Care Home: The Fairway

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What the care home does well The standards of administration and management of the service have improved under the new management. The residents seemed more active, members of staff seemed more relaxed and team working was evident. The positive changes were reflected in the following comments made by residents and relatives in a recent survey carried out by us: "I am absolutely delighted with the care and attention shown to my [name]. They could not receive a better service. This gives me, my [name] and [name] huge peace of mind". "My family are very, very pleased with the home. From the receptionists, the carers and the cook to the managers, all appear warm, caring and friendly." "The staff work enormously hard to maintain a high standard." "Always have time to listen - Always available whatever time of day." "The staff are always welcoming & friendly. They show a great deal of care to the residents." "Just to reinforce my gratitude to staff. They are always friendly to me, and obviously take great care in looking after my [name]. Who is able to respond to this kindness in their own way. The home is going from being a solid care home to greater things. There are changes constantly now there is a new manager - but I have always found it to be a place that I can trust completely to look after my [name]. It took me 3 months of hard work to find the Fairway 2 years ago - it has not failed me! The greatest thing a home must have is caring staff - the Fairway has it." What has improved since the last inspection? The home has had a new registered manager since August 2007. Positive changes to the service have been made since her appointment. Dementia Mapping, an observational tool, has been introduced, as part of the assessment of care needs to ensure that residents with dementia will have an improved quality of life. What the care home could do better: The management needs to review the way staff are deployed to ensure that residents in the lounges on the upper floor are adequately supervised at all times. Other areas for improvement may be guided by the following comments received from relatives and residents: "The staff have made efforts to ensure my [name] is involved in activities. I do however feel that the activities could be expanded to include taking residents out for a few hours or more each day. Perhaps this will happen in summer". "The activities are very stimulating. It would be nice to have more trips out in the summer months. Fortunately [name] does go out with the family on a regular basis". "Great care taken of the ladies` finger nails but not so good for men". CARE HOMES FOR OLDER PEOPLE The Fairway Green Lane Highlands Oxhey Hertfordshire WD19 4LX Lead Inspector Yoke-Lan Jackson Unannounced Inspection 14th April 2008 11:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Fairway Address Green Lane Highlands Oxhey Hertfordshire WD19 4LX 01923 221345 01923 209997 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.quantumcare.co.uk Quantum Care Limited Wilhemina Elizabeth Gauthier Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (45) The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th April 2007 Brief Description of the Service: The Fairway is a residential care home, provided by Quantum Care Limited (a charitable organisation) since 1992. The home was formerly a County Council care home. The home is located in Oxhey, close to Watford town centre and local shops are within walking distance of the home. The home is set within pleasant grounds and is located off a main road within a side road. There are good public transport links with a local train and bus services nearby. This purpose-built care home provides accommodation on three floors and in four separate units. All units are provided with a small kitchen in which residents and relatives may make drinks and snacks. The administrative office is on the ground floor. The surrounding grounds are mainly laid to lawn, with a small patio overlooking each French door. There is garden furniture and seating for residents. The home charges £420 - £555 per week. Information about the home and the service it offers is contained in the Statement of Purpose and Service Users Guide. A copy of these and the most recent CSCI inspection report are available in the home. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use the service experience good quality outcomes. The unannounced inspection was carried out on 14/04/08. The home manager was present in the afternoon. The deputy manager was present throughout the day. The home has 47 residents. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were interviewed and documents were examined. Information received by us since the last inspection was reviewed. This included the Annual Quality Assurance Assessment (AQAA) which providers of registered services are required to complete. Survey questionnaires, were sent to residents and their relatives and their responses and other information received were also reviewed. What the service does well: The standards of administration and management of the service have improved under the new management. The residents seemed more active, members of staff seemed more relaxed and team working was evident. The positive changes were reflected in the following comments made by residents and relatives in a recent survey carried out by us: “I am absolutely delighted with the care and attention shown to my [name]. They could not receive a better service. This gives me, my [name] and [name] huge peace of mind”. “My family are very, very pleased with the home. From the receptionists, the carers and the cook to the managers, all appear warm, caring and friendly.” “The staff work enormously hard to maintain a high standard.” “Always have time to listen - Always available whatever time of day.” “The staff are always welcoming & friendly. They show a great deal of care to the residents.” “Just to reinforce my gratitude to staff. They are always friendly to me, and obviously take great care in looking after my [name]. Who is able to respond The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 6 to this kindness in their own way. The home is going from being a solid care home to greater things. There are changes constantly now there is a new manager - but I have always found it to be a place that I can trust completely to look after my [name]. It took me 3 months of hard work to find the Fairway 2 years ago - it has not failed me! The greatest thing a home must have is caring staff - the Fairway has it.” What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients can be assured that a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. EVIDENCE: The care plans examined included the pre-admission assessment documents for each resident. The home will only admit a person whose needs can be met. A resident who was admitted to hospital was reassessed before the resident was readmitted to the home to ensure that all their care needs can be met. A relative commented, “I was very impressed with the time given to me and my family to assess the suitability of The Fairways for my [name]”. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to be treated with respect and can rest assured that their personal and healthcare needs can be met. They are protected by the home’s medication policy and procedures. EVIDENCE: The revised care plans are person-centred and those examined were detailed and were kept up to date. Appropriate risk assessment documents were in the care plan files examined. Each resident has a regular review of their care needs and there is a yearly review that involves all parties including next of kin and the relevant social worker. The reviewed care plan was properly documented, dated and signed by all the parties involved. There is an effective monitoring system for residents at risk of falling. The manager said that incidents of falls have decreased and none of the residents have pressure sores. All residents have access to healthcare if required. Each of the residents is registered with a general practitioner of their choice. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 10 An additional service that is being practiced in the home is Dementia Mapping, an observation tool, which is carried out twice a year by the Deputy Manager and her team. During each session six to eight residents with dementia are observed for a specific time. The results are analysed and each resident’s care needs are revised accordingly. Since dementia mapping has been used, there has been a significant improvement in the condition of each of these residents. The home uses the Monitored Dosage System for individual residents. All medicines are stored in drug trolleys that are kept in a locked storage room when not in use. The storage room temperature is monitored regularly to ensure that it is below 25 degrees centigrade. The Medication Administrative Record charts examined showed some inconsistencies in that authors failed to sign after their written instructions. Some containers of medicines have no opening date written on the container. The home manager has agreed to address these shortfalls immediately. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that their choice and preferences will be respected. Although there are in-house activities taking place, residents on the first floor seemed isolated at times compared with the lively atmosphere on the ground floor. EVIDENCE: On the day of the inspection, members of staff were observed to interact well with the residents. Some female residents were having their nails manicured in the dementia unit, Batchwood. The activity co-ordinator was busy in the activity room with a number of residents who were pre-occupied with books and pictures that interest them. It was a picture and discussion session for residents with similar interests. In Preswick, residents were busy playing a game of dominoes. On the upper floor, in Sandy Lodge and Hartsbourne, there were no activities observed before lunch. Visitors are welcome at all reasonable times. A couple of residents were busy conversing with their visitors on the day of the inspection. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 12 Lunchtime was observed to be unhurried. There was a choice of two hot dishes. Residents seemed happy with the lunchtime menu. Members of staff were readily available to assist those residents who needed some help. In a recent CSCI survey, the resident’s and their relatives’ comments include: “Staff ratios have increased since the last inspection in my [name] lounge this was needed and works well now. Staff can be seen sitting & having a chat to residents. This is obviously only for a short time but is a good procedure. I often find staff chatting to my [name] when I arrive for a visit. There is an easy, relaxed atmosphere.” “Due to medical needs my [name] follows a special diet which is followed by the home very carefully. They sometimes finds it difficult to feed them self so has one-to-one attention however, they are encouraged whenever possible to feed them self fruit or biscuits and drink independently.” “My [name] thoroughly enjoys his food and is well catered for.” “My [name] enjoys their meals at The Fairway. From what I have seen, they look excellent.” “[name] appears to have good nutrition.” “Food sometimes tends to be a bit bland with not much seasoning.” The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that they will be safeguarded from abuse, they will be listened to and any complaints made will be handled promptly and effectively. Residents’ legal rights are protected. EVIDENCE: Residents and their relatives are aware of the home’s Complaints Procedure. A relative said “The procedure was made clear at the start”. Since the last inspection, there have been no written complaints received. Residents’ meetings are held regularly and the management deals with issues raised at the meetings promptly. A relative commented, “ I would ask to speak to the manager/deputy manager/duty manager or if really concerned directly to Head Office. Admin staff are always available to talk to if any queries.” Members of staff have training on the protection of the vulnerable and are aware of the joint agency Safeguarding Adults procedures of Hertfordshire County Council Adult Care Services. Staff interviewed said that they are aware of the Whistle-Blowing Policy. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that they live in a safe and comfortable environment and that they will have access to all communal areas. EVIDENCE: Since the last inspection, extensive redecoration and refurbishment have taken placed. The lounge in Batchwood now includes the adjoining room. Another communal room has been converted into an activity room and is occasionally used as a training room for staff. The home has two refurbished bathrooms with assisted baths. However, the shower room is currently out of use due to repair work. The residents interviewed said that they are satisfied with their bedrooms, which are furnished with personal items on display. The bedrooms, community areas and toilet facilities are cleansed daily by domestic staff. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 15 A relative remarked, “The home always appear bright and clean and there are no unpleasant odours.” The deputy manager was assisting with domestic chores on the day as a cleaner has gone on sick leave. A workman was busy clearing up the surrounding ground. All debris and hazards to safety were removed by the afternoon. The home manager said that there are plans to improve the patio with potted plants and new garden furniture this summer. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them. They can be confident that they are safeguarded by the home’s robust recruitment policy and procedures. EVIDENCE: Residents are well supported by an effective staff team with a skill mix that benefits residents. Although staff numbers were adequate, residents in the lounges in Sandy Lodge and Hartsbourne were left on their own for a while as the two members of staff attended to the personal care of a resident, who needed hoisting. A third member of staff was relieving other staff for breaks in Preswick, instead of supervising the residents. The deputy manager, who conducted the tour, addressed the issue immediately. She said that a member of staff should have contacted the team on the ground floor for help. The manager said that the posts for additional care workers, domestic staff and an additional activity co-ordinator have been advertised. In the meantime, agency workers are deployed to make up the staff numbers. Staff recruitment records were examined and they were found to be thorough and were kept up to date. Criminal Record Bureau (CRB) checks were made and new members of staff only commence working after CRB clearance. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 17 The home manager hopes to update all staff appraisal records this year. Staff supervision takes place every six weeks. There is a rolling training programme for all staff and induction training for all new recruits. The deputy manager, who specialises in dementia mapping, was selected by the residents, relatives and members of staff to represent The Fairway for the annual Champion Awards Competition organised by the provider, Quantum Care Limited. The award ceremony is on 09/05/2008. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the service and care provided will continue to improve under new management. They can be assured that their health, safety and welfare are promoted and protected. EVIDENCE: The standards of administration and management of the service have improved since the new home manager was appointed. Positive changes include an effective care team with team leaders and duty managers getting more involved with the care workers in providing practical support in the care of residents. Each team leader has specific roles in specialist areas such as health and safety, dementia mapping and medication. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 19 The home manager was registered with the Commission in August 2007 and she is currently working towards attaining the NVQ4 Award in Management and in Care. She said that improvement is ongoing. This summer she is planning to improve the surrounding grounds to make them more attractive with more plants, new garden furniture and more seating for residents and their visitors. The grounds have not been fully developed as communal areas. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The home is not involved with the residents’ finances, but management oversee the personal allowances for each resident and proper accounting records are kept. All servicing records are well maintained. There is an annual quality assurance and monitoring system that includes survey questionnaires for residents, relatives, staff and others. Information received is collated and analysed and an annual report is produced and a copy is provided to us. The Annual Quality and Assurance Assessment (AQAA) forms issued by us were returned on time for this inspection. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations It is recommended that the deployment of staff for Sandy Lodge and Hartsbourne Units is reviewed to ensure residents in the lounges are being supervised at all times. The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Fairway DS0000019568.V362437.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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