Care Home: The Fairways Residential Care Home

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What the care home does well The home provides a comfortable and homely environment for the residents to live in. We were told that prospective service users would be invited to the home for a meal and spend time with other residents to see if The Fairways was the place they wanted to live.A relative told us that there cared for resident came to visit and had a couple of hours at the home including something to eat before they came to live at The Fairways. The atmosphere within the home was warm and friendly. The staff were happy and relaxed in their approach to service users and appeared to have a good rapport with them. Staff were observed to be pleasant and courteous with service users. This was confirmed in discussions with service users.Staff were seen to have good interactions with service users and were observed attending to service users individual needs. Service users health,personal and social care needs were recorded and met and the medication practice was good. Staff demonstrated a good knowledge of service users needs and what they needed to do to make sure the needs were met. The home kept a log of complaints and compliments and evidence seen indicated that the comments and complaints received by the home had been dealt with in an appropriate manner. What has improved since the last inspection? We made a recommendation on the last inspection to further promote the privacy,respect and dignity of service users that, bath products should be maintained within individual service users bedroom and door locks on the bathroom and toilet door should be repaired or replaced so they lock. We looked around the bathrooms and toilets and found that this had been actioned by the manager. The manager told us that all toiletries were kept in service users bedrooms and that the door locks had all been checked and were operating correctly. We made a recommendation on our last visit that, any details on the medication administration records that are handwritten should be signed and dated and an additional member of staff should also sign to agree the information. We looked at the medication administration records and we found that this recommendation had been addressed.This will ensure that people receive the correct levels of medication. We made a recommendation on our last visit that, any details on the medication administration records that are handwritten should be signed and dated and an additional member of staff should also sign to agree the information. We looked at the medication administration records and we found that this recommendation had been addressed.This will ensure that people receive the correct levels of medication.Best practice states to ensure the safe administration of controlled drugs that two staff sign the medication administration records when giving residents this type of medication. This had been completed by staff on these records. The manager has been involved in Trafford Council`s strategy for promoting the Dignity Challenge and are currently in the process of looking at ways to promote this in the most efficient and effective ways possible.Treating service users with respect and upholding their privacy are some of our founding principles and make up a key feature of the managers induction training sessions. The manager has recently purchased a DVD "What Do You See" which the manager has found very useful and informative. Staff said they have found the DVD very enlightening. Since our last visit the manager said,the home had extended the activities programme to include theatre trips twice a year, cinema trips, monthly crafting sessions. Musical therapy sessions and sing a longs have been arranged on alternate months between the two homes, so enabling those who choose not to go out to still enjoy entertainment. New shows have also been put on with a professional touring company.More games have been bought, for example, indoor carpet bowls, bean bag throwing game and lots of crafting equipment. In the last twelve months the manager had arranged for a number of bedrooms to be redecorated.A new television has been purchased in the lounge to improve service users enjoyment and comfort when watching television.Service users spoken to about this said they enjoyed to watch television and they could see and hear the television. The dining room and lounges have benefited from redecoration.The rooms were light, bright and clean.The main hallway has been re plastered and redecorated, making the entrance to the house welcoming. New curtains and blinds have been fitted in rooms around the house,again adding to the appearance of the house. What the care home could do better: The manager needs to purchase weighing scales that are right for the people who live at The Fairways so that all service users can be routinely weighed,so the manager has the knowledge that service users weights are routinely checked. To support the medication practice and routines in addition to providing additional safeguards for service users, the manager needs to arrange that all service users have a photograph accompanying their medication records. The manager needs to make sure that when verbal references are received the detail is clearly recorded in the staff file,with confirmation in writing by the referee on file whenever practicable before staff start work. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Fairways Residential Care Home 269 Church Road Urmston Manchester M41 6EP     The quality rating for this care home is:   three star excellent 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: Kath Oldham     Date: 0 2 0 6 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 32 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 32 Information about the care home Name of care home: Address: The Fairways Residential Care Home 269 Church Road Urmston Manchester M41 6EP 01617468160 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) : The Knoll Care Partnership Ltd care home 20 Number of places (if applicable): Under 65 Over 65 0 0 20 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 20 20 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home The Fairways is a residential care home that is registered to provide care for up to twenty residents whose care needs are due their old age, or due to them having a diagnosed mental disorder or a diagnosis of dementia. The Fairways is one of two care homes owned by the Knoll Care Partnership Limited, the other being The Knoll. Mrs Jayne Callaghan is the registered manager at the home. Accommodation comprises of twenty single bedrooms, eleven of which have ensuite facilities. There are eleven Care Homes for Older People Page 4 of 32 Brief description of the care home bedrooms on the first floor and nine on the ground floor. There are separate lounge and dining room areas on the ground floor and first floor areas of the home. There is an assisted bathroom on the first floor. There is passenger lift access to the first floor. The home is suitable for wheelchair users and there is ramped access to the rear of the building. The Fairways is a large property set in pleasant grounds. To the rear of the property is the local golf course. The grounds are enclosed and offer residents ample external space to sit out, weather permitting. There are designated car parking spaces to the front of the building. The home is situated in the Flixton area of Manchester and is within easy reach of local shops, public transport and the motorway network. The home has a statement of purpose and service user guide, which were given to people living at the home or their families. The fees for staying at the home were between #360 and #398.60 per week. 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: This visit was unannounced, which means that the manager, staff and service users were not told that we would be visiting, and took place on 2nd June 2009 commencing at 9:10am. The manager was available on the visit. The manager and deputy provided us with a lot of detail, information and support during the visit in addition to the support from staff and service users. The inspection of The Fairways included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection in June 2007 Care Homes for Older People Page 6 of 32 We looked at the Annual Service Review (ASR) that was carried out on 13th May 2008. This is a review of good and excellent services that takes place between key inspections. Good services only have an inspection every two years and excellent services every three years. At that time we found no evidence to suggest that our quality rating had changed or that we needed to bring the inspection forward. We also sent The Fairways a form before this visit for them to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information the manager of The Fairways provided to us on 23rd April 2009 and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). The Fairways was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying and working at The Fairways the views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at The Fairways talking with the manager, deputy and staff. A tour of The Fairways was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how The Fairways was meeting the needs of service users and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of service users. The care service provided to two service users was looked at in detail to help form an opinion of the quality of the care provided. The term preferred by people consulted during the visit was service users. This term is, therefore, used throughout the report when referring to people living at The Fairways. A brief explanation of the inspection process was provided to the manager at the beginning of the visit and time was spent at the end of the visit with the manager and deputy to provide verbal feedback. We have received no complaints about this service or had any safeguarding referrals. What the care home does well: What has improved since the last inspection? We made a recommendation on the last inspection to further promote the privacy,respect and dignity of service users that, bath products should be maintained within individual service users bedroom and door locks on the bathroom and toilet door should be repaired or replaced so they lock. We looked around the bathrooms and toilets and found that this had been actioned by the manager. The manager told us that all toiletries were kept in service users bedrooms and that the door locks had all been checked and were operating correctly. We made a recommendation on our last visit that, any details on the medication administration records that are handwritten should be signed and dated and an additional member of staff should also sign to agree the information. We looked at the medication administration records and we found that this recommendation had been addressed.This will ensure that people receive the correct levels of medication. We made a recommendation on our last visit that, any details on the medication administration records that are handwritten should be signed and dated and an additional member of staff should also sign to agree the information. We looked at the medication administration records and we found that this recommendation had been addressed.This will ensure that people receive the correct levels of medication. Care Homes for Older People Page 8 of 32 Best practice states to ensure the safe administration of controlled drugs that two staff sign the medication administration records when giving residents this type of medication. This had been completed by staff on these records. The manager has been involved in Trafford Councils strategy for promoting the Dignity Challenge and are currently in the process of looking at ways to promote this in the most efficient and effective ways possible.Treating service users with respect and upholding their privacy are some of our founding principles and make up a key feature of the managers induction training sessions. The manager has recently purchased a DVD What Do You See which the manager has found very useful and informative. Staff said they have found the DVD very enlightening. Since our last visit the manager said,the home had extended the activities programme to include theatre trips twice a year, cinema trips, monthly crafting sessions. Musical therapy sessions and sing a longs have been arranged on alternate months between the two homes, so enabling those who choose not to go out to still enjoy entertainment. New shows have also been put on with a professional touring company.More games have been bought, for example, indoor carpet bowls, bean bag throwing game and lots of crafting equipment. In the last twelve months the manager had arranged for a number of bedrooms to be redecorated.A new television has been purchased in the lounge to improve service users enjoyment and comfort when watching television.Service users spoken to about this said they enjoyed to watch television and they could see and hear the television. The dining room and lounges have benefited from redecoration.The rooms were light, bright and clean.The main hallway has been re plastered and redecorated, making the entrance to the house welcoming. New curtains and blinds have been fitted in rooms around the house,again adding to the appearance of the house. 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. Care Homes for Older People Page 9 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to assess and monitor individual needs,ensuring that a suitable service is provided based on personal needs and preferences. Evidence: Three service users who completed comment cards said they received enough information before they moved in to help them decide if The Fairways was the right place for them. The AQAA completed before the visit by the manager told us, All relevant information is given to all prospective service users or family members in an easy to follow format.All prospective service users and their families are encouraged to visit the home as many times as they like prior to admission. Upon admission of a new service user all staff are made fully aware of that individuals conditions,medical background and needs based on a thorough assessment carried out by a manager prior to Care Homes for Older People Page 12 of 32 Evidence: admission. We were told that prospective service users would be invited to the home for a meal and spend time with other residents to see if The Fairways was the place they wanted to live.A relative told us that there cared for resident came to visit and had a couple of hours at the home including something to eat before they came to live at The Fairways. We were also told that service users would only be admitted after management had undertaken an assessment and that they were assured that The Fairways had the skills and knowledge to provide the right care and support to the service user. The manager said that the needs of existing service users already at The Fairways were as important as the prospective service users when considering if the home and the staff team could meet individual needs. Care plan files included a copy of the terms and agreement so that service users had information about the facilities and services available at The Fairways including the key facts of the contract terms. The comment cards returned to us before the inspection visit confirmed that service users had enough information to decide to move into the home. Before anyone moves into The Fairways a comprehensive needs assessment is carried out by an experienced and trained manager. Standard 6 was not applicable, as the home did not have any intermediate care beds. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Fairways have their needs met and their care is provided in a manner that protects their privacy and dignity. Evidence: Two care plan files were examined during this visit.Overall,care needs were clearly identified and included the things staff needed to complete to meet service user needs There was a lot of of information on each file about the care needs of individual service users. Care plans focus on the needs of each individual and include health,social care, leisure, lifestyle, cultural and religious needs. Each person is supported in developing and reviewing their plan or if this isnt possible family members or friends are consulted.The approach used ensures that individualised support is provided and,risks are managed in a way that promotes independence,decision making and choice. The manager plans to further improve the care plans to provide even more detail to describe service users needs and preferences. This will develop the care plans further Care Homes for Older People Page 14 of 32 Evidence: and evidence that service users get the care they need when they want and need it. We were told that the reviewing of all care plan files was an ongoing process. There was evidence during this visit that files were organised so that staff had access to up to date information about current care needs. All service users have their own care plans and the manager actively encourages them to be involved in their plan of care. Key workers are appointed and rotated over the course of a year and will assist the service user and their family to develop and update their care plan with them. Because the home has a stable workforce it is hoped that their key worker will already be known to each service user. The manager feels that the rotation of key workers keeps all relationships fresh.The care plans are easy to follow and understand. The manager and staff try to find out as much information as service users are willing to share so that their care can be tailored specifically to their needs and desires. This also allows staff to support individuals to lead purposeful and fulfilling lives and to make their own informed decisions. The manager told us we shall look at ways of modernising these plans and updating them to make them even more person centred. Two service users chose the optionusually to respond to the question do you receive the care and support they need. One said they always received the care and support they needed. Staff said that they were given up to date information about the needs of people they support or care for.One staff member said, In my opinion the Fairways rest home is very well run and residents are very well looked after and taken care off. We were told in the AQAA, We have in place, thorough, well developed care plans which all staff read regularly. All care staff are knowledgeable about the service users in their care and keep themselves well informed of any changes.The manager ensures all paperwork is maintained as appropriate. All service users are treated with dignity and respect by all the staff and management.We have good working relationships with other agencies who aid us in assisting our service users to remain healthy. The variety of training provided to staff helps to promote excellent standards of health and personal care. We made a recommendation on the last inspection to further promote the privacy,respect and dignity of service users that, bath products should be maintained within individual service users bedroom and door locks on the bathroom and toilet door should be repaired or replaced so they lock. We looked around the bathrooms and toilets and found that this had been actioned by the manager. The manager told us Care Homes for Older People Page 15 of 32 Evidence: that all toiletries were kept in service users bedrooms and that the door locks had all been checked and were operating correctly. There was evidence that service users were supported to access health care services as appropriate.Records in files demonstrated that service users were supported to keep appointments with health care professionals including hospital appointments, regular contact with specialists when necessary and dental and optical appointments. The health and personal care that people receive is based on their individual needs and the principles of respect privacy and dignity are put into practice. This is evident in care plans that record personal and health care needs and detail how they are to be met. Records in the home provided evidence that the service supports service users to access health care support services as appropriate.Where it has become necessary to involve other professionals,the staff have made referrals and maintain the documentation and recordings to demonstrate that service users are receiving the correct support. All service users are free to retain their own GP (if that GP is within the catchment area). If they need to change GP,the manager will organise this at their request. The manager feels the home has a good relationship with all local GP practices and have written statements to this affect. Good working relationships with the district nursing team are apparent and the manager said they work hard to ensure that they work well in partnership with all health care professionals. The weight of service users is checked monthly or more frequently depending on service users health and need. For some service users, with limited mobility this isnt always possible. This is because some service users do not have the ability to stand on the scales. To ensure that all service users are weighed and a check can be made on their weight, the manager needs to purchase new weighing scales which, are the right kind for all service users to use. Interactions between service users and staff were observed to be relaxed and appropriate,whilst being respectful and maintaining individuals dignity. For service users who were supported with personal care this was provided in a discreet and sensitive way. The manager has been involved in Trafford Councils strategy for promoting the Dignity Challenge and are currently in the process of looking at ways to promote this in the most efficient and effective ways possible.Treating service users with respect Care Homes for Older People Page 16 of 32 Evidence: and upholding their privacy are some of our founding principles and make up a key feature of the managers induction training sessions. The manager has recently purchased a DVD What Do You See which the manager has found very useful and informative. Staff said they have found the DVD very enlightening. A medication policy was in place. All staff responsible for the administration of medication have received training. This ensures staff are aware of how to give out medication and the need for precise recording to keep service users well. Medication is safely managed and service users may control their own medication if, following a risk assessment they are considered able to do so. The majority of service users are supported with taking their medication by staff. The practice of handling medication was carried out in a manner that ensured the safety and well being of service users. Medication was administered using a monitored dosage system. Medication records contained sample signatures of those staff responsible for the administration of medication, this is as it should be. Medication was seen to be appropriately and securely stored, to ensure service users are kept safe.Medication audits and checks are carried out by management to ensure the competence of staff and ensure staff are following the medication policy and procedures and that service users are getting the correct medication when they should do. We made a recommendation on our last visit that, any details on the medication administration records that are handwritten should be signed and dated and an additional member of staff should also sign to agree the information. We looked at the medication administration records and we found that this recommendation had been addressed.This will ensure that people receive the correct levels of medication. Best practice states to ensure the safe administration of controlled drugs that two staff sign the medication administration records when giving residents this type of medication. This had been completed by staff on these records. To assist in the identification of service users and to act as a prompt and an aid to staff and to make sure they give the right service users their medication, best practice indicates that a photograph of the service user should accompany their medication administration records. Although on most of these records there were photographs on others there werent. As an additional safeguard it would be best practice for this to be arranged so all service users have a photograph accompanying there medication records. Several members of staff attended a medication awareness course held on the 12th Care Homes for Older People Page 17 of 32 Evidence: May 2009.This course is open to all staff and some have been specifically chosen as the manager believed further training was required.The course will be made available again on an ongoing basis. Care Homes for Older People Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were offered choices and consulted regularly about the kind of lifestyle they wanted and peoples dietary needs were met. Evidence: When we last visited The Fairways in 2007 we made a recommendation for the manager to have some discussions with people living at the Fairways,about activities they would like to take part in and to provided these where possible. Since our last visit the manager said,the home had extended the activities programme to include theatre trips twice a year, cinema trips, monthly crafting sessions. Musical therapy sessions and sing a longs have been arranged on alternate months between the two homes, so enabling those who choose not to go out to still enjoy entertainment. New shows have also been put on with a professional touring company.More games have been bought, for example, indoor carpet bowls, bean bag throwing game and lots of crafting equipment. Service users are enabled to make choices about activities and these are supported and respected by the staff team. Service user surveys and records confirm Care Homes for Older People Page 19 of 32 Evidence: opportunities to access community facilities, entertainment and shopping trips. We were told about the gardening club and that service users had planted sunflower seeds and there was a completion for the largest sunflower. On the visit service users were making invites to their friends and relatives for the forthcoming party to celebrate the home being opened for 20years. Service user and family meetings provide another opportunity to ensure that service users and their families and friends are involved in decisions. Notes of recent meetings show a range of topics being discussed and addressed, including activities, food likes and dislikes and refurbishment plans. Service users who were spoken to confirmed that staff supported them and encouraged them to try out different activities,such as craft sessions,the gardening club, going out for lunch and taking part in music to movement. The manager demonstrated that there was an awareness of the importance of extending leisure and social opportunities further and said they were open to new ideas and suggestions and they try to support service users to do what they want or would like to do. The manager is now looking at schemes where the manager can get more community involvement within the home for example,getting the mobile library to stop close to the home so that some service users can loan their own large print books. The manager is also considering opening up the gardening club to the wider community.The manager hopes to make shopping trips more regular too, so enabling service users to retain more control over their lives. Records of food eaten by individual service users was routinely kept. This provides additional details whether the diet,for example,is sufficient in terms of nutrition or if someone is losing or gaining weight. One member of staff told us, Meals are very good and they have a well balanced diet. Service users told us that the food was good and they always got plenty to eat. One service user said they had a particular health problem and the cook knew what they could and couldnt eat to make sure they kept well. The meal served on the visit looked appetising. All service users have an eating and drinking risk assessment.One service users has difficulty in swallowing and as a result a special diet has been developed in conjunction with the dietitian. The manager and staff have discretely integrated the special needs into our normal mealtime procedures and in so doing respect and promote the dignity of the individual. Care Homes for Older People Page 20 of 32 Evidence: Service users told us they had a choice of meal and staff had asked them what they liked and wanted to eat for there meals, which they said was written down in their files. There is a three week menu which is changed now and again to take into account service users wants and preferences, in addition to seasonal changes. In response to the request of service users at the last residents meeting,the manager has amended the menus to include hot dogs and burgers as well as new salads. The manager said,every now and then we stray from our home cooked philosophy,but only when we have our occasional chippydinner.These are always popular with the service users. A menu is displayed on the tables in the dining room so service users can check what the meals are that day. A hairdresser visits weekly and all service users can decide whether they would like their hair cut, styled or set. The manager has arranged for ministers of different denominations to visit the Fairways to maintain links with the wider community and help nourish the service users spiritual needs. Visitors from St.Michaels C of E church visit every other week and talk to all service users who wish to.Eucharistic ministers from St.Monicas RC Parish visit weekly and distribute Holy Eucharist to service users who wish to take part. Care Homes for Older People Page 21 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. There are good procedures so people who live in the home are able to express their concerns and be listened to,their rights are protected and they are safeguarded from abuse. Evidence: All service users that completed a comment card sent to them before our visit,indicated that there is someone they can speak to informally, if they are not happy and that they knew how to make a formal complaint. There is a clear and accessible complaints procedure in place which outlines the timescales for dealing with a complaint and informs how complaints are dealt with. A complaints record is in place to record comments and issues raised and includes the action taken to look into any comments or to put things right or change things. Service users indicated in the comment cards that staff listen to them and act on what they say. Information about making a complaint is made available to service users,their families and friends. This makes sure everyone knows what to do if they are not happy with something or they would like to comment on the service provided. The Care Quality Commission has not received any complaints about The Fairways. Care Homes for Older People Page 22 of 32 Evidence: During the visit service users were seen approaching staff with comments, the staff took time to listen and respond appropriately, with respect to the person making the comments. As part of the homes quality assurance procedures,the manager ensures that all service users and their significant others are aware of our complaints procedure and how to raise any concerns they may have. Questionnaires are sent out annually to service users, their families or friends and next of kin. In addition GPs and visiting district nurses are also sent out questionnaires to provide them also with an opportunity to comment about the service provided at The Fairways. This provides an opportunity to make comments and suggestions which are then acted upon and responded to by the management of the home. The receipt of comments the manager said, helps us determine improvements and or changes that need to be made over the coming months and so direct our operational policies. In the last twelve months the Protection of Vulnerable Adults (POVA)policy has been reviewed and updated. The manager has ensured all staff are up to date with their POVA and whistle blowing training. Staff with were able to demonstrate an understanding of issues surrounding abuse.Most were aware that Social Services took the lead if an allegation of abuse was made and the Care Quality Commission had to be informed. Records and conversations with staff confirmed the provision of adult protection training and an understanding of the procedure to be followed. The policy on the Mental Capacity Act has been written by the manager and then read by staff.This ensures staff have an understanding of this legislation.The manager has attended a course on the implications of the Act. Many of the staff have attended a half day course.The manager has attended a course on the Deprivation of Liberties Standards to increase her knowledge in this area of expertise. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in suitably adapted,clean,comfortable and pleasant surroundings. Evidence: During this visit we had a look around the building.This included communal areas and a selection of service users bedrooms. There was evidence that a number of service users had chosen to personalise their rooms with their own belongings reflecting their tastes and interests.One service user said they were, very comfortable in their room and had everything that they needed. The home presented as clean and tidy with no unpleasant odours. Service users and staff confirmed this as the usual appearance of the home.Comment cards from service users confirmed their satisfaction with the home in terms of cleanliness and comfort.All service users who completed a comment card said the home was always fresh and clean. In the last twelve months,we were told that the manager had arranged for a number of bedrooms to be redecorated.All the bedrooms we had a look at had the same colour of duvet cover. To enhance and promote the personalitys of service users, the manager needs to give thought to individualising these purchases and giving a choice of colour and design to service users. Care Homes for Older People Page 24 of 32 Evidence: A new television has been purchased in the lounge to improve service users enjoyment and comfort when watching television.Service users spoken to about this said they enjoyed to watch television and they could see and hear the television. The dining room and lounges have benefited from redecoration.The rooms were light, bright and clean. The main hallway has been re plastered and redecorated, making the entrance to the house welcoming. New curtains and blinds have been fitted in rooms around the house,again adding to the appearance of the house. A new ramp has been installed to the front of the property, and the front car park has been resurfaced.This provides service users who have difficulty with mobility, easier access to the house in addition to further promoting the appearance of the house from the outside. New windows were being fitted to the house during our visit to promote the appearance of the home and replace some windows that were showing signs wear and tear.This again promotes the comfort and respect of service users. To further develop on infection control, and to make more convenient to staff and to enhance high standards of the control of infection, wall mounted soap dispensers, apron dispensers and paper towel dispensers have been installed in all the bathrooms. Care Homes for Older People Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A settled,competent and well trained staff team provide a personalised package of support to the people living at The Fairways. Evidence: Three service users who completed comment cards said that staff were available when they need them and that staff listen to them and act on what they say. We were told in the AQAA that,the manager is, very proactive with staff training and all new staff undergo thorough induction training. All new staff undertake to complete level 2 NVQ if they do not already hold the qualification. Over 50 per cent of staff have NVQ level 2 or above. All staff are up to date with mandatory training. Adequate staffing levels for roles and low staff turnover. A duty roster is in place and details the names of the staff on duty. Staff undertake care and domestic duties.In addition,one member of staff during the week does the cooking and also provides care to service users. This detail needs to be recorded on the duty roster so it is clear what hours are allocated to caring for service users. The manager told us that staffing levels are reviewed regularly and changes are made as needed.For example,extra staffing will be used to take service users out or when Care Homes for Older People Page 26 of 32 Evidence: service users are unwell. The manager has stable staff team,who are prepared to take on extra hours,the manager can easily change hours very quickly,to meet the needs of service users. We asked staff if there are enough staff to meet the individual needs of all the people who use the service. Two staff chose the optionusually and one said, always.One member of staff added,the homecould sometimes do with extra staff. Another staff member said, we could do with a cleaner.A member of staff told us, As a whole the rest home is a lovely place to work. The staff team said that they were in receipt of regular supervision.Staff also said that they had access to training and development opportunities. Staff said they felt confident in their role and they were supported and directed by the manager and deputy. Staff have met with their manager individually and have discussed their performance and how to further develop the care and support of service users. Service users said they felt supported and could ask staff for support and assistance to promote their wellbeing.Staff were seen chatting with service users and supporting service users with activities. We recommended on our last visit that all staff should receive updates annually for moving and handling training. This is to make sure staff know how to move and handle service users safely and not put themselves or service users at risk of harm. Since that visit we were told by the manager that all staff have received updates to their moving and handling training. Most staff choose to progress once they have their National Vocational Qualification(NVQ) level 2 and will study to obtain NVQ 3. Two members of the team also have their NVQ4. We looked at some of the staff files for people who had been recruited to carers jobs since we last visited. For two of the staff we couldnt find a second written reference. We were told that a verbal reference had been provided and a note made on the job application form of this fact. Confirmation of the verbal reference needs to be obtained and placed on the staff file before staff start work. This ensures that all procedures have been followed and the person spoken to has confirmed the content of there conversation in writing. Care Homes for Older People Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Fairways has an experienced management team, who ensure the home is operating efficiently and effectively and in the best interest of the people who live there. Evidence: The manager has many years experience of working in and managing residential care homes.The management team remains unchanged and all are secure and confident in their roles.The manager has all relevant courses to support her in her role, including the Registered Managers Award and a level four qualification in care. She regularly reviews her training needs and attends courses each year to support her in her job and ensure she is up to date with changes in practice and regulations. All service users and staff who were spoken to were very positive about the managers approach and competency.A member of staff said, the home is run very well altogether. Care Homes for Older People Page 28 of 32 Evidence: A selection of records relating to fire detection and alarm systems was looked at and presented as being appropriately maintained. No obvious risks to health and safety were observed during this visit. The manager told us that the health,safety and welfare of all service users and staff is there primary concern and all paperwork to this end is maintained well. All staff keep themselves up to date with all homes policies and procedures. All our staff are informed of importance of good hygiene practice and gloves,aprons and alcohol hand gel always available. The manager continues to ask for comments about the service they provide at The Fairways by sending out questionnaires each year to visiting GPs and district nurses,in addition to asking service users and their relatives or friends and staff there views and opinions. The information is then analysed and assists the management team to further develop the service they provide. 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 1 8 The manager needs to purchase weighing scales that are right for the people who live at The Fairways so that all service users can be routinely weighed,so the manager has the knowledge that service users weights To support the medication practice and routines in addition to providing additional safeguards for service users, the manager needs to arrange that all service users have a photograph accompanying their medication records. 2 9 Care Homes for Older People Page 31 of 32 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. 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