Inspection on 03/05/06 for Farnham Common House

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Farnham Common House 05/06/07

Farnham Common House 14/11/05

Farnham Common House 15/06/05

Farnham Common House 23/05/05

Farnham Common House 30/09/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Farnham Common House Beaconsfield Road Farnham Common Slough Bucks SL2 3HU Lead Inspector Mike Murphy Unannounced Inspection 3rd May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Farnham Common House Address Beaconsfield Road Farnham Common Slough Bucks SL2 3HU 01753 669900 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) manager.farnham@fremantletrust.org admin@fremantletrust.org The Fremantle Trust Mrs Yvonne Peace Care Home 50 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2005 Brief Description of the Service: Farnham Common House opened in May 2004. It is a care home providing personal care and accommodation for 50 older people. The development is the result of a partnership between The Fremantle Trust, London and Quadrant Housing Association and Buckinghamshire County Council. The service is run by The Fremantle Trust. The home is located in Farnham Common, Buckinghamshire, on the A355 road and is conveniently located for buses between Beaconsfield and Slough (hourly service) and about half a mile from shops and other amenities of Farnham Common. The home is divided into four houses - two of ten places and two of fifteen places. One house on the ground floor is dedicated to the care of people with dementia. The home is purpose built and provides a good quality, well equipped and spacious environment for service users. All bedrooms are single and all have en-suite facilities comprising wc, sink and shower. The home is set in compact and pleasant grounds. There is usually sufficient parking for staff and visitors cars. The home’s fees are from £372.82 to £570.57 per week. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors between 09.30 am and 7.00 pm on a weekday in May 2006. The methodology included discussion with the registered manager and service manager, examination of records, a tour around the building, consideration of comment cards submitted by service users, relatives and professionals in contact with the home, observation of care, examination of the home’s arrangements for the storage and administration of medicines, and discussion with service users, staff and visiting professionals. The inspection finds an uneven picture but the overall trend indicates a continuing improvement in the quality of the service. There is a high level of satisfaction with the service as expressed through questionnaires returned to CSCI and comments to inspectors during the course of the inspection. At the same time weaknesses in the quality of assessment and care plan records remain. It is important that they continue to be addressed through staff training and supervision and that progressed be monitored through occasional audit. One cannot be certain at present that the records are an accurate reflection of assessments, are as reliable as they might be in recording residents needs and actions to meet those needs, or act as a reliable means of communication between staff. The pace of life in the home seems to meet the residents needs. Residents pursue a range of activities and report that they are free to make their own choices. The work of the recently appointed activities organiser is appreciated. There are still ten hours of that post free and the registered manager is keen to encourage care staff to participate in organising activities. Most residents are very satisfied with the quality of the food. The home’s policies for managing complaints and ensuring the protection of vulnerable adults are good. A high proportion of relative and resident respondents who returned comment cards to CSCI were unaware of the home’s complaints procedure. The registered manager is asked to address this. Staffing levels are satisfactory although some additional support may be required at mealtimes on the higher dependency house. Arrangements for the recruitment of staff are satisfactory and staff benefit from the organisation’s training programme. The home participates in the internal quality assurance audit. Regular meetings are held with residents and a consultation meeting with relatives is held twice a year. The registered manager needs to augment these arrangements with more frequent meetings with the relatives of residents with dementia and we understand that these are to be re-established in the near future. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service.The needs of prospective residents are assessed by the referring care manager and by the registered manager prior to admission. This process should ensure that the home is able to meet the needs of the prospective resident. However, weaknesses in recording assessments make it difficult to assess the quality of the process and may also lead to weaknesses in communication which can mean that a resident’s needs not being fully met. EVIDENCE: Residents files in two units were examined. All residents are assessed by the registered manager or deputy manager before admission. In the case of prospective residents referred by social services the assessing manager usually has a copy of the assessment carried out by the referring care manager. Examination of records showed some variation in the quality of recording assessments. While some records appeared satisfactory there is still a proportion which may raise questions about the quality of the assessment. In one case the assessed needs of a resident who had formerly been admitted for Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 9 short term respite care had not been updated when that resident took up a permanent place in the home. Significant sections of another assessment had not been completed and the pages were not in order. Some entries had not been signed or dated. Files were not in chronological order. Waterlow (pressure area risk indicator) and nutritional assessments had been completed but did not have a date for review. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The inspection has found uneven standards in the quality of care plans which may mean that residents needs are not fully met. The home maintains good liaison with healthcare services in the community and residents healthcare needs are met. Performance with regard to the recording of medicines administered by staff continues to improve. This reduces the potential for errors. The standard of the accommodation and the practice of staff and visiting professionals carrying out examinations in resident’s bedrooms maintain the privacy and dignity of residents. EVIDENCE: A sample of care plans on the first and ground floor were examined. The home is required to use the Fremantle care planning system. The structure of care plans is comprehensive but complex and the quality of its application in practice is variable. Uneven standards were found at every stage. The quality of assessments varied. This in turn affects the quality of the care plan. The quality of records of care provided varied. The consistency of reviews varied. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 11 At the same time however, the standards of practice observed were generally good. Residents generally reported satisfaction with their care. Healthcare professionals were generally satisfied with the quality of care provided in the home but some reports were qualified with an indication that there were weaknesses on occasions. This picture of a reasonably high levels of satisfaction with the care provided combined with uneven standards in the care recorded may suggest that standards may be higher than the records indicate. If this is the case then the registered manager needs to continue to address the weaknesses so that the home provides evidence to support that view. It was noted in one care plan that ‘Tippex’ erasing fluid had been used. This practice must stop. Errors should have a straight line drawn through them and be signed and dated. Care plans set out the action to be taken by care staff and in many cases these were satisfactory in terms of recording the appropriate action to be taken to deal with a care need and to ensure this was communicated to successive care staff. In some cases, however, the action required to assist a resident was vague i.e. ‘needs full assessment’, or the consequences of not intervening and providing effective care were incorrect or imprecise i.e. ‘poor nutrition’ (could lead to) ‘inadequate diet’, and, ‘dehydration’ (could lead to) ‘hospitalisation’. The views of a visiting GP, district nurse and community psychiatric nurse (CPN) (the latter accompanied by a clinical psychology trainee) were sought. Residents were seen by these professionals in their rooms which took regard of the residents’ privacy. The GP and district nurse described good communication with the home. The district nurse reported that there was no resident from her surgery with pressure damage at the time of the inspection. The CPN from the Department of Old Age Psychiatry at Wexham Park Hospital was familiar with the home and said that staff carry out any advice given and attend reviews where held. No significant problems were reported. One criticism was that the visit of the CPN (who on this occasion was attending to give an injection to a resident) was not always incorporated into the resident’s routine by staff on the day even though it had been put in the diary earlier. It was suggested that the subject of mental health matters in old age might usefully be included in the staff training and development programmes. The CPN said that she was always happy to provide advice when required. Care plans included pressure sore risk assessments and nutritional assessments. Records support residents’ comments that they saw the chiropodist regularly. Records also confirm that residents are seen by an optician, their GP or dentist where required. Weights were generally recorded although the body mass index was not always calculated (the home’s methods allow for this). In cases where weight loss was a problem the care plan did not always include reference to the weight chart. It is also felt that an entry such as ‘Carer to ensure that Mr X eats and Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 12 drinks.’ lacks sufficient detail where there is concern about a residents loss of weight. Continence assessments were not noted and specific instructions on continence aids where used (e.g. size or night or day) were not included on care plans. The summary of daily routine and night care plan are both very useful documents. The involvement of the resident, or in some cases the nearest relative, as indicated by a signature was noted. Arrangements for the storage of medicines are satisfactory. All care staff have received training from an accredited BOOTS Chemists trainer. Records of the administration of medication were examined and generally found to be in order. Medication administration records showed no gaps. However, on some records it was noted that staff are writing over entries. This was discussed with the manager and it was agreed that this practice would cease. Staff were not consistently counter signing hand written entries on the Medication Administration Records sheets or dating where a course of treatment is completed or discontinued. The home is advised to ensure that its policy and practice conforms to the guidelines of the Royal Pharmaceutical Society of Great Britain on the administration of medication. Some residents were prescribed Warfarin or anti-epileptic medication and it would be good practice for the manager to develop protocols for the administration of such medication. One professional respondent noted in a comment card that residents medication is appropriately managed “95 of (the) time”. Residents privacy and dignity is maintained. Staff were seen to knock on service users doors and to await a response before entering. It was noted that personal care is carried out in resident’s bedrooms or bathrooms. Residents are seen by visiting professionals in their rooms. However, notes on wardrobe doors which include references to residents care would be better placed in the care plan in order to avoid compromising confidentiality. The manager wrote to the Commission a few days after the inspection to say that these had ‘…either been removed completely or repositioned in a discreet place’. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents have opportunities to be on their own or with others as they wish. They may participate in activities as arranged by staff or pursue their own interests if they prefer. Residents may have visitors at any time. This supports residents in continuing to exercise control over their lives. The overall standard of food and nutrition is good. However, the level of assistance to more dependent residents in one of the homes should be reassessed to ensure that those residents nutritional needs are fully met. EVIDENCE: Residents described an unhurried and relaxed feel to the day. Residents said that they read books or newspapers, listened to the radio, watched television or listened to music. One resident talked of enjoying listening to opera and jazz. The same resident also described a visit by the local MP who participated in a discussion group, an event which, while partly political, also discussed issues which the resident said were sensible to anybody listening. Discussion groups were described as “favourable and interesting” and the coffee mornings seemed a great favourite with several residents. A further resident described “a bar evening”. One resident had gone out for the day. One resident said that Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 14 he would recommend the home to any one. Another resident stated that if she wanted to stay in bed she would say ‘bed for me’ and her choice would be respected. Another resident said that he was able to pursue his interest in transport – buses in particular – through collecting models, magazines and having trips out a couple of times a week, with occasional longer trips by bus. Residents are free to spend time on their own or with others as they wish. Residents may have visitors at any time. There was a programme of activities displayed on each unit. There was also a list of the dates of Communion services (although the denomination was not stated). The activity organiser was on leave at the time of the inspection. Residents praised her contribution to their activities. The registered manager said that there was still around ten hours of activity co-ordinators time vacant. The role of activity co-ordinators is two fold: to assess and devise appropriate activities and to support care staff to develop skills to continue activities when the co-ordinator isn’t on duty. It is hoped that the latter of these can be developed further over the course of the year. Activities appear to stop half an hour before a meal and it was suggested that it might be helpful to involve residents who wish to, to be involved in preparing the table for the meal. Some residents described Bingo as ‘not their cup of tea’. Meals are served four times a day. A cooked breakfast is available at 9.00 am although a lighter breakfast can be provided at any time. Lunch is served at 1.00 pm and is the main meal of the day. The evening meal is served at 6.00 in three of the houses and at 5.00 pm in ‘House One’. Supper, a light snack, is available later in the evening on request. Residents generally expressed satisfaction with the food. Arrangements for providing assistance to residents were generally satisfactory but the arrangements on House One need further consideration by the registered manager. The lunchtime meal on the day of the inspection was pleasant and well presented. Residents choose their meal the day before. Four staff were involved in the meal process in House one – for fifteen residents. Two staff provided assistance to residents and were observed to do so with sensitivity. Two other staff served lunch to the remaining residents. It was observed in house one that three residents had difficulty eating and spat out some of the food. This could have been off putting for other residents eating at the same table. It may indicate a need for staff to review with the manger the extent of support which residents in this house may need at mealtimes. This point was discussed with a member of staff and the chef. Further ideas regarding high protein snacks were discussed with the chef in relation to these three residents. The opinion of a dietician might be considered. Throughout the day it was noted that residents were offered drinks regularly with extra drinks being offered to several residents whom staff were concerned about (perhaps relating to infection). This is good practice. The practice in House One of providing ‘smoothies’ around 11am is also a good practice. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 15 Residents in House One were unable to describe a formal supper period although the chef confirmed that although food is available supper is not included on the menu. It is important that there is not a significant gap between the last main meal around 5.00 pm and breakfast next morning. Supper is offered to residents and included as part of the night care plan. One resident described the food as “ok” and one resident has a fridge in her room and stated that her daughter brings in food. All other residents spoken to, and those completing CSCI questionnaires, described the food as good. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a system for recording and investigating complaints although a significant number of relatives and residents were not aware of the procedure. The home has a robust framework of policy, procedure, reporting arrangements and staff training with regard to the protection of vulnerable adults. Together, these aim to protect residents from abuse and to ensure that complaints are properly investigated. EVIDENCE: The home is required to comply with the Fremantle Trust complaints policy and procedure. This uses ‘Fremantle Feedback’ as a vehicle for communicating complaints and compliments. Copies of the relevant form are on display in the home. A complaints and compliments file is maintained in the manager’s office. One of the inspectors met with a relative to discuss dissatisfaction with some aspects of the service. The complainant had met with the registered manager and the service manager and efforts were being made to address the concerns although these had not been resolved at that time. It is noted that four relative respondents and eight of eighteen residents who returned comment cards were not aware of the home’s complaints procedure. The registered manager will need to address this and ensure that the complaints procedure is made known to all residents and their relatives. The Fremantle Trust has a policy governing the protection of vulnerable adults (POVA). The subject is included in staff induction and in periodic update training for all staff. According to records submitted with other papers for the Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 17 inspection, the most recent training event on POVA took place towards the end of March 2006. Arrangements for the management of resident’s money are subject to the financial procedures of the trust and are overseen by the home’s administrator. These ensure that records of all transactions are maintained, that receipts are retained and that there are arrangements for the secure storage of cash and valuables. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides a spacious, clean, well equipped, comfortable and safe environment for residents. The environment supports choice (by providing a range of living settings) and residents privacy and dignity. EVIDENCE: The home is located on the main road between Slough and Beaconsfield just to the north of Farnham Common. It is accessible by car and there is a bus service by day (buses approximately hourly, morning to late afternoon). There is parking to the front of the home and a relatively small pleasant garden to the rear and sides. The ground floor communal accommodation opens on to the garden. This is a relatively new home which had been open for two years at the time of this inspection. It provides a spacious and good quality environment for residents. The home is divided into four areas (‘Houses’), two on the first floor and two on the ground floor. One of the houses on the ground floor is designated a high dependency area for residents with dementia. Access is by Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 19 coded locks and visitors are required to sign on entering and leaving the building. The entrance hall has seating for visitors and residents. Background music is occasionally played and fresh coffee is available from a machine. Information leaflets are provided in display racks. Stairs lead directly to the first floor. A lift is available if required. The home is generally well maintained and at the time of this inspection all areas were clean and tidy. A problem with the drains had been reported to managers and was being investigated. All bedrooms are of a good size and have en-suite facilities (wc, wash basin and showers). Rooms have been personalised by residents. It is well equipped. Support rails are in place and the home has hoists and assisted baths where needed. Most areas have good lighting and are well ventilated. Each house has a living, dining and kitchen areas. Meals are cooked in the main kitchen. The laundry is well equipped and is located on the ground floor and is not near the kitchen. Heating is through under floor heating. Hot water in all areas to which residents have access is regulated. Some defects were noted and it is recommended that managers arrange regular checks to identify any building issues and draw up plans for repair in order to maintain the quality of the environment. This should include the investigation of cracks in walls and under the window ledges which were noted in a number of rooms on the first floor. The washing of walls and redecoration in some bedrooms is recommended. Otherwise all areas, including bathrooms and sluices, were very clean. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staffing levels appear satisfactory and the home, in conjunction with the Fremantle Trust’s training department, provides training and all levels and across a broad range of subjects. This helps to ensure that there are sufficient numbers of appropriately trained and supported staff to meet residents needs. EVIDENCE: The registered manager submitted details of staff in post, staff turnover, duty rotas, staff training and the names of staff who are responsible for administering medication with the pre-inspection questionnaire. The registered manager states that the home requires 952 hours to meet the needs of 15 residents with high needs, 10 residents with medium needs and 25 residents with low needs. At the time of the inspection it provided 972 hours. In terms of numbers, at the time of the inspection the home employed 36 care staff, 5 relief care staff, and 10 ancillary staff. These figures do not include the registered manager. Staffing levels were not raised by residents, staff or those who responded through comment cards. It has been noted earlier that the level of staff support at mealtimes to residents in the high dependency unit on the ground floor would benefit from further review by the registered manager. It is reported that 40 of the staff currently hold NVQ2 or above and estimated that this will increase to 60 when the eleven staff currently undertaking NVQ training complete the course. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 21 The home is required to conform to Fremantle Trust policy with regard to the recruitment of staff and is supported in doing so by human resource staff at the Trust’s head office in Aylesbury. The files of five staff recruited since the last announced inspection were examined. All applicants had completed an application form, the information provided by applicants raised no concerns, two references were on file for each applicant and were in order, a POVA First check had been obtained before those appointed started work in the home, and an enhanced CRB certificate was awaited for all five staff. As new staff, all were working under the supervision of senior care workers and house leaders. Staff training is organised from the Trust’s head office and training events take place throughout the year. This includes a five-day induction course, foundation training, periodic updates on ‘mandatory’ subjects (such as moving & handling, POVA, infection control), training on specific topics (such as challenging behaviour, care of the dying, ‘health care’, falls, tissue viability, catheter care), specific conditions (such as dementia, diabetes, Parkinson’s disease) and NVQ training. Records are maintained by the registered manager and staff also maintain records in their own folders. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is run by a qualified and experienced manager with an experienced team of senior staff which should ensure that residents care needs are met. Systems for quality assurance, the management of residents monies and health and safety are in place and should support the provision of a safe and secure service which is responsive to the needs of residents and their relatives. However, there is a need to maintain attention to the detail of these to ensure that all elements of these systems are implemented and to prevent standards of service from slipping. EVIDENCE: The registered manager is qualified and very experienced in residential care for older people. She is not responsible for any other registered service. There are clear lines of accountability within the home (manager, deputy manager, Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 23 senior care workers, care workers) to senior managers (service manager and above). The home conforms to the quality assurance framework of the Fremantle Trust. The main quality assurance activity is the annual quality assurance survey. This is next due to be carried out in June/July 2006. There is an annual development plan. This is developed in line with the organisation’s business planning cycle and is drawn together in October/November each year. There is a residents committee which meets weekly This has recently included a meeting with the local member of parliament. The home holds consultation meetings with residents and relatives six monthly. The registered manager intends to re-establish meetings with carers of people with dementia in the near future. 26 CSCI comment cards were received from residents, relatives and health professionals. It should perhaps be stated that this methodology is unsuited to ascertaining the views of residents with moderate to severe dementia. With regard to overall satisfaction with the care provided four of four relative respondents were ‘satisfied’ and three out of four professional responders were ‘satisfied’. This question is not included in the CSCI residents questionnaire but in answer to the question ‘Do you feel well cared for?’ 18 of 18 respondents said ‘Yes’. 17 of 18 resident respondents said that they felt safe in the home and 16 of 18 respondents liked the food. Overall, therefore, there is quite a high level of satisfaction with the care provided. Comments from individuals some of which are at variance with this include concerns about safety at night, that complaining ‘makes no difference’, while another comment was ‘I speak to the manager who cares if I’m not happy but cannot remember her name’, that in terms of staff treating residents well ‘some do, some don’t’, a health professional complained about a lack of hand towels and the failure of staff to provide them, and two professionals hinted at communication problems on occasions. So while overall there is a good level of satisfaction with the service there are some important points of detail for the manager to attend to on supervision of disorientated residents at night, communication between staff and complaints. The home uses the organisation’s IT system for financial transactions. Head office deal with fees – the home only deals with residents monies. It is required to conform to Fremantle financial procedures. All transactions are recorded and receipts issued retained. Money is held in a Natwest bank account. Residents cannot ‘overdraw’ their accounts. There is a safe in the administration office. Cash and valuable possessions can be held in the safe. Access to the safe is only by the manager, administrator and deputy manager. There is a smaller safe for petty cash Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 24 monies. The system is subject to audit in accordance with Fremantle Trust financial procedures. Bedrooms have a lockable space. The organisation has a health and safety policy and structure for implementation, monitoring and consultation on health and safety matters. The staff induction and training programme includes training on moving & handling, fire safety, first aid, food hygiene and infection control. One of the team leaders is a ROSPA (Royal Society for the Prevention of Accidents) trainer in moving and handling. There is always a first aider on duty. Records of accidents facilitate analysis by managers. The home, through contracts arranged by Fremantle head office and liaison with London and Quadrant Housing Association, has arrangements in place for checking the safety of the building and equipment. The home had an inspection by the fire authority in April 2006 – no matters of concern were raised. A fire risk analysis was carried out in March 2006. The most recent fire drill was in April 2006. Fire training for staff is scheduled for July 2006. A house fire check of exits and position of equipment had been carried by the deputy manager out a couple of days before this inspection. The building was completed about two years ago and equipment and systems are new. It was noted however that a Gas Safety Certificate issued in June 2005 listed a number of items which required attention and there was no record of such work having been carried out. This matter was being followed up by the maintenance manager at Fremantle head office. This apparent omission of an important safety matter affects the rating of this standard. Heating is under floor and the problems reported over the first year now seen to have been resolved. Windows are restricted. Security in terms of access through the front door is good. Staff need to be aware of security issues relating to the ground floor doors which open directly on to the garden when the warmer weather arrives. All hot water outlets in areas to which service users have access are regulated. A number of waste bins did not have lids or were of the swing top variety. Those without tops should be replaced, preferably with pedal operated bins which do not require staff touching the lid. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP16 Regulation 22 Requirement The registered manager is required to ensure that service users and their families are familiar with the home’s complaints procedure Timescale for action 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations It is recommended that the registered manager continue to maintain a programme of staff training and supervision in the assessment of care needs so that standards at all stages of assessment improve. It is recommended that the registered manager maintain a programme of staff training and supervision in care planning to ensure compliance with the minimum standards It is recommended that the registered manager prohibit the use of Tippex’ and similar erasing fluid on records. It is recommended that the registered manager maintain a DS0000060674.V289789.R01.S.doc Version 5.1 Page 27 2 OP7 3 4 OP7 OP9 Farnham Common House 5 OP19 6 OP38 programme of regular audit of the home’s arrangements for the storage and administration of medicines. It is recommended that the registered manager establish a system of regular checks on the home’s environment and report to the appropriate senior manager in order to maintain the quality of the environment for residents. It is recommended that swing top bins be replaced with pedal operated bins which do not entail the user touching the lid of the bin. Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Farnham Common House DS0000060674.V289789.R01.S.doc Version 5.1 Page 29 - 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. 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