Inspection on 27/07/09 for Far End

This inspection was carried out on 27th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Far End 03/08/07

Far End 09/01/06

Far End 05/01/06

Far End 19/07/05

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 12/10/2009.

Key inspection report Care homes for older people Name: Address: Far End Sandhurst Lodge Wokingham Road Crowthorne Berks RG45 7QD     The quality rating for this care home is:   one star adequate 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: Denise Debieux     Date: 2 7 0 7 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 35 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 35 Information about the care home Name of care home: Address: Far End Sandhurst Lodge Wokingham Road Crowthorne Berks RG45 7QD 01344772739 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: tddundas@talktalk.net Ms Dorinda Trezise-Dundas,Ms Patricia Trezise-Dundas care home 3 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: 3 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Far End provides care and accommodation for up to three older people and is situated in a peaceful location close to the village of Crowthorne. The home adjoins a large Victorian property with 14 acres of surrounding land, which is also owned by the providers. The providers live on the ground floor of the home, which they share with a variety of Care Homes for Older People Page 4 of 35 Over 65 0 3 3 0 Brief description of the care home animals, including both large and small dogs, cats and a caged bird, and though residents are said to be able to share the lounge/diner/kitchen with them, they do not opt to do so, preferring instead to spend their time in their bed sitting rooms. The residents each have their own single bedrooms on the first floor, where there is also a toilet and a bathroom/toilet, there is also a kitchenette but this is not used as such at present. Access to the first floor is via stairs, fitted with two chair lifts for those who need them. The dogs remain in the ground floor areas, but the cats are popular visitors to the residents bedrooms. Residents are able to have pets of their own, and one has a pair of caged birds. Current fees are £423 per week. This information was provided on 27 July 2009. Care Homes for Older People Page 5 of 35 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: one star adequate 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: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 27 July 2009 starting at 2pm. Both registered providers/owners were present as representatives for the establishment, one of the providers is also the registered manager for the home. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last inspection on 3 August 2007. The people who live at Far End prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit all three residents were involved in the inspection. There were no other staff present apart from the providers. Prior to the inspection, survey forms Care Homes for Older People Page 6 of 35 were sent for all three residents, for three social and health care professionals and for members of staff employed at the home. Survey forms were returned by two residents, two social and health care professionals and two members of staff. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the manager. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Residents care plans, staff recruitment and training records, menus, health and safety risk assessments, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the home was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and providers for their time, assistance and hospitality during this visit and the residents, social and health care professionals and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be more detailed and include information that would enable as Care Homes for Older People Page 8 of 35 needed staff to provide care to the standard the residents currently receive, in the way they prefer. More specific risk assessments need to be included to ensure that potential risks to individual residents health and safety are identified early and minimised and that the requirements of the Mental Capacity Act are taken into account and documented. This will enable residents to have confidence that any carers supporting them will have access to accurate and up to date information regarding their needs and preferences as to the way their care is delivered; that potential risks to their health and safety will be monitored and minimised and that any carers working at the home will have access to information needed to keep the residents safe. Medication handling practices need to be improved so that residents are protected from the potential risk of medication errors. The current recruitment and staff training practices need to be improved so that residents can be confident that any staff employed to work at the home are checked to make sure they are suitable to care for them and that they are cared for by staff who are competent and who have received the relevant training. Residents rights and best interests are not fully safeguarded by the homes record keeping, policies and procedures and management and administrative systems need to be improved to ensure that the health, safety and welfare of residents and staff is promoted and protected. 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 35 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 35 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 who may use the service, and their representatives, have the information needed to choose a home that will meet their needs. This home does not offer intermediate care. Evidence: There have been no new admissions to the home since the last inspection. The current residents have all lived there for over three years and both residents who returned survey forms said that they had received enough information about the home before they moved in. In the AQAA, to demonstrate what the home does well, the manager stated that: We always encourage prospective residents to attend Far End with either family or friends for a visit prior to any formal decision. At this stage we discuss what service we provide, our staffing and also try to gain an idea of what the prospective residents expectations and needs are. It is also vital that we ensure that we can meet their care Care Homes for Older People Page 11 of 35 Evidence: needs, for example we would not be able to have a resident that would wander due to the nature and grounds of Far End, it would be important to know this at an early stage so as not to encourage a new resident only to possibly disappoint them further along the process. We ensure that our terms and conditions are known, rooms, care package, fees, additional expenses etc. Each prospective resident is assessed by us to ensure we can provide the full service required. If necessary we will visit prospective residents in their own home to discuss any needs or expectations prior to any visit to Far End. We are one of the few homes that will accept residents pets as we feel that, along with any furniture and personal possessions that we encourage our residents to bring into the home, the knowledge that they can bring a beloved pet enhances an easy transition to life at Far End. In discussion with the manager it was also established that they are careful to determine that prospective residents are comfortable with the providers own dogs and cats and introductions are included in the initial visit to the home. At a previous inspection a requirement and recommendation were made that the homes statement of purpose should be updated to clearly explain that there is no dedicated residents lounge or dining room and that the statement of purpose should be dated. We were shown the updated document, which now includes the required information and had been dated by the manager. The previous requirement and recommendation have both been met. Care Homes for Older People Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal and health care needs are met because the care team have an in depth knowledge of their abilities, needs and preferences in the care and support they require. However, the care plans in place do not contain the information that would enable as needed staff to provide care to the standard the residents currently receive and in the way they prefer. Residents are supported to take medication mostly in a safe way but some medication handling practices need to be improved. Evidence: The home has a small and close care team of three, and the staff demonstrate an in depth knowledge of each individual residents needs, abilities and preferences in how they wish their care to be delivered, resulting in the two residents who returned survey forms stating that they always receive the care and support they need. One social and health care professional commented on their survey form that the home: Provides very personal care to a small number of residents. At the last inspection a requirement was made that the care plans be kept secure and Care Homes for Older People Page 13 of 35 Evidence: a recommendation was made that a systematic format be developed to record healthcare appointments. The care plans are now kept in a locked cupboard in the providers dining room and any healthcare appointments and visits are recorded on a sheet at the front of each care plan. The previous requirement and recommendation has been met. In the AQAA, to demonstrate what the home does well, the manager stated that: We activate a personal care plan for each resident which includes a detailed risk assessment, which covers all the needs and anticipated needs for our residents. This is reviewed on a monthly basis and details all the health care and personal needs, including social contact. We have a close relationship with all our residents and feel that we can always react to any emotional needs and have time to address and discuss any worries they may have in a timely and compassionate manner. Where necessary we assist our residents with their personal hygiene to ensure that this standard is met, we do, however, encourage them to attend to their own personal needs for as long as appropriate to maintain independence. Assistance is offered sensitively affording our residents the dignity they deserve. We like to feel that we allow all our residents a feeling of independence and dignity, ensuring that they are addressed properly and have the degree of privacy afforded to them that at the same time will not expose them to danger. At present, care provided is based on the knowledge of the staff members and the two care plans sampled, whilst covering the identified care needs, were basic and did not include the in depth knowledge the permanent staff have regarding individual residents abilities in different areas, the support they require and the way they prefer that support to be provided. Staff are careful to monitor food intake and weight and seek help from professionals if there are any concerns identified, but formal nutritional screening is not currently in place. Some risk assessments were seen in the plans sampled but they did not include detailed action staff need to take to minimise any identified risks and expected risk assessments for the potential for skin breakdown, falls and moving and handling are not routinely carried out or reviewed and a requirement has been made. As stated above, the care plans are kept in a locked cupboard in the providers dining room and it is not routine for the staff to refer to these plans when providing care. The original needs assessment forms could not be found on the day of this visit, although they had been seen by us at the last key inspection. Daily notes are kept in a folder, separate from the care plans, where the staff record any changes and how the resident is feeling on that day. A 1-5 scale is used to chart different areas, such as mood, appetite etc, but there is no guide to the use of the scale for staff, to ensure they are each scoring in the same way. The manager stated that any changes in care are passed verbally between the staff and Care Homes for Older People Page 14 of 35 Evidence: that staff were always kept up to date. However, where previously there had been a number of additional as needed staff to cover holidays or sickness and who knew the residents well, we were advised that the care team now only consists of the manager and one part time care assistant, with the co-provider providing occasional, additional support with personal care if needed. There are no current plans to employ more staff and the part time worker has another job. Should the manager need to have her shifts covered at short notice, the current care plans would not provide the information that would be needed by an agency worker to provide the care and support the residents need, in the way they want, or to protect the residents from the potential risk of harm. This is especially important as only one member of staff is on duty at any one time and there is one resident who would not be able to give clear directions to someone that did not know her. A requirement has been made relating to care plans. It was not possible to establish when the care plans had originally been written or who had written them as they had not been signed or dated by the author. However, the manager does initial and date each care plan once a month to evidence when the plans have been reviewed. The residents are not asked to sign their care plans and there was no evidence to show that the residents and/or their representatives had been involved in the process or were aware of and had agreed to the content. At the last inspection a requirement was made that a record be kept of all medication coming into the home and a recommendation that administration instructions be supported in writing by the pharmacist or the GP. The requirement and recommendation have both been met. The medication administration records and medication storage were both sampled. Medication is provided mostly in the blister pack system by the local pharmacist who also supplies printed medication administration record (MAR) sheets. Records of medication received were noted on the MAR sheets. Medications are kept in a locked kitchen cupboard inside a room that is also kept locked. At present there are no residents prescribed controlled drugs and the manager is aware that the present storage arrangements would not meet the legislation for the storage of controlled drugs. The manager stated that a new cupboard would be purchased and fitted if the need arose. The medication records sampled were clear and it was seen that all medications had been signed for, however, it was noted that medications for two residents had been signed for by the staff at times when these residents had been at their day centres. The manager explained that one resident took their medication on return to the home on the days she goes to the day centre and was not aware that the time on the MAR sheet should be amended to show the actual time the medication was given. For the second resident it is important that her midday medication is given Care Homes for Older People Page 15 of 35 Evidence: on time and the home take the medication out of the dispensed pack for the resident to take with her. On the days that this happens, staff at the home still sign the MAR sheet as if they had administered the medication themselves. This is potentially unsafe practice and is against current guidance. The manager was advised that guidance is available on the CQC website for providers to follow in these circumstances and it is important that a way for residents to receive their prescribed medication when away from the home is implemented that meets current legislation and guidance so that residents are protected from the potential risk of medication errors. The manager was also advised that the latest copy of the Royal Pharmaceutical Society of Great Britains guidance The Handling of Medicines in Care Homes is available on their website for downloading and would help the home ensure that medication handling practices at the home are safe. A requirement has been made. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. On the day of this visit all interactions observed between the manager and the residents were seen to be caring and respectful. All personal care was carried out behind closed doors and the two residents spoken with said that they felt their privacy and dignity was always respected. Care Homes for Older People Page 16 of 35 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. Each resident is treated as an individual and the daily routines at the home are flexible and varied to suit their preferences. The home supports the residents to follow personal activities and interests and to keep in touch with their family and friends. Meals are varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with. All residents at Far End attend the local day centre four days a week. One resident commented on her survey form that: They keep us active by going to the day centre four days a week. The grounds at the home are extensive and two residents spoken with told us how much they enjoyed looking at the view from their bedrooms and going into the grounds. In the AQAA, to demonstrate what the home does well, the manager stated that: We ensure that prospective residents are informed of what they could expect on coming to stay with us, and that, being a small home, social interaction is limited within the home. We encourage visiting between rooms but also ensure that a residents right to Care Homes for Older People Page 17 of 35 Evidence: privacy is adhered to. We ascertain our residents interests and encourage their continuing interest, for example one of our residents is very much interested in crafts, knitting, sewing, crochet and painting; we have provided additional materials for her to use. All our residents attend the Day Centre regularly and are encouraged to become involved in the activities that are facilitated there. There is strong support from family and friends for all of our residents which we actively encourage. We have held several parties at Far End for a resident as she has no family that can facilitate this. We have ensured there is easy access for disabled friends and family. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships both inside and outside the home. On the day of this visit residents all had their lunchtime meal at the day centre. The home works with the day centre and has copies of their menus provided for the week so that they can ensure variety and balance in the meals they provide at Far End. In the AQAA, to demonstrate what the home does well, the manager stated that: Dietary preferences and needs are always taken into consideration and we try to maintain a flexible menu so residents can have a choice of meal. To this end we use pre-prepared meals which give a much wider choice. One of our residents is unable to indicate a preference, however due to the input from family and friends, and also from our own experience, we ensure she receives the meals we know she likes. Meals are supplemented by our home grown fruit and vegetables. We try to maintain a routine regarding mealtimes and our residents are happy to eat their meals in their own rooms although they can, if they choose, eat with another resident should this be agreeable to both parties. Residents are left to eat their meals at their own pace and assistance given if requested or difficulties are noticed. Once finished plates and trays are removed. There is always fruit and biscuits available in the residents rooms. The two residents spoken with both told us they enjoyed the meals at the home, one resident commented that one particular member of staff was a very good cook. Care Homes for Older People Page 18 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a simple, clear and accessible complaints procedure which includes timescales for the process. Not all required policies and procedures are in place to protect residents from potential harm or abuse. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents guide. All residents spoken with said that they knew who to talk to if they were not happy, with one resident adding that: the staff are always very helpful. At the last inspection a requirement was made that the home establish a complaint log. This is now in place, meeting the requirement. There have been no complaints made to the home since the last inspection but the manager advised that, should a complaint be made, the details would be kept in the log together with copies of any letters sent, the actions taken as a result of the complaint and details of how the complaint was resolved. The home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure and evidence was seen that the manager and care staff attended safeguarding training in July 2008. This meets a requirement made at the last inspection. The staff surveyed stated that they knew what to do if anyone raised concerns about the home. At the last inspection a requirement was made that the home must compile a whistle Care Homes for Older People Page 19 of 35 Evidence: blowing policy that relates to the home. At this inspection it was seen that this requirement had not been met and the only whistle blowing policy in place was written by the local authority for their own staff and did not relate to the home, this is the same policy that was in place at the last inspection. A discussion was held regarding the purpose of a whistle blowing policy and the information it should give to staff. Following the inspection an email was received from the provider stating: I have also written the Whistleblowing Policy plus a guide to answer any questions. This document will be reviewed at the next key inspection at the home. Certificates were seen confirming that the manager and one care worker had attended Deprivation of Liberty Safeguards training in May this year and the manager stated she was aware of the requirements of the Mental Capacity Act. During this visit we saw a length of chain outside one bedroom, hanging on a hook. The manager explained that, when the floors are cleaned in the hallway the chain is put across as a reminder to the resident that the floors are wet and that she could fall. However, at present, this practice and the reasons for it are not included in the residents care plan and the use of this chain is potentially restricting the residents freedom of movement around the home. We discussed with the manager the importance of ensuring that the Mental Capacity Act code of practice is followed and that there is clear written evidence that this has been done. The manager was also referred to the CQC guidance document on The Mental Capacity Act, which is available on our website. In their AQAA the manager identified that at present there is no policy on physical intervention and restraint. The need for appropriate policies and procedures to be in place to protect residents is addressed further in the Management and Administration section of this report. In the AQAA, to demonstrate what the home does well, the manager stated that: Over the last 3.5 years we have not received any formal complaints, having recognised any potential difficulties during the day to day care of our residents, we feel that all persons who live at Far End or have an interest in Far End feel comfortable and confident to let us know of any potential problems or issues prior to coming to the stage where formal complaint is necessary. The residents spoken with said that they felt safe at the home with one resident adding Oh yes and another commenting I feel very safe here, they are very good. Care Homes for Older People Page 20 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. Evidence: On the day of this visit we were shown around all areas of the home. The personal bedrooms were all seen to be personalised to the individual residents wishes and to contain many personal mementos. Residents spoken with expressed their satisfaction with the accommodation provided at the home and that the home was always fresh and clean. A comment was received on a survey form about the front door area being dark, especially in the winter. This comment was shared with the owners who now plan to investigate alternative lighting options with a view to possibly fitting an automatic dawn to dusk light fitting. In the AQAA, to demonstrate what the home does well, the manager stated that: In our Welcome to Far End information and on any visit by a potential resident or their representative we ensure that people are aware that Far End is run as a small family type home and that there are no separate rooms for social activity, dining etc. We do point out that all of our rooms are situated on the first floor and that each room is of Care Homes for Older People Page 21 of 35 Evidence: large dimensions that facilitates the ability to separate their sleeping area from their living area, each of which also contains a sofa for the comfort of any visitors. As stated residents are welcome to bring any of their belongings to their rooms and, should they have little or no belongings, items will be provided to their likings and taste to ensure that their rooms are personalised and their own for the duration of their stay. The walls are painted and the surface is such that it is easily cleaned and if necessary disinfected. Residents are given access to the ground floor of Far End and are welcome to spend some time there. The areas that residents may have access to have been risk assessed. Residents can also have use of the large conservatory should they wish to, both as a peaceful pleasant area with a view to the garden or to meet with family or friends. The extensive grounds to the front and rear of Far End are easily accessible to residents and any visitors should they wish to go into them. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a good standard of housekeeping apparent. Care Homes for Older People Page 22 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a small and competent staff team that know them well, but current practices for recruiting and employing additional as needed staff are potentially placing them at risk. Evidence: As mentioned earlier in this report, the home has a small and close care team of three: the manager and one part time care assistant, with the co-owner providing occasional, additional support with personal care if needed. The part time care assistant works twenty hours a week, the remaining shifts are covered by the manager who also provides sleep in cover overnight and being on call if needed, there are no waking night staff. At the time of the last inspection there were a number of as needed staff and volunteers who covered some shifts at the home and provided holiday cover for the providers. The manager advised that this is no longer the case and that there are no plans at present to recruit additional permanent or as needed staff. The manager explained that, recently, they had employed someone to cover some shifts at short notice when both providers had been unable to cover the shifts themselves. The manager also explained that this person was known to the providers via a relative of one of the residents and that the person also knew the current residents. However, none of the recruitment checks required by legislation had been Care Homes for Older People Page 23 of 35 Evidence: undertaken prior to the person working at the home and alone with the residents. The manager advised that they have now applied for a criminal records bureau (CRB) check but that they thought they could accept a CRB and protection of vulnerable adults (POVA) list check carried out by a previous employer and that other checks had not been undertaken as the person was known to them. We were advised that, apart from the providers and the part time member of staff, no other people are booked to work at the home at the moment. The providers were unaware of the requirements of the Care Homes Regulations in relation to recruitment and employment of staff, and were not aware that these requirements apply equally to as needed staff and volunteers. We advised the providers to obtain copies of the CQC CRB guidance and related annexes, plus the Department of Health guidance on the Protection of Vulnerable Adults 2009 to help them gain a full awareness of what is required when employing people to work with vulnerable adults in a registered service. We also took some time reviewing the associated regulations with the providers. At present there is no clear procedure or plan in place that deals with covering the home in the event of a need to cover shifts at the home at short notice, especially if the need is to cover the shifts worked by the manager. The providers need to develop and implement a procedure for covering staff absences, both planned and unplanned, that complies with legislation and safeguards the residents. It is important that the system includes occasions when cover cannot be provided by the three current members of staff. A requirement has been made. At present there is no central log of staff training kept and it was not possible to fully ascertain that staff have been provided with all required training. Evidence was seen of training in fire safety, health and safety, first aid, medication and safeguarding adults, but other evidence and certificates could not be located, e.g. control of infection, manual handling, basic food hygiene. The manager advised that they currently rely on the company that provides their mandatory training to send them reminders. There was no evidence that the providers had established that the as needed member of staff had received all the safe working practise training and was up to date. There was no written record of the induction provided to the as needed member of staff. In discussion the manager advised us that she had provided the new person with an induction to the home and the needs of the residents. However, the providers were not aware of the Skills for Care Common Induction Standards or that they are mandatory for all new staff. A requirement has been made relating to staff training. Concerns relating to record keeping are addressed further in the Management and Care Homes for Older People Page 24 of 35 Evidence: Administration section of this report. In the AQAA, to demonstrate what the home does well, the manager stated that: The owners ensure that any training sourced through the Local Authority that is required is either free of charge, or paid for by Far End and not at the expense of the additional staff. Any training undertaken, if not all members attend, is cascaded to the other members. The owner/managers recently attended the Health and Safety in Care Homes Seminar in Reigate which we found very informative and discussed the same at length with our part time staff. The manager and member of staff attended a Deprivation of Liberties course in May this year, again the information provided was useful and cascaded to the other owner. Both residents who returned survey forms said that the staff always listened and acted on what they said and that they receive the care and support they need. One resident said that staff are always available when needed and one answered usually. One resident commented that: Everything is done on time, food, washing etc. When asked if the manager and staff have the right skills and experience to support residents social and health needs, one health and social care professional answered always and the other answered usually. Care Homes for Older People Page 25 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere and policies and procedures are in place to protect residents financial interests. Residents are confident that their views are sought and listened to. Residents rights and best interests are not fully safeguarded by the homes record keeping, policies and procedures and management and administrative systems need to be improved to ensure that the health, safety and welfare of residents and staff is promoted and protected. Evidence: The manager has the required experience to run the home and is in the process of completing her registered managers award. In the AQAA, to demonstrate what they do well, the manager stated: The manager has twenty one years of experience regarding the care of vulnerable of adults, with varying needs and disabilities. She and her co-owner, who has eight years experience in tandem with the owner, are competent and experienced to run a home of the nature and needs of Far End. The Care Homes for Older People Page 26 of 35 Evidence: owner has the relevant NVQ level 4 in both Care and Care Home Management, is currently undertaking her Registered Managers Award and expects this to be completed by the end of this year. At present there is no formal quality assurance system in place. However, in discussion with the manager we were advised that the manager speaks with all residents on a daily basis and always asks if there is anything they would like done differently. In addition, and in the AQAA, the manager stated that: communication with family, with the residents permission, is discussed fully and no question or request is treated as trivial and our methods of managing Far End is open. We ask for the views of the residents, family and friend and outside professionals regarding our service and review the comments, acting on any suggestions made. We are in regular contact with the local day centre that our residents attend and any changes in needs is communicated with them and we are updated by them with regards to any information that should be of importance to us, e.g. change in eating habits. The size of Far End tends to preclude the viability of an anonymous survey. Policies and procedures are in place to protect residents financial interests. The manager stated that the home does not handle the financial affairs for any residents. Where possible, and if they want to, they manage it themselves or family or representatives do this for them. At the last inspection two requirements were made relating to health and safety. One was for the manager to arrange to have all portable electrical appliances tested for safety (PAT test). This requirement had a timescale for action of 3 September 2007. It was noted from information provided in the AQAA that, although this requirement had been met, the testing had not taken place until May 2008. Although the date for the next annual test was May 2009, we were advised this years testing had not yet been carried out. However, the provider contacted us following this visit and advised that the PAT testing had been carried out the day after the inspection. The other requirement was that the manager carry out a fire risk assessment for the home. On the day of this inspection the fire risk assessment was not available and we were advised that the co-owner was working on getting it completed. We received an email following this inspection to confirm that the work on the fire risk assessment had been finished. During this inspection a number of concerns have been identified relating to the management and administration of the home. Administrative systems are not in place to enable the manager to monitor and evidence that they are doing everything they should and records required by regulation for the protection of residents and for the Care Homes for Older People Page 27 of 35 Evidence: effective and efficient running of the business are not always in place and not always up to date and accurate. For example: pre-admission assessments for current residents could not be located and were not in their files, although seen at the last inspection; some, but not all, staff shifts are recorded on a calendar kept in the kitchen and there is no duty rota or clear record of who has worked at the home and when; there is no log kept of training and training certificates are not filed, meaning that some evidence could not be found despite extensive searching; there is no system in place that enables the manager to ensure that staff receive mandatory training and updates when they are due; there was only one staff personnel file and dates of when the person started work at the home could not be found; staff induction is not recorded; quality assurance activity is not recorded. Health and safety legislation and requirements are not always met and there is no system in place for the manager to monitor and ensure that required safety checks are arranged and carried out when they should be, for example: PAT testing, fire risk assessments. Some practices at the home evidence a lack of awareness of current legislation and guidance, for example: staff recruitment and some elements of the handling of medication. The AQAA was returned in good time and gave us a reasonable picture of the service provided, however not all sections had been completed (for example sections entitled What we could do better were left blank). Some statements made in the AQAA were not supported by the findings on the day of the inspection. For example: in the AQAA dataset the manager stated that all the people who had started work in the home in the last twelve months had satisfactory pre employment checks and that one member of staff had completed the induction training expected by the national minimum standards (described and recommended by Skills for Care). Information provided in the first part of the AQAA sometimes conflicted with information provided in the second part (dataset). For example: In the first part of the AQAA the manager stated: Policy and procedures are in place regarding manual handling of residents and equipment, fire safety, first aid and use of first aid equipment supplied. However, in the dataset part of the AQAA the manager stated that policies on moving and handling and first aid were not in place, which was confirmed by the manager during our visit. The owners have recognised that these are areas they need to improve and work has already started. In the AQAA the manager stated: The co-owner is now employed in a part time basis away from Far End and is therefore now able to concentrate on our policy procedures and also enrolling for appropriate NVQ qualifications. We are currently in the process of reviewing our policies to ensure they are up to date and in line with current legislation and are available for inspection at any time. It is positive to note that the day following this inspection the owners started work on a number of areas. In addition to the updates provided to us, and that have been quoted earlier in Care Homes for Older People Page 28 of 35 Evidence: this report, we were also advised via email that: We have now completed a staffing rota and guidance for use, in addition a new policy and procedure regarding the induction training for any new staff is in place. We are currently reviewing all of our policies to ensure that they are up to date with current legislation. All interactions observed between the manager and residents were inclusive, caring and respectful. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 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 1 7 15 The registered person must 27/09/2009 ensure that each person has a care plan that they have been involved in making and that clearly sets out the actions staff need to take to meet the individual residents personal and health care needs in the way they prefer. So that residents can be confident that any carers supporting them will have access to accurate and up to date information regarding their needs and their preferences as to the way their care is delivered. 2 7 13 The registered person must 27/08/2009 ensure that potential risks to the health and safety of residents are monitored, regularly reviewed and that steps for staff to take to minimise the risks are included in their care plans. Page 31 of 35 Care Homes for Older People 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 Risk assessments must include identifying the potential risks of skin breakdown, falls and risks associated with moving and handling. (This requirement also relates to NMS 8) So that residents can be confident that any potential risks to their health and safety are identified and as far as possible minimised and that any carers working at the home have access to information needed to keep the residents safe. 3 9 13 The registered person must 27/08/2009 ensure that medication administration record sheets accurately record the actual time the medication was given and who it was given by. So that residents can be confident that staff keep an accurate record of medication they have taken. 4 29 19 The registered person must develop and implement a system that ensures that no person is employed to work at the home before all the required information and documents, as specified in paragraphs 1-9 of Schedule 27/08/2009 Care Homes for Older People Page 32 of 35 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 2 of the Care Homes Regulations (as amended), have been obtained. (Or written confirmation received from an agency, that they have obtained the required information, in the case of employing agency workers.) So that residents can have confidence in any staff employed to work at the home because checks have been done to make sure they are suitable to care for them. 5 30 18 The registered person must 27/08/2009 ensure that at all times suitably qualified, competent and experienced persons are working at the home as are appropriate to the health and welfare of the residents and that staff working at the home receive training appropriate to the work they are to perform, including structured induction training. So that residents can be confident that they are cared for by staff who are competent and who receive the relevant training. Care Homes for Older People Page 33 of 35 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 6 37 17 The registered person must ensure that all records specified in Schedules 3 and 4 of The Care Homes Regulations 2001 (as amended) are in place, maintained at the home and kept up to date and available at all times for inspection. So that residents can be confident that their rights and best interests are safeguarded by the homes record keeping, policies and procedures and that the health, safety and welfare of residents and staff is promoted and protected. 27/10/2009 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 Care Homes for Older People Page 34 of 35 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 35 of 35 - 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!