Care Home: Fassaroe

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What the care home does well Fassaroe House provides a friendly, homely and comfortable environment for people to live in. There is good atmosphere and residents, relatives, staff and management all said that they get on well together. The majority of people living there appeared relaxed and content in their environment. Residents said the staff are very kind and good. The home makes sure that people have the information they need about the service and what is on offer. People are fully assessed before they come to stay. This makes sure the service can give them the support and care that they need. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. Any complaints or concerns are taken seriously and acted on promptly. Each of the residents has their own room. If people want to they can bring in personal belongings, which make them feel more comfortable and `at home`. What has improved since the last inspection? Statement of Purpose of the home has been up-dated so that it reflects the present situation with in the home. The resident`s care/support plans and risk assessments have been re-done. They are now more tailored to meet the individual needs of the people at the home. Staff are offering care and support to people in the way that suits them best. They are supporting people to do as much as possible for themselves while keeping them safe. Staff are now receiving the guidance and direction they need to look after people. The medication practices and procedures are being followed by staff to make sure people receive the medication they need on time and safely. Staff were seen to treat people with dignity and respect. This is now incorporated throughout the care plans and through staff training. Activities and leisure pursuits have been developed so as to allow and encourage people to have meaningful and active lives that suit their preferences and capabilities. Mealtimes arrangements have been re- organised so that residents receive their meals in a more dignified and timely way. Staff have received training in infection control and are following the homes procedures to make sure people are protected from cross infection which could lead to out breaks in illness. Competency and appraisal of care staff and updating mandatory training have taken place and is on-going. Staff have been given the opportunity to develop there skills sothey can look after people in the correct way. Staff have received the training they need to protect people from abuse. They have also received training in specialist areas which improve the care and support given to residents. The home has developed its quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the residents. All safety checks are being done at the necessary intervals so people live in a safe environment. What the care home could do better: There needs to clearer pathways in place to monitor peoples support and care needs. This will make sure any problems can be quickly identified and dealt with. This will promote health and well being for residents living at the home. The service needs to develop an on-going maintenance plan for the decoration and upkeep of the service. The manager needs to register with the commission. This will show us that she has the commitment and reliability to manger the service effectively and in the best interests of the people who live there. The registered person needs to make sure that the AQAA required by the commission is filled in to a good standard and contains the necessary information to tell us the home is providing the service to meet the needs of the people who live there. The registered provider also needs to provide sufficient information in the monthly visits to show that thorough checks are being made to make sure all areas of the service is functioning as it should. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fassaroe 5-7 Warwick Road Walmer Deal Kent CT14 7JF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary Cochrane     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Fassaroe 5-7 Warwick Road Walmer Deal Kent CT14 7JF 01304361894 01304382149 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Fassaroe Ltd care home 28 Number of places (if applicable): Under 65 Over 65 0 28 dementia old age, not falling within any other category Additional conditions: 28 0 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 : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Fassaroe is a 28-bedded home for older people with dementia care needs. The service came under new ownership in January 2007. The home is situated in a quiet street off the main road leading into the seaside town of Deal. Local shops and amenities are close by and the town is approximately 1 mile away. The home is also close to the beach. There is a reasonable bus service into Deal and Dover. The home itself is situated over two floors, with the main communal spaces being on Care Homes for Older People Page 4 of 31 Brief description of the care home the ground floor and bedrooms on both floors. There is a garden surrounding the building. The home has the benefit of a good-sized and well-equipped laundry and large kitchen. The current weekly fees for the service at the time of the visit range from £386.86 (KCC rate) to £550.00 (depending on the room size and service users needs). Information on the Home services and the CQC reports for prospective service users is detailed in the Statement of Purpose and Service User Guide. Care Homes for Older People Page 5 of 31 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 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: We last inspected this service on 28th May 2008. This visit to the service was an unannounced Key Inspection which took place over one day. We stayed at the home for about 7 hours. The manager was available throughout the site visit. The people living at the home and the staff on duty were helpful and co-operative. To collect evidence for this report we spoke with residents, relatives and had discussions with the management team and care staff. Care Homes for Older People Page 6 of 31 We observed how staff supported residents during social activities and when offering care and support. We looked at and discussed residents individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. During this visit, we looked around part of the home. Before we called to the Service, we sent surveys to people who live there and to members of staff and professionals who visit the service. We wanted them to tell us what they think of Fassaroe House. An annual service assurance assessment (AQAA) was also sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information we have received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. We also looked at any complaints received and any issues that affect the safety of the residents. What the care home does well: What has improved since the last inspection? Statement of Purpose of the home has been up-dated so that it reflects the present situation with in the home. The residents care/support plans and risk assessments have been re-done. They are now more tailored to meet the individual needs of the people at the home. Staff are offering care and support to people in the way that suits them best. They are supporting people to do as much as possible for themselves while keeping them safe. Staff are now receiving the guidance and direction they need to look after people. The medication practices and procedures are being followed by staff to make sure people receive the medication they need on time and safely. Staff were seen to treat people with dignity and respect. This is now incorporated throughout the care plans and through staff training. Activities and leisure pursuits have been developed so as to allow and encourage people to have meaningful and active lives that suit their preferences and capabilities. Mealtimes arrangements have been re- organised so that residents receive their meals in a more dignified and timely way. Staff have received training in infection control and are following the homes procedures to make sure people are protected from cross infection which could lead to out breaks in illness. Competency and appraisal of care staff and updating mandatory training have taken place and is on-going. Staff have been given the opportunity to develop there skills so Care Homes for Older People Page 8 of 31 they can look after people in the correct way. Staff have received the training they need to protect people from abuse. They have also received training in specialist areas which improve the care and support given to residents. The home has developed its quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the residents. All safety checks are being done at the necessary intervals so people live in a safe environment. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 who are thinking of moving into Fassaroe House are asked about what support they need and how they want this to be given. They will only be admitted if the home are confident of meeting these needs. People know what they are paying for. Evidence: The home has a Statement of Purpose and a Service Users Guide. The Statement of Purpose contains the information needed. It sets out the objectives and philosophy of the service and is up to date to reflect the present situation in the home. The Service Users Guide has been reviewed and updated and contains information to assist people in making a decision about whether the home is the right place for them to live. The guide is not written in a format that might make it more accessible and understandable for the people the home caters for. It does include information on how to make a complaint. Care Homes for Older People Page 11 of 31 Evidence: Everyone who uses the service has a terms and conditions/ contract in place. This explains what the service provides for the money paid. The terms and conditions/contracts are kept within the individual file of each person so they are accessible to residents and their families and representatives. They are signed by the person/ representative and the owner of the home. We looked at the assessment of the 2 most recent people who have come to live at the home. The service has developed an assessment format which looks at the person as a whole. It identifies the persons care/support needs and also looks at other aspects of their lives. It gives a information about their past, their likes and dislikes. Pastimes and religious and cultural preferences. The pre-assessment tool is also supported by other assessments for nutrition, skin integrity and cognition and behaviours and also in conjunction with joint assessments done by care managers. It would benefit the residents if this information was used as baseline to monitor whether people improve or deteriorate after they have come to live at the home. The manager told us she would do this. The home does not offer intermediate care. Care Homes for Older People Page 12 of 31 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: Since the last inspection the home has changed the way it plans care for the residents. Each person has an individual plan which people can say what assistance and support they want and how they want it to be done. Also, the plans give information to care workers so that they know what to do. We looked at three of these plans in detail. They give a clear account of who needs to do what and why. They did reflect what people can do for themselves as opposed to what they cant do. For example they explained that a person could wash and get dressed independently but needed some prompts and direction to help focus on the task in hand. The plans also gave details on how best to support people with regards their nutrition, skin and how best to manage some behaviours. On admission to the home all Care Homes for Older People Page 13 of 31 Evidence: residents have a skin integrity assessment. This makes sure that anyone who is at risk of developing pressure areas is identified on arrival. The appropriate aids are then put in place immediately to prevent skin breakdown. People had special mattresses on their beds and they were sat on cushions that help prevent the skin from breaking down. Some people had cream applied to their pressure areas. The assessments are reviewed at regular intervals. 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. Residents 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. 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. We saw that care plans are reviewed on a monthly basis. We found that sometimes people have visits from doctors or other specialists. A record of this is kept in the in a different part of the plan but we found then that changes to care are not monitored on a daily basis and plans had not been updated. For example one person had a change to her medication. There was nothing written to show if this being effective or if it made no difference. There was no trail. This means there is a risk of things getting missed. The manager told us she would address this issue. 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. The home looks at ways in which people can be kept as safe as possible while at Fassaroe house. They include 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 homes have been proactive in reducing the numbers of falls to residents by having risk assessments and looking at all the reasons why people might fall. They have then taken the steps to prevent this happening. For example one person had here medication reviewed and changed. Other people are supported when mobilising. There are guidelines and directions for staff if people have behaviours that might present a risk to themselves or others. Each resident is registered with a local Care Homes for Older People Page 14 of 31 Evidence: doctor and any area of concern related to health is referred to them. The home has contact with the district nursing team. The home also has contact with the local older peoples mental health team and consultant psychiatrist. This means that people at Fassaroe House are well supported and can easily access the specialist community services when they need them. Visiting professional reported the home offers a good standard of care. The residents have regular appointments with opticians, a chiropodist and dentists. Medication procedures were looked at. These have improved since the last inspection. All staff who administer medication have received training and their competency are regularly assessed. The prescription sheets were all signed and no gaps were identified. Medication policies and procedures are in place. Medication is stored safely and at the correct temperatures. Some of the people staying at the home are prescribed medication (this includes topical creams) on a when required basis. It is recommended that medication prescribed when required needs to have written instructions and guidance for staff to ensure that the medication is administered consistently and can be monitored. There was no monitoring system when pain relief was given to people. As the resident group have varying communication difficulties, staff would be expected to observe and record the effect of such medication. The registered manager said she would address this. Since the last inspection the manager has given a lot of attention to how the residents are respected and treated and how their privacy and dignity is upheld. The staff receive have training and discussions about this when they first start work at the home. This is carried on and re-enforced throughout there induction and is included in all other aspects of training and care at the home. We observed that 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. Residents and relatives told us that the staff are very approachable and obliging. Care Homes for Older People Page 15 of 31 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. There are activities for people to do if they wish. People are free to receive visitors. Good quality meals are served. Evidence: There was a friendly, relaxed and welcoming atmosphere on the day of our visit. Some people were in the lounge or conservatory reading newspapers, books or magazines. Staff were encouraging and supporting some people to participate and join in board games. Other people had chosen to sit in the quieter lounge or stay in their rooms. Residents, relatives and staff told us that the activities that happen in the home have improved. There is an activities person who works 16 hours a week at the home. There is a weekly activities programme in place, which people can choose to participate in. The manager told us that each week someone comes in to lead gentle exercises and that another person comes to take an arts and crafts session. There are also outside entertainers who come in to play music and to give talks. There are also pet visits and reminiscence. The activities person also organises game sessions. People do on occasions go out to the in the local area for walks. Relatives told us this is an area that could be developed more. The manager plans to arrange more community trips when the weather improves. The staff are recording when people do things but they are not Care Homes for Older People Page 16 of 31 Evidence: saying what they do if they chose not to participate. They are not recording how they are trying to engage people and how they spend their time. The manager told us she would address this. People told us that they enjoy the activities that happen at the home. One person said there is always something to do. There are plenty of people to chat to. Another told us, you join in if you want to, you have a choice. No one forces you to do any thing you dont want to. 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. The staff were observed making visitors welcome and involved. The service told us and evidence was seen if a resident expressed a wish not to see or speak to a particular person, this would be respected and recorded as their preference. In most areas residents are encouraged to maintain their independence and have control over their own lives. They have choices about what they eat, when they get up and go to bed. They are encouraged to choose what they wear. The home does need to evidence and demonstrate more how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their lifes. All residents and their relatives are invited to attend residents meetings, which are held at regular intervals. The meetings give people the opportunity to express their views and make suggestions regarding their care at Fassaroe and also to make any suggestions on how the service can be improved in any way. The manager told us that suggestions are listened to and acted on. The service doesnt get involved in handling peoples financial affairs. Instead, most people get help from members of their family. People are encouraged to make their bedrooms personal. They can bring in things for 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. The home employs 2 cooks and 2 kitchen assistant who cover the kitchen 7 days a week. We spoke to the cook who is committed to providing a good standard of food and catering to the residents. He uses fresh ingredients of a good quality and told us he didnt become a cook to open frozen packets. The menus are planned over a 4 week period. Residents likes and dislikes are taken into consideration. There is a daily set menu and choices are available. We observed lunchtime at the home. Since the last inspection how meals times are arranged and the support people are given has improved. People had more space to eat their meals as the home were using the quite Care Homes for Older People Page 17 of 31 Evidence: lounge and conservatory. There was a friendly, relaxed and sociable atmosphere. The tables and the food were well presented. Staff were available to offer discreet assistance if required. People were given time to eat their meals without feeling hurried. People were given a choice about whether they wanted their lunch or if they would rather leave it for a while. Staff were seen to ask people what they want and offer them a choice of food and drinks. A record is kept of food eaten by individuals is kept so any problems can be quickly identified and the appropriate action taken. Care Homes for Older People Page 18 of 31 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. They can be sure they will be protected from all forms of abuse Evidence: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available. Since the last inspection there have been no complaints made directly to the home. The Commission have received one complaint about staff working at the home. The registered provider has dealt with this complaint according to the homes complaints procedure and this issue has been dealt with and resolved. Residents and relatives told us that they feel their complaints are taken seriously and acted on. They said that issues are often raised in family and residents meetings. They said the manager deals with these promptly and effectively. The home told us that it has policies and procedures relating to safeguarding adults, which staff are introduced to during their induction training. The care staff have received training in safe guarding adults. Staff were able to tell us about abuse and what they would do if they if they suspected or evidenced that someone was not being treated as they should be. Staff told they knew about the whistle blowing policy and would have no hesitation in reporting any suspicions or concern immediately. Care Homes for Older People Page 19 of 31 Evidence: Since the last inspection there have been incidents which have been reported to the local safeguarding vulnerable adults team. This means that the complaint was looked at by the local social services safe guarding adults team. This was dealt with through safe guarding procedures and the alerts have been closed. The service has been active in dealing with the alert. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home does not handle residents finances. Care Homes for Older People Page 20 of 31 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 needs to continue to improve and maintain the environment to provide people with a comfortable, homely and safe place to live. On the whole the residents benefit from a clean and homely environment. Evidence: We looked around different areas of the home. We looked at all the communal areas and some of the residents bedrooms. All external doors have keypad systems and locks to ensure safety of residents from wandering into the street. There is an enclosed garden to the rear which has seating for people in the better weather. The communal space consists of a large lounge/dining room, a small quiet lounge and a conservatory. These are bright and airy rooms in which a range of activities can take place. Many of the bedrooms are well decorated and furnished and have been personalised by residents and their relatives. Some of the bedrooms need redecoration and up grading. There was an odour detected in one of the bedrooms. The manager told us that the carpets are cleaned regularly but this does not always eliminate the odours. Rooms where this is a problem would benefit from different flooring which is easier to clean and keep fresh. Paint on skirting boards and walls in corridors is chipped and old. The manager is aware of the maintenance required in the home there Care Homes for Older People Page 21 of 31 Evidence: is currently no formal plan in place for the renewal of the fabric and redecoration. We spoke to the maintenance man. He told us that he also works at the companys other home in the area and has to divide his time between the 2 homes. There are not enough maintenance hours available within Fassaroe to make sure the home has ongoing maintenance. Maintenance is done on a when required basis and not planned for. Faults and repairs and redecoration are identified in a maintenance book and are dealt with when and if there is time. The registered provider is responsible for the planned ongoing maintenance, refurbishment and up keep of the home. We will make a requirement in this report that the service develops a planned programme of maintenance with timescales. This will make sure that people who live in the home live in an environment that is continually well looked after and maintained to a good standard. We looked at the kitchen. It is well equipped, clean and well organised. The cook makes sure that the fridges and freezers are cold enough to store food safely. He also makes sure that hot foods are cooked through thoroughly. The baths are fitted with a special hoist. And there is wet room so people can access the shower easily. People have the equipment they need to more around the home as independently as possible. We saw one person being assisted by a staff member to walk. They didnt rush the person but encouraged them to go at there own pace. People told us they always felt comfortable and warm. One person told us there bedroom was cosy and they liked to spend time there. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. Since the last inspection all the hot water taps have been fitted with thermostats to control the temperatures. This means that they wont get hot enough to scald someone. Infection control policies and procedures have been addressed since the last inspection. Soiled materials are now transported through the home safely. Staff have received training in infection control and their competencies are checked regularly. The laundry room is suitable for purpose with adequate equipment in place. Although some tiles have fallen off the walls. The person who does the laundry told us that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. Residents said that the laundry service was good and they had no complaints.They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 22 of 31 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 practices protect residents. Evidence: We looked at the staff duty rota and we spoke to residents, relatives and staff. The staff group within the home has changed considerably in the last year. But the staff team is now stabilising and settling. We found that the home consistently has enough staff on duty to look after the residents. This is supported by the improvements at the home since the last visit. There are usually 5 care staff on in the morning 4 in the afternoon and 3 waking night staff. There is also an activities co-ordinator for 16 hours per week. During the day, there are other members of staff on duty. They work in the kitchen or do the housekeeping. There is also a part-time maintenance man. Residents told us that there is staff available when you need them. They said the staff are very good and very kind. Care Homes for Older People Page 23 of 31 Evidence: At the visit we saw peoples needs being anticipated and promptly met by staff. We noticed that two people who asked to be helped to use the toilet were assisted straight away. When people asked for a drink they where responded to quickly. The training provided by the service has improved since the last inspection. We looked at the training the staff have received to help them look after the residents in the best and safest way. The manager told us and evidence was seen to show all new staff receive a thorough induction into their role and responsibilities in the workplace as well as undertaking the Common Induction Standards. 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 with dementia. The majority of staff have received training in dementia, challenging behaviours, and safe guarding adults. 3 senior staff have just completed training in equality and diversity and nutrition .There has also been training in palliative care and the Mental Health Capacity Act 2005. The service told us that 50 of the staff have NVQ level 2 or above. To make sure the residents are kept safe and are protected the home has thorough recruitment practices in place. We looked at three of the staff files these included 2 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. The safety checks have been done, however we did find that one person did not have a reference from the care home they had previously worked at. The manager told us she would request this reference. Not all the staff had an up to date photo on file. The manager does not keep a record of the questions she asks people at interview and there 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 manager does carry audits on the files to make sure everything is in place. Care Homes for Older People Page 24 of 31 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 good 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 residents is promoted and protected Evidence: The manager has been in post for a year but to date she is not registered with the commission. The Provider and the manager have told us that the application for registration has been sent to the local office and is waiting to be processed. The manager has the qualifications that are recommended by the commission. This means that she has the management skills and knowledge to provide a consistent and reliable approach to benefit and improve the service offered to the people who are living at Fassaroe House. The manager has a positive attitude to running the home and to meet its stated purpose, aims and objectives. She is pro-active and has lots of ideas and plans on how to improve the service for people. The staff and the residents reported that they were well supported and responded in a positive, relaxed manner in Care Homes for Older People Page 25 of 31 Evidence: the presence of the manager. Opportunities for change and development are on going. To make sure people have a say in how the service is run and how things are going for them, quality assurance surveys are sent to residents, relatives, and other stake holders and some have been returned. The surveys have identified some of the strengths and weaknesses of the home. Shortfalls have been identified and people are informed about these and how there are going to be addressed in residents and family meeting. There is also information posted on the homes notice board. The registered provider of the service undertakes the monthly visits to the home to make sure things are running smoothly and any identified issues are being acted on pro-actively. However the reports that he is writing about these visits are scant and do not contain the relevant and significant information to make sure the service is being effectively managed and that any shortfalls are being addressed. We cannot see that his visits are effectively improving the service for the residents. It is the provider responsibility to monitor and make sure the home is being effectively managed and that people are receiving the care and support that they are paying for. We spoke to the provider about this and he told us he would improve the standard of recording. We received an AQAA from the home when we asked for it. However the information in it was insufficient to assist us with the main parts of the inspection process. The manager had not taken into account the shortfalls identified at the last inspection and did not tell us in the AQAA how these had been addressed. There was little information on how the service had improved and how the were planning to improve further. We spoke to the manager about this and she told us she would take longer to do the next one and she would make sure it contained the necessary information. The service has no involvement with peoples finances. Staff receive regular supervision and annual appraisals. Staff receive the support they need to do they jobs effectively and safely. There are regular staff meetings which staff said they benefit from. Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and system have been undertaken. An accident book is maintained. All fire assessments and checks are done the required intervals. Water temperatures are now taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and were within the stated ranges. The manager is aware of untoward incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely. Environmental risk assessments are in place. Care Homes for Older People Page 26 of 31 Evidence: Staff have received the necessary training. Care Homes for Older People Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The providers must make 30/06/2009 sure that the premises are well maintained. This means that sufficient maintenance hours must be provided for the ongoing general upkeep of the home; and a clearly documented maintenance plan must be put into place with time scales that are adhered to. This will make sure that areas that require work are identified and this work is carried out in a timely manner. People live in a environment that is well maintained, homely and pleasant. 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 29 of 31 1 7 The care plans need to be updated to reflect the changing need of the residents. Any changes to care need to be monitored. There needs to be protocols and guidance in place for all medication that is given on a when required basis. Medication given for pain needs to be monitored for effectiveness. All bedrooms need to free of any odours. 2 9 3 26 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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