Inspection on 10/08/09 for Far Croft

This is the latest available inspection report for this service, carried out on 10th August 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Far Croft 20/10/05

Far Croft 22/06/05

Far Croft 29/03/05

Far Croft 11/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Far Croft North Road Wellington Telford Shropshire TF1 3EU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jonathan Potts     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Far Croft North Road Wellington Telford Shropshire TF1 3EU 01952223447 01952245558 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.coveragecareservices.co.uk Coverage Care Services Ltd care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 41 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: Dementia (DE) 41 Old age, not falling within any other category (OP) 41 Date of last inspection Brief description of the care home Far Croft is registered as a Care Home to provide care for a maximum of 41 older people, this including up to 6 people that may have care needs associated with a dementia. The Home, which is purpose built, provides long term care and respite care (this within a designated respite unit) and all bedrooms are single. The gardens and grounds surrounding Far Croft are well maintained and provide a safe and pleasant outside environment for people and their visitors. Coverage Care Services Ltd make their services known to prospective service users in: The Statement of Purpose, Care Homes for Older People Page 4 of 31 41 0 Over 65 0 41 Brief description of the care home Company Brochure and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in the homes foyer. Coverage Care Services (a not for profit organisation) rates are reviewed annually on 1st April each year and service users are notified one month in advance. The only additional charges to service users are for toiletries, hairdressing, newspapers and escorting to hospital for routine appointments. This is clearly laid out in the terms and conditions. Fees for Farcroft as of 1st April 2009 are: 437 to 462 pounds per week. 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: 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: We did not tell the home we were going to visit , and arrived at Farcroft at 8.50am on the 10th August 2009, leaving at 6.10pm. The visit was carried out by one of inspectors. Before we visited the the home we reviewed all the information we had received about it since our last review of the home, this including information sent to us every year by the homes manager (this in a document called an Annual Quality Assurance Assessment - AQAA). We also reviewed all the other information we have received about the home, this including that from the home (in the form of notifications about such as incidents that they have to legally tell us about) and from other organizations. We also sent out Survey forms. We received a number of these back, 10 from people living at the home, 11 from their relatives or representatives and 1 from a health professional. We spoke to nine people who live at the home, five staff, the registered manager as well as the homes operations manger during our visit. We also looked at care and Care Homes for Older People Page 6 of 31 management records as well as having a look around the building. The last main inspection of the home was on the 10th August 2006. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The homes manager has told us of a number of areas where the home has improved, this reflecting our view that the home is responsive to the changing needs of people who live at the home, and their views. We noted that there are some comments we received that state activities could be better and some aspects of food could improve (both these a minority view based on comments received - others very complimentary about the food they have). The manager is aware of these issues and is looking to improve the service in these areas. In respect of activities she has trained staff in areas related to stimulation and exercise, more pets and contact with animals is now used and she is looking at ways in which to extend the homes use of volunteers to assist with the provision of activities. The homes achievement in gaining a platinum healthy eating award from Environmental Health recognizes the homes work in promoting and providing healthier food choices. The manager has told us that she has worked to improve their relationship with health services, and comments that we have received from one health professional have underlined this when they said there is good communication with district nurse team. Care Homes for Older People Page 8 of 31 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 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 and their representatives have sufficient information available to them to be able to make an informed decision as to whether Farcroft can provide a suitable home for them. The home has suitably robust checks so as to ensure it knows if it can meet the needs of those people who move in to the home. Evidence: We saw the homes statement of purpose and service users guide, which was updated in April 2009. We saw that this was readily available at the home, the manager having a number of copies which she had quick access to, this so they could be given to people when requested, or prospective service users and their representatives when they visit. We found the statement of purpose and service users guide to be informative and suitably presented (i.e easy to read and accompanied with photographs). The manager told us that where copies of the documents are needed in alternative formats she can obtain these from the companys head office. Care Homes for Older People Page 11 of 31 Evidence: We saw the home also has a small brochure available that contains key facts about the home, a number of copies of this in a display stand in the homes foyer. The home also has a website (as we have seen) where people can access information about the company and all its care services. We looked at care records for four people living at the home and saw that detailed contracts signed by the individual or their representative are kept, the dates showing that these are agreed at the point people are admitted to the home. People told us in surveys returned to us that they received sufficient information to allow them to make a decision about the homes suitability prior to moving in (70 of those returned saying this was always the case, 30 usually). We spoke to two people in respect of their admission to the home and both confirmed that they knew Farcroft from having stayed at the home previously on a short term basis. Both told us that they were happy to return to the home, and knew what to expect from the service, one saying it was the best option where they did not consider living at their own home was safe. Both of these people told us that they were happy with their move into Farcroft. We looked at the pre admission assessments for four of the people living at the home and found that these were all supported by assessments carried out by social workers or their equivalent, with supporting information available from hospitals where the person had come to Farcroft after discharge. We saw that assessments relating to people admitted for respite care (as was applicable to two of the peoples care records we looked at) are retained, and information updated at the point, or very shortly after they return to the home for a later stay. 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. Individuals who live at the home receive the care and support they have asked for in a way that promotes their dignity, and their health care needs are met. Better medication management will improve individuals safety. Evidence: We looked at four individuals care plans in some depth and discussed these with three of those people to whom they related. We saw that the plans detailed what the staff needed to do to support these individuals in respect of such as personal, health and social care (the latter more detailed when there was a greater level of assistance needed). We saw that where there was a need clear information is available as to how to promote communication with the individual. We also saw that the home has detailed plans for night time care, this making it clear the specific support people need at at time where they may be more vulnerable. We saw that all care plans are supported by risk assessments that inform the former. The three people living at the home whom we discussed care plans with told us that the information within them, with little exception was accurate, and reflected the way Care Homes for Older People Page 13 of 31 Evidence: they wished to be supported. They all told us that the staff (one saying it was their key worker) had discussed their plans with them, and had agreed its contents. We saw that individuals signed the plans where able. One individual told us that their key worker discussed their care plan with them on a regular basis and we saw written evidence of all the plans we looked at been updated on a regular cycle. The three individuals we spoke to about their care plans told us how the staff promoted independence by allowing them to complete their own care wherever possible, such as washing and dressing themselves, and encouraging such as managing their own medication where able. People or their representatives told us that they are happy with the care they receive at the home. They told us that staff are respectful in the way they deliver care, call people by their preferred titles and let individuals do what they can for themselves. This reflected comments from surveys we received from residents and their relatives, with comments such as the following: I have been looked after well since Ive been here, The staff look after me, Keeps me well informed of any incidents or concerns, phones me monthly to let me know of any changes to the care plan, All the staff show my (relative) all the care and support (they) need. (Their) quality of life has improved since (they) moved to Farcroft, Staff look after residents really well and make every effort to make the residents feel at home, the staff particularly the manager Carole Williams have been very supportive in recognizing my mothers needs. The staff always have time to discuss my mothers situation. The majority of people who returned our surveys (residents and relatives) stated that they received the medical support they needed and that the care and support provided was as agreed. We looked at records relating to contact with health care professionals for four people and found that the staff had promoted this contact with such as G.Ps, district nurses and other community health professionals as needed. We have also been kept up to date through formal notifications as to any incidents of serious illness that have occurred at the home, these showing an appropriate response by the home. One health professional responded to our survey stating that the homes assessments ensure that the right service is planned for the individual and that peoples social and health care needs are properly monitored, reviewed and met by the service. They also added that there was a very caring and friendly atmosphere and there was good communication with the district nurse team. Care Homes for Older People Page 14 of 31 Evidence: We did however see that there whilst the home monitors individuals weights on a regular basis the use of a body mass index score (BMI) to show whether any weight loss is significant would be useful. This comment is in response to noted weight loss for one individual, although when we met the individual in question they were seen to look in good health. We looked at the homes systems for the management of medication on the Sandringham and Dementia care units. The medication records we saw on Sandringham are well completed, the only omission a list of staff names against staff initials, this to assist with tracking who is giving the medication. This was not the case on the dementia care unit where we saw a number of medication administration records contain gaps and errors. Examples of these included medication that had been popped out of blister packs not signed out and medication written up for once a day that was signed out for twice a day. The last audit of the homes medication by the contracted pharmacist did not however reflect our findings (this carried out in March 2009), with the outcome that no issues had been identified. An internal audit by the operations manager in May 2009 showed the home was handling medication safely. We discussed these issues with the manager on the day of our visit and have received contact since this time from the manager and operations manager for the company, who carried out a full audit of the homes medication the following day, a report relating to this sent to us. This has told us that the home has responded robustly to all the concerns raised, and action is been taken to ensure that there is no repeat. A request has also been made by the home to the pharmacist at the local Primary Care Trust (PCT) to carry out a medication audit in the near future, this to ensure the issues identified have not reoccurred. The management response to our concerns has reassured us that changes will be made to ensure that the management of medication is safe. We saw that the home does promote individuals to self administer their own medication, this supported by a risk assessment process. More regular review of these risks assessments was suggested to the manager as one individual who was handling their medication had misplaced the key to the lockable drawer in their bedroom, meaning medication was unsecured. 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. The home works hard to promote peoples access to their chosen daily routines and stimulation that is in keeping with their expectations and needs .People are enabled to keep in contact with their relatives, friends and Representatives. Individuals dietary needs are well catered for through provision of a varied and appropriate selection of meals. Evidence: We looked at four care plans in respect of how the home promotes an individuals chosen daily routines and found that these told us how care should be provided so that individuals independence is promoted. The way in which this was done was confirmed as accurate, and as agreed, by three individuals living at the home that we spoke to. We saw that three of these plans highlighted the preferred activities the individuals like to be involved with, although in some cases the detail as how their involvement was to be promoted could have been clearer, rather than just comments as to staff needing to encourage them to get involved in the social events available. This was not the case in all care plans however , as the one we looked at for a longer standing resident with dementia was very detailed and it was very clear as to how her choices would be promoted and social stimulation provided. Care Homes for Older People Page 16 of 31 Evidence: The manager told us how she and the staff have worked hard to promote stimulation and activities for people living at the home, this through a variety of methods such as providing pets (such as fish and guinea pigs), accessing community services to allow access to animals (dogs and donkeys), planning special events and reviewing the use of external entertainers. We saw activities advertised on notice boards around the home, and a number of people involved in individual activities. A number of staff have also been trained in such as extend and otago, these related to exercise and activity, thereby promoting health through such as exercise. The views of people using the service as to the activities was however mixed. Eight out of the ten stated that there are always or usually activities available that they could participate in with one commenting that the home was giving the right activities you need, dont think they could do anything any better. Some of the relatives also told us in surveys that they arrange activities for them which is good for mind and body, you do not see them all sleeping in their chairs although others stated that there could be some more activities to keep the residents motivated, provide more entertainment/interactive activities - as always this is very dependent on funds available and staff. However Farcroft do try to do a variety of things but more craft/painting interactive activities that challenge the residents would be great and more trips out, short breaks. We also noted that 3 out of the 7 staff that responded to our surveys commented on more entertainment for service users, another saying they could provide more time with residents (1 to 1). We saw that activities are an item that is discussed with people that live at the home at regular unit meetings. Discussion with the manager indicated that this is an area where she is looking to further improve the service offered by the home, with plans to look at such as holidays and continue discussions with people living at the home, this to ensure activities are centered around personal needs. The manager has told us that she is looking at building a bank of volunteers to assist with activities. We have been told by relatives through surveys that the home is good at keeping them up to date with developments, and helping the people living at the home keep in touch with them. Comments made to us included the following: We are always made to feel very welcome and feel like we are part of a large family, The staff at Farcroft are very kind to us, they find time to chat, maybe about my (relative) or everyday things, nothing is too much trouble and the staff always have time to discuss my (relatives) situation and if I call at an inconvenient time someone always calls me back. In discussion the manager told us about how they encourage people to visit telling us how they will provide opportunities, such as for one family where they arranged for them to visit and have a meal with their relative. The individual whose family visited confirmed that the home had arranged this family meal. Care Homes for Older People Page 17 of 31 Evidence: We saw the main meal of the day at the time of our visit and spoke to three people living at the home about the meals. They all said that they liked the meals, that the kitchen staff are flexible and that you can mix and match the choices. We saw that there were at least three different meals choices available on the day from observation, this as part of 3 courses including starter, main meal and sweet. Drinks we saw are readily available and staff we saw refilled peoples glasses on request. We also saw that vegetables are presented in serving dishes on the tables, this so that people can add their own portions, with the staff heard to offer seconds after the serving of the main meal. People told us that staff ask them what their menu choices are on the mornings, this as we saw was documented on menu lists that staff showed and discussed with us. Other people we spoke to during the course of our visit also said that the food available was good, although we did receive some limited comments that sandwiches for tea time to regularly - kept cold as prepared during the day but have always become soggy by tea time. When this was mentioned to the manager she was fully aware of the issue, although discussion with at least 7 people living at the home on the day gave rise to no concerns as to the tea time meals, with comment to the fact that there are hot alternatives available. We saw that menus and food choices are a regular item for discussion at unit meetings with the people that live at the home. We also saw (from a displayed certificate) that the home has recently achieved a platinum healthy eating award from Environmental Health, this in recognition of the home promoting and providing healthier food choices. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are aware of the homes complaints procedure and the home responds appropraitely to complaints. Practices at the home safeguard and protect the individuals living there. Evidence: We saw that the home has a complaints procedure that is readily accessible to people living within the home, their representatives or any visitor, this presented in leaflet form. The leaflet is presented so that it is easy to pull out key information, telling people what will happen as a result, including timescales. Our contact details are also included. We looked at the homes complaint record, this showing that any complaints are clearly documented, and show the outcome of the complaint when resolved. Where appropriate the home has also let us know about any issues that fall within the remit of legally required notifications. Surveys we received from people living at the home told us that 6 out of 10 respondents knew about the homes complaints procedure, 3 saying they didnt. 9 out of the 10 respondents told us they knew who to speak to if unhappy with the majority stating that staff listened and acted upon what they said. All 11 of the relatives and representatives that responded to our survey all stated they are aware of the homes complaints procedure, 9 of these stating that the home responded appropriately if Care Homes for Older People Page 19 of 31 Evidence: concerns are raised, the other 2 saying this was usually the case. We spoke to two people living at the home about raising concerns, and whilst they stated they had none, they both said they knew who to speak to, the one saying the head lady the other their key worker (who they said puts things right whenever possible). One commented on the fact they are comfortable raising any concerns with staff. We had one survey from a health professional who confirmed that the home always responds to concerns raised. The manager sees the complaints procedure as a tool for monitoring the quality of the service and as stated in the complaints procedure, people are asked to tell the home what they think, good or bad. Links with the police have been fostered following on from some issues so that individuals can better communicate with them if there is an issue. From discussion with the local authority safeguarding team on a number of occasions we are aware that any safeguarding issues the home becomes aware of are quickly referred for investigation in accordance with the homes robust procedures. Staff are provided with training in recognizing and reporting abuse, this as seen in the induction in two staff files we looked at. Discussion with the manager shows that she places a high priority on the safety of people living at the home. One of the individuals living at the home commented in their survey that the home was good in that it provides security - feel safe. The same view was stated by one of the people we spoke to on our visit in that they felt safe at the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an environment that is well maintained, homely and suitable for meeting the needs of those people that live there. Infection control receives a high priority, thus protecting the health of people living at the home. Evidence: We looked around the building during our visit and found that the home was well maintained, and provided a homely environment. We saw from records and servicing certificates that equipment is checked on a regular basis and the handyman completes checks on such as water temperatures to ensure risks to people living at the home are minimized. We looked at a number of bedrooms and communal areas and found that these are light, well decorated and furnished. A number of the bedrooms that we saw had been personalized so as to reflect the tastes of the occupant, with those in the dementia care unit having items of significance outside their bedroom doors to assist them identify their rooms (in memory boxes). We also saw that there is clear signage so that people can easily find such as toilets and bathrooms. There are numerous sitting areas available, with seats available in alcoves around the home so that people have a range of areas where they can sit, and all bedrooms are single occupancy. The homes has a number of adaptations suitable for the needs of the people living at the home such as hoists, shaft lift, handrails in corridors, adapted baths, showers and such like. Care Homes for Older People Page 21 of 31 Evidence: We noted that the communal lounges in the home have kitchenette facilities and people living at the home that we spoke to about these said that if they are able they can make their own drinks, and any visitors are also able to make their own beverages. We saw that the management carry out regular audits of the premises, these documented. The management have a rolling programme of maintenance and the manager told us what has been improved (new furniture and flooring in the dementia care unit, new hi lo bath, new Otis sanitizer as examples) and was clear as to where improvements are needed/planned (these areas as we saw recorded in the homes maintenance plan). We spoke to three people living at the home about the communal area they sit in and they told us that it is clean and they like it. They told us how the staff use a folding table so that this can be moved out the way in between meal times so that they have more space and there are less obstructions. We also spoke to a person with a visual impairment and they told us that she was able to find her way around independently as their bedroom and toilets are close to the lounge area, and the way was kept clear of obstructions (this as identified in their care records). People told us they have keys to their bedroom doors and lockable areas if they wish. One relative told us that individual rooms well appointed, no restriction on what people take into their rooms. We looked at the gardens areas, the main one laid out with raised beds and sitting areas and some interesting focal points (such as an ornamental well). There is a separate area outside the dementia care area that provides sitting space and room for the guinea pigs cages, this area separate from the main garden. Whilst the space is limited the home has tried to make the garden areas as interesting and safe as possible, the staff member we spoke to saying people are accompanied outside due to the banked area to the side. We saw that the home was very clean and we did not smell any unpleasant odours during our visit. We saw that the home was very clean, this showing that the homes cleaning schedule is effective (with a documented record of where staff had cleaned seen). In surveys 8/10 people who live at the home told us that the home is always fresh and clean. We heard from people living at the home and their relatives/representatives that Farcroft is very clean and tidy , rooms are clean and is always clean. We saw the homes procedures for infection control and the last audit that Care Homes for Older People Page 22 of 31 Evidence: management had carried out in April 2009, this informing the steps the home has taken to maintain infection control. The manager informed us that there has been no incident of reportable infections at the home over the last 12 months, and felt that the precautions the home took to manage infection are robust. Care Homes for Older People Page 23 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. The staff at the home are well trained and available in sufficient numbers, this meaning people living at the home receive a good support. Recruitment practices protect people living at the home. Evidence: People living at the home told us in survey forms that staff are always (4 out of 10) or usually (5 out of 10) available when needed and relatives/representatives stated that they had the right mix of skills to support people. People we spoke to during our visit told us that staff are very good, very helpful with one saying that their key worker listened to them. We had numerous comments through our surveys as to peoples view of the staff team this including the following: Happy friendly staff, Staff invariably polite and helpful, Staff always willing to try new ideas/discuss alternatives, They are always very helpful and friendly, The staff always have time and Provide supportive care 24 hrs a day and are willing to go the extra mile. We looked at the staffing rota and based on what we saw we judged that sufficent staff are available. We saw that there are various ancillary staff available, such as a laundry worker, domestics (called support workers), catering staff and a handyman. There are seniors available on every shift and the home has an allocated Care Homes for Older People Page 24 of 31 Evidence: administrator. We saw on the day of the visit that steps are taken to cover staff sickness so that minimum staffing levels are maintained. Six out of the seven staff that completed survey forms stated that there was usually sufficent staff on duty, although one did comment that they felt there should be more support staff in the afternoon and one felt that more time to spend 1:1 with people that live there would be better. We looked in depth at two staff files (for staff that had been employed in the last year) and sampled others. The two we looked at showed us that the home has a robust recruitment procedure with prospective staff thoroughly vetted to ensure they are suitable and safe to work with vulnerable people. No staff are employed until the home has recieved a suitable enhanced disclosure and POVA (Protection of Vulnerable Adults) check. Staff are usually enrolled on vocational training following induction, this resulting in the home having well trained staff, with almost all having an NVQ level 2/3 or 4 in care or a combination of qualifications. Seven staff told us in surveys that the have recieved training that is relevant to their job, helps they understand/meet individuals needs, keeps them up to date and gives them information about health care. From sampling of staff files we saw that this was accurate, with training given a high priority from the point staff are employed, with their completing a robust induction (that meets national skills for care standards). We also saw identification of training needed for staff to reach a minimum level of competency. We saw that this was assessed through appraisal and regular supervision. The former was evidenced by records that we saw and discussion with staff. Care Homes for Older People Page 25 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 consults with people who live at the home and others to inform the management of the service, this so that it reflects their views. The home is well managed by staff that have proven leadership skills and the confidence of those people that use the service. Evidence: We looked at the home certificate of registration at the time we visited the home (this on public display) and this reflected the information we have about the home, evidencing that the one on display is current. The homes registration is reflected in the homes statement of purpose where it is stated as to what service the home offers and to whom. From information provided to us by the home and feedback we have received the home is not accommodating any people whose needs they are unable to meet. The registered manager of the home, Carole Williams, although only having managed Care Homes for Older People Page 26 of 31 Evidence: the home for approximately the last 18 months has extensive management experience of care services (some of this as managed Farcroft in the past). She also has a number of care and management qualifications that mean she has an extensive knowledge of how to manage a care home. This has been further evidenced by the information she submitted to us prior to the inspection, and discussion with her at the time of the visit to the home. We have also heard the views of people who live at the home and their representatives with some making the following comments that reflect of the management of the home: The staff and management are always available and do their very best to deliver an excellent service, the staff particularly the manager Carole Williams have been very supportive in recognizing my mothers needs, general improvement in all aspects of Farcrofts care and service since the appointment of the manager (C.Williams), We made a very good choice in Farcroft and I have to say on the whole I am very pleased with the service my mother receives. My comments here would only go to enhancing what is a very good service. We saw that senior managers review the conduct of the home on a regular basis through monthly monitoring visits, quality monitoring as well as management meetings, some of these focusing on specific areas (such as health and safety). Quality monitoring takes place on an on going basis through in house audits, meetings (with people that live at the home and staff) and day to day contact between the manager and people living at the home, their visitors (as we saw during our visit) and staff, this to ensure that the views of people are reflected in the running of the service. We saw that the home uses its own annual surveys to canvas the views of the people that use the service as well as their representatives, the summary of the findings included in the homes service users guide (this seen to reflect some very positive outcomes). The only area where we noted any issue with quality monitoring was in respect of medication management, although the actions the home has told us it has taken immediately after we raised concerns showed us that the management are committed to addressing these issues (see health and personal care section of this report). We saw the home maintains records to help ensure that the health and safety of people living at the home is maintained, with such as complaints, accidents and incidents closely monitored to identify any trends and need for corrective actions. We sampled some of the homes risk assessments in respect of safe working practices and found that these are detailed and identify how the home can minimize risks to promote peoples safety. The only issue that has arisen from this (based on comment on one relative) is that there are occasions where independence is limited due to risk assessment, this only a bit of irritation occasionally however. We have seen and been told by people at the home that they do have scope to be independent in a number of Care Homes for Older People Page 27 of 31 Evidence: areas though. The homes record keeping as seen from our sight of care and management records is generally very good, although we did see occasions where there was some slippage, such as inventories of peoples property not dated, and occasionally missing dates in other care documentation. This was brought to the managers attention at the time of our visit and it was suggested more thorough audits of care documentation to ensure it was all to the homes usual high standards maybe useful. Care Homes for Older People Page 28 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 29 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 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 To introduce the use of B.M.I. (body mass index) to calculate the outcome of any weight loss or gain for people, this so the home can respond appropriately if there is a need. To ensure that there is a list of staff names against their initials in all medication administration records, this to assist with tracking who has administered medication. To introduce more robust monitoring systems to audit the homes management of medication. 2 9 3 9 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!