their own rooms and listen to the radio, read or watch T.V. We saw that there was a range of things people could do and records showed that people did different things. The staff organise quizzes. One resident has started a twice weekly discussion group. The manager supports them to research a chosen topic Care Homes for Older People Page 18 of 32 Evidence: and then whoever wants to can join in the discussion. People told us they enjoyed this. Sometimes there is a sing-a long and out-side entertainers do visit regularly. Some people go out with support from the staff and others go out with friends and relatives. The AQAA told us that outings are arranged to suit residents interests such as Pantomimes, Horse and Cart rides and The Rare Breeds Farm. They also hold an annual Garden Fete with live entertainment stalls and raffles plus there a number of raffles throughout the year to raise monies for the Residents Outings fund. The AQAA also said that one person is a keen gardener. The service have now specially adapted low level steps and handrail into the garden so the person can access the garden independently. They have also created a raised flower bed so the person can continue to plant and grow things. The people we spoke to felt they have a choice about how they live. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the choices they are offered. The home is demonstrating how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their liives. People are encouraged to make their bedrooms personal. They can bring in things from their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like home. All residents are invited to attend residents meetings. These are held at regular intervals. The meetings give people the opportunity to express their views and make suggestions regarding their care at Fairways. They also make suggestions on how the service can be improved. The manager told us that suggestions are listened to and acted on. Residents are encouraged to maintain contact with family and friends and are able to receive visitors in the privacy of their own room if they wish. Or there is a quiet lounge on the first floor of the home. The home employs two cooks. They have a weekly menu and an alternative choice of meal is always on offer. Care Homes for Older People Page 19 of 32 Evidence: Special diets are catered for. Residents said they enjoy their meals and there is always choice. One person told us that the kitchen staff are very accommodating and will get you whatever you want when you want it. They said there are always snacks and drinks available. We observed lunchtime at the home. There was a friendly, relaxed and sociable atmosphere. The tables and the food were well presented. People were given time to eat their meals without feeling hurried. Care Homes for Older People Page 20 of 32 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 good 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 the service are confident complaints will be listened to and dealt with appropriately. People who use the service are protected from abuse. Evidence: The home has a complaints procedure which is displayed in the hallway of the home. It contains all the information to tell people what they have to do if they want to complain and what will happen. The procedure is not easy to see and we did not see it displayed in other areas of the home. We spoke to service users who told us, If I was worried about anything I would tell the manager. She sorts things out. There has been one formal complaint made to the home in the past twelve months. This was dealt with according to the homes policies and procedures. An outcome was reached and we saw evidence of this at the visit. A home has a complaints log for more informal complaints made by people. A record is kept of the out-comes. We could see that all complaints are taken seriously and the manager is pro-active in resolving these. These informal complaints are kept all together in one book. This means that the nature of the complaint is not kept in a confidential way. The service would benefit from doing these separately and recording the outcomes individually. Care Homes for Older People Page 21 of 32 Evidence: The home told us that it has policies and procedures relating to safeguarding adults. The staff have received up to date training in safe guarding adults. Staff were able to tell us about abuse and what they would do if they suspected or evidenced that someone was not being treated as they should be. Staff told us they knew about the whistle blowing policy. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home has policies and procedures in place to assist in and support people to manage their finances. The policies and procedures protect people from financial abuse. Care Homes for Older People Page 22 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service continues to improve and maintain the environment to provide people with a comfortable, homely and safe place to live. The residents benefit from a clean environment. Evidence: We looked around different parts of the home. We looked at all the communal areas and we were invited into some of the residents bedrooms. There is an enclosed garden to the rear which has seating for people in the better weather. The communal space consists of a lounge and dining room, and a large conservatory. There is another smaller lounge on the first floor of the home. These are bright and airy rooms in which a range of activities can take place. The AQAA said all the communal areas have been redecorated including hallways, staircases, woodwork, TV lounge and quiet lounge. Many of the bedrooms are well decorated and furnished and have been personalised by residents and their relatives. Some of the rooms have recently been re-carpeted The AQAA told us that the exterior and interior maintenance has been extensive: for example the building has been almost completely double glazed over the last two years. Each of the rear ground floor rooms has direct door access to the well Care Homes for Older People Page 23 of 32 Evidence: maintained garden with views over the Littlestone Golf Course. There is a wireless Fire Detection System which was installed in 2007. A new wireless Nurse Call System was fitted in 2006. In the last two years the kitchen has been refurbished with new equipment including a range cooker. There is a environmental development programme in place to address any areas needing improvement on a priority led basis. Residents we spoke to said that they like their rooms and they can furnish their rooms however they choose. One lady said, I have everything I need here. I have bought in bits and pieces from my old home. People told us that they are always warm. People have the necessary aids and equipment to assist them in maximising their abilities and improving their comfort and health. These including pressure relieving equipment, specialist chairs, walking frames and wheel chairs. The home is clean and hygienic with no unpleasant odours. Procedures are in place to control the spread of infection. There are the facilities available in all the appropriate areas for hand washing and the home has the appropriate facilities for the disposal of clinical waste. There is a laundry room and soiled laundry is transported correctly and washed at the appropriate temperatures. Care Homes for Older People Page 24 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of staff with sufficient training and experience to meet the needs of the residents. The staff have a good understanding of the residents and positive relationships have been formed. Recruitment practises protect residents. Evidence: We looked at the number of staff on duty for each shift and spoke to residents and staff. From this we were able to see that there are enough staff on duty throughout the day and night to look after the people. During the day, there are other members of staff on duty. They work in the kitchen or do the housekeeping. There is also a maintenance person. Residents told us that there is staff available when you need them. They said the staff are very good and very kind. At the visit we saw peoples needs being anticipated and promptly met by staff. We noticed when people asked to be helped they were assisted straight away. Care Homes for Older People Page 25 of 32 Evidence: We saw records of staff training. Training is well organised and is updated at the required intervals. Any gaps in mandatory training are quickly identified and the necessary training is then accessed as soon as possible. The home provides specialist training to ensure that staff have knowledge and skills to look after people. On the day of the visit, two senior members of the staff team were at Mental Capacity Act Training and Deprivation of Liberties Training. This means that staff will know the correct action to take if there are any concerns in these areas. The registered manager is also trying to access diabetes training for staff. This should provide staff with the skills and knowledge to help them look after and support residents in the best possible way. New staff receive an induction which they first start work at the home. The AQAA told us this is linked to the Skills for Care programme. Staff told us they receive the training that they need. They said the manager encourages them to develop their knowledge and skills. We did find that staff competencies are not being formally checked. This means that staff may not be providing care in the way they have been trained. The manager did tell us that she monitors and observes the performance of staff on a daily basis. She told us that she will develop this into a more formal format. The staff have almost reached 50 of staff trained to NVQ level 2 or above. The manager told us they will keep working towards this target. To make sure the residents are kept safe and are protected the home has thorough recruitment practises in place. We looked at three of the staff files these included two of the most recently employed staff. The manager completes a number of safety checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. Not all the staff have an up to date photo on file. The manager does not keep a record of the questions she asks people at interview and their responses. She said that she would do this. It will make sure that all areas have been explored by the service especially when asking about gaps in employment history. The files could be better organised and audited to make sure all the necessary information has been obtained. Care Homes for Older People Page 26 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interest of the people who live there. The health, safety and welfare of the service users is promoted and protected. Evidence: The registered manager has the required qualifications, experience and skills to run the home in the best interests of the people who live there. She is continually supported by the registered provider who visits the home several times a week. They have formal weekly meetings where a broad range of issues concerning the home are discussed, resolved, and a plan of action is put in place. They are keen to identify any shortfalls in the service and take action to improve. During the visit the registered manager and the provider were open and transparent. They knew and were willing to discuss the weaknesses in the service and how they planned to address them. The registered manager was able to give a clear vision of where the home is heading and is able to communicate a clear sense of direction and purpose. The way the home Care Homes for Older People Page 27 of 32 Evidence: is run shows an understanding of peoples diverse needs and how the service plans to meet them. The residents and staff were positive and complimentary about the leadership and management of the home. One person told us, The manager goes out of her way to support us. She does extra things that I am sure she doesnt have to do. It makes a difference. The home has quality assurance systems in place. The AQAA told us, We actively encourage and welcome the views of our residents, their relatives and friends. A comprehensive Annual Questionnaire is sent to residents and their families covering a wide range of issues. All feedback is collated and measured by management enabling us to address concerns, shortfalls or issues affecting service delivery. This enables us to address individual concerns and issues which are routinely discussed at the Residents Meetings. We also provide a (tick box) Brief Questionnaire in our reception lobby which is always available for any visitor to complete and rate their opinion of Fairways. The Brief Questionnaire provides an instant measure of our environment and how visitors perceive us. Any negative concerns are addressed immediately. Regular audits are done on the systems used within the home this makes sure that standards are maintained and with the aim of identifying shortfalls. We received an AQAA from the home when we asked for it. Some of the information was detailed and gave us the information we needed to assist us in the inspection process. There could have more information in some areas especially in how the service had improved and how they are planning to improve in the future. We spoke to the manager about this and she told us she would make sure more information is included in the next AQAA. There is a system whereby each member of staff meet regularly with someone senior to discuss their work. This means that they can talk through any work problems they may have and how they plan to develop. The staff told us they now feel supported by management. Environmental and personal risk assessments are in place. We saw that all fire assessments and checks are done at the required intervals. The manager told us water temperatures are taken and comply with regulations. Financial procedures are in place to safeguard residents monies. Care Homes for Older People Page 28 of 32 Evidence: The registered manager keeps us up to date about things we need to know about the service users and the home. Care Homes for Older People Page 29 of 32 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 30 of 32 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 Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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