Inspection on 19/07/05 for Far End

This inspection was carried out on 19th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Far End 27/07/09

Far End 03/08/07

Far End 09/01/06

Far End 05/01/06

Far End 21/02/05

Far End 16/08/04

Far End 24/02/04

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Far End Sandhurst Lodge Sandhurst Road Crowthorne Berks Lead Inspector Debbie Willcox Unannounced 19th July 2005 at 08:45 am 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 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 and Care Homes for Adults 18 – 65*. 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. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Far End Address Sandhurst Lodge Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01252659842 Ms Patricia Trezise- Dundas Ms Patricia Trezies-Dundas Care Home (CRH) 3 Category(ies) of Old age, not falling within any other category registration, with number (OP). Learning disability (LD), Learning of places disability over 65 years of age (LD(E)) Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 No service user may be accommodated under the age of 45 2 No service user may be accommodated who exhibts wandering behaviour r challenging behaviour Date of last inspection 2 February 2005 Brief Description of the Service: Far End provides care and accomodation for up to 3 people who are aged over 65 years of age and is situated in a peaceful location close to the village of Crowthorne. The home is adjoining a large victorian property with 14 acres of surrounding land owned by the proprietors. The extensive grounds are well maintained consisting of lawns with shrubs and trees. The proprietors live on the ground floor of the home and share with the service users a large lounge/diner/kitchen. Service users have their own rooms on the first floor, where there is a toilet, bathroom with toilet and additional smalll kitchen area on the first floor. In addition there are many pets in the home including several dogs and cats. Service users can bring into the home their own pets. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on a weekday by one inspector. Time was spent talking with all three people who live in this home as well as time spent with the proprietor/manager and the one employed member of staff. All people living within this home have a high level of mental frailty and have limited abilities to communicate coherently their views regarding the quality of the service they receive in this home. What the service does well: What has improved since the last inspection? What they could do better: Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 6 The standard of cleanliness within the home is in need of improvement and monitoring. There is a need for clear management systems to ensure the control of infection and trip hazard prevention, given the vulnerability of the people living in this home this must be responded to as a matter of urgency. A written rota with names detailed as to who was and is responsible for the care of residents on any given day. This is needed to ensure compliance with regulatory standards. 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. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed at this inspection. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 8,10, Further work is needed to ensure that systems for administering and recording of medication are robust enough to ensure safety for service users. The home is currently able to meet the needs of service users living within the home. EVIDENCE: Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 10 Medication storage and administration was viewed at this inspection. Frusemide prescribed for service users once daily in the morning is on occasions given in the afternoon/early evening. The manager was advised to gain authorisation from the GP for this change. The home uses a monitored dosage system for medication. The medication administration record sheet for Haloperidol prescribed for one service user did not detail prescribed dosage and instructions for administration, only the name of the drug was written. A signed statement has been obtained from the GP in respect of giving homely remedies. Service users have single bedrooms. Service users spoken with and able to comment said that they are treated with respect on the whole but one person did comment that ‘Sometimes I am spoken to like a child and I do not like that’. All three service users were seen to be physically fit and well at the time of this inspection. Given their ages all three service users appear fit and physically agile whilst mental frailty levels for two people have deteriorated. A regular review is needed to ensure that the home can continue to meet the deteriorating needs of individuals and that the environment is suitable. There has been an ongoing issue with service users not being reviewed by the placing local authority on an annual basis as is required. Following feedback to Bracknell Social Services two service users have had a review in the last 12 months. However one service users review is still outstanding. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users in this home enjoy a full and active life during the weekdays. EVIDENCE: Service users in this home enjoy a variety of activities during the week as all three attend a local day centre for 3-days per week. The one employed staff member organises trips out on a Thursday such as local parks, shopping and lunches out. For two service users there was evidence of visits from relatives on a regular basis. During this inspection service users were seen to be assisted with breakfast. The main mal of the day provided by the home is a microwaveable meal. Whilst at day centre a hot meal is provided. A record of food consumed in the home is maintained. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Training is provided for staff in responding to abuse of vulnerable adults. EVIDENCE: The one employed staff member provided evidence of training in responding to abuse of vulnerable adults booked for the week following the inspection. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,26, Systems must be put in place to control the spread of infection and to prevent harm from infection and trip hazards for the vulnerable people living within this home. EVIDENCE: All three people living within the home have their own rooms. Meals are taken in individuals rooms. It was evident from observation, discussions with service users and staff the home does not have communal space dedicated solely for the use of service users. Service users visit each other in their rooms. On the day of this inspection cat litter trays were found in one service users bedroom as well as on the landing at the top of the stairs. Pet food bowls and cat litter trays can present as a hazard in terms of infection control and trip hazards. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 14 Incontinence pads were found to be stored in bins in the bedrooms. Cat and dog hair was evident on furniture and bedding throughout. Whilst it is recognised that residents may want to have pets in their rooms clear management systems are needed to ensure protection from offensive odours, the spread of infection and trip hazards. This is essential given the vulnerability of this service user group. Bedrooms are of a good size and service users are able to bring into the home their own possessions. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 The one employed staff member has access to ongoing training, which is of benefit to people living within this home. The current recorded rota system is insufficient and not compliant with regulatory standards. EVIDENCE: A previous requirement for a rota to be produced clearly stating the days on which and including the names of those responsible for the care of service users to be produced has been partially met. The owner’s private calendar is doubling up as a rota record. This record was unclear and confusing. The manager was informed of the need to have a clear separate recorded rota designed for the running of the home detailing the name of the person on shift and responsible for the care of residents including times of shift worked. Time was spent with the one employed carer who informed the inspector that she works 3 days per week, 8-4. The carer was clear regarding the responsibilities of her role. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 16 A 5-day training course accessed via the local authority for all mandatory training such as health and safety, manual handling, fire safety, food hygiene and protection of vulnerable adults had been organised for the employed carer to attend the following week following this inspection. The owners live on the ground floor of the home. All three people living in the home sleep well and at present do not require additional help during the night and so no waking night staff are currently employed. Staffing levels will need to be constantly reviewed in line with any changing needs of those living within the home. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,38, The manager has worked at ensuring that the one employed member of staff has access to mandatory training. Steps must be taken to ensure that food is stored in a manner that protects service users from the risk of infection. EVIDENCE: The owner/manager has an NVQ level 4 qualification in care and management. Evidence from discussions with staff indicated that there is open discussion on a regular basis regarding the care of service users and staff support is provided. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 18 Food in the fridge that had been opened such as ham and tomatoes was not dated on opening and ham not covered to prevent contamination. Fridge and freezer temperatures are recorded daily. The home has had no recorded accidents or incidents in the last 18 months. The inspector was informed that an authorised HSE book is used to record accidents when these occur. A visit from the environment health agency was last conducted in August 2004 and all requirements have been met. Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 19 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 x 2 x 3 x 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 3 x 3 3 x 1 Score Standard No 7 8 9 10 11 Score x 3 x 2 x Standard No 27 28 29 30 3 3 x 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score x x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 x 34 x 35 x 36 x 37 x 38 2 Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? 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 27 Regulation 18 Schedule 4 Requirement A duty rota to be produced detailing the names and shifts worked for those responsible for the care of service users including volunteers employed. ORIGINAL TIMESCALE FOR COMPLIANCE WAS 31/03/05 A management system including risk assessment for the control of infection from cat littler trays and trip hazards to be implemented.l The medication administered chart to detail in full medication prescribed including dosage and times to be given. Any changes in prescribed times for administration of medication to be authorised by the prescribing GP. All food opended and then stored in the fridge to be labelled with the date of opening and disposed of in accordance within food safety guidelines. Timescale for action 01/11/05 2. 18 16,23(2) 01/11/05 3. 9 13 01/11/05 4. 9 13 01/11/05 5. 38 13 01/11/05 Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 21 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 Good Practice Recommendations Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor 1015 Arlington House Theale RG7 4SA 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 Far End H01 11254 Far End V230665 190705 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!