Inspection on 19/01/09 for Farm Lane Care Home

This inspection was carried out on 19th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Farm Lane Care Home 21/04/08

Farm Lane Care Home 24/09/07

Farm Lane Care Home 11/09/06

Farm Lane Care Home 09/02/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Farm Lane Care Home 17 - 25 Farm Lane Fulham Broadway London SW6 1PX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ann Gavin     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Farm Lane Care Home 17 - 25 Farm Lane Fulham Broadway London SW6 1PX 02073864180 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : manager.farmlane@careuk.com Care UK Community Partnerships Ltd care home 66 Number of places (if applicable): Under 65 Over 65 0 66 dementia old age, not falling within any other category Additional conditions: 66 0 The maximum number of service users who can be accommodated is: 66 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Farm Lane is a care home providing accommodation and nursing care for older people, people with dementia and people in need of rehabilitation before returning home after a stay in hospital. The home opened in September 2005 and is located in a residential area of Fulham, close to shops and other local facilities. Accommodation is provided on the ground, first and second floors and there is a large attractive roof garden and conservatory. Passenger lifts enable people living in the home to use all parts of the building. The weekly fee for the service ranges from #650 to #900 Care Homes for Older People Page 4 of 36 Care Homes for Older People Page 5 of 36 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: This was an unannounced inspection carried out by two inspectors, Ann Gavin and Sheila Lycholit, over two days Monday the 19th to Tuesday 20th January 2009. During the visit time was spent talking with the people who live in the home, relatives,staff on duty and the Managers. The care of a seven people living in different units across the home was tracked. This involves talking with the residents, the staff involved in their care, reviewing their care plan and all documentation linked to them. A tour of all the units, communal area of the home and some of the residents bedroom was also undertaken. Care Homes for Older People Page 6 of 36 Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The number of medication errors is of concern. The Manager and Deputy Manager have taken steps to improve the handling of medication, including regular audits. The PCT Pharmacist was visiting at the time of the inspection to advise on handling medication and was proposing to observe the administration of medication as part of his review A number of care plans, in particular social activity plans, are insufficiently personalised. Some of the recording of daily notes on the Saturn,care planning system, system lacked sufficient detail. Care Homes for Older People Page 8 of 36 Staffing levels, with 1 RGN and 5 care staff on each of the two 26 place units, means that staff are not always able to spend sufficient time with residents. The RGNs spend much of their shift on handling medication and on caring for residents who are unwell or whose condition is of concern and have little time to monitor the work of care staff, agency staff or to check on the well being of the other residents on the unit. An additional pressure at weekends is that the RGNs are responsible for answering the phones for the home, which further erodes time spent on nursing tasks. As noted above, the percentage of care staff that have completed NVQ2 remains low at 48 percent. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 36 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 36 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 moved into the home have their physical and social needs assessed prior to being admitted there is a need to continue to develop their social and cultural aspirations. Farm Lane has a good, well equipped rehabilitation unit, which promotes independence enabling people to return home. Evidence: The home also has its welcome pack available in seven different languages.These were identified as the main languages for people living within the London Borough of Hammersmith & Fulham. The welcome pack is also available in large print. Extract from the managers AQAA Annual Quality Assurance Assessment The visitors book and discussion with the Manager confirmed that relatives and carers have the opportunity to visit the home. The Manager has discussed the previously short deadlines with the PCT and Hammersmith and Fulham Procurement Team and Care Homes for Older People Page 11 of 36 Evidence: negotiated a longer admission period for the two long-stay units. It is unclear whether prospective residents funded by Hammersmith and Fulham are given a choice of home. It is recommended that the Manager continues to monitor the number of relatives and prospective residents who visit before deciding to choose Farm Lane so that good practice is maintained. Assessment forms for two residents recently admitted to the dementia care unit were looked at. Both showed an improvement since the last inspection, with more detailed information about their needs. The home has a rehabilitation unit on the ground floor with physiotherapists, occupational therapists and a speech and language therapist. The unit is well equipped to enable residents to work on regaining their independence in every day activities and mobility. The rehabilitation manager spoke about how they assess people before they are admitted to the unit. This is normally done jointly with the unit manager which ensures that both people rehabilitation and nursing needs can be assessed and met. People are admitted to the unit for a set period of six weeks which if necessary can be extended to eight weeks. Each person sets their long term goals with one of the therapists on admission to the unit. Each resident sets these in order of priority and together with the therapist weekly goals are set to achieve the final aims. The multidisciplinary team meet on a Friday and people have their weekly goals reviewed. These are written and placed on the wall of peoples rooms. The rehabilitation manager said that people do not object to having them displayed on the wall, rather they are happy so that both they and all the people who support them can work to the same goals. Speaking with some of the people admitted onto the unit, they were very happy about the level of support and input they have received and can see the great strides they have made in their personal goals. The only thing they would like to change is the same comment which was echoed by other people in the past that the afternoons and evenings after therapy are very long as there are no set activities within the unit. Contracts are available for each resident, though the number of the room is not specified. The unit manager was very clear about assessing peoples needs and the level of support the team were able to offer. Care Homes for Older People Page 12 of 36 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. People who live in Farm Lane have their health and personal care needs assessed with good access to the local health care services. Staff need to ensure that residents care plans reflect the individuals preferences as to how they wish to be supported rather than generalise peoples needs. There are still errors in the administration of medication. A more robust auditing and greater staff support could improve this Evidence: A lot of work has gone into the improvement of the management of medication, supervision for staff and documentation in relation to the care of service users and the general day to day experiences of our service uses. Looking back at twelve months, these areas have greatly improved. Barriers occur as a result of the availability of nursing time. An assessment of the nursing tasks shows that although the nurses are able to carry out their day to day tasks with the maximum amount of effort, we could provide an even greater service given additional nursing staff. Extract from the Managers AQAA Annual Quality Assurance Assessment Care Homes for Older People Page 13 of 36 Evidence: The care of one person on the ground floor, three people on the first floor and three people on the second floor were case tracked as part of the inspection. This involves talking with the person, reviewing their care plan and all documentation linked to them and by talking with staff. Peoples care plans are held electronically. Each person has a range of assessments regarding their health care needs including levels of independence, risk of developing pressure sores, nutrition. When people have any skin problems staff maintain records with details of the support they offer along with any interventions required and undertaken. Residents weight is monitored, normally monthly and action taken where concerns are identified. The care plans have developed since the last inspection and are more centred on the individual such as X prefers a wash rather than a shower, enjoys chocolate, cakes. However more work is required to make them more specific to each person detailing their preferences and the way they wish to be supported. Equally the daily notes should reflect the support offered to people with timings and including explanations of support offered when it is different from their care plans. Many people went to bed early on the first day of the inspection. This practice was difficult to assess as peoples preferred times of wanting to go to bed were not always noted. It is important that peoples preferred bed times are recorded in their care plan and any variations to the timing is recorded and explained. The Manager and senior staff have established closer working with health care colleagues, resulting in residents receiving attention and assessment more promptly. Contacts with the CMH,community mental health team. Dietician have increased. Records show that referrals are made to the GPs who visit regularly, when there are any concerns about a residents health. The GPs also visit out of hours when necessary. Although residents on the long stay units do not have access to the rehabilitation units services, the Manager is negotiating for the rehabilitation team to contribute by means of staff training and general advice, for example in falls management. Looking at medication on the first floor highlighted that last months MARS, Medication Administration Record Sheets, held errors, with gaps in signatures. One person was without their medication for three days due to it not being ordered. In the control drug register there was only one signature when a staff member had destroyed 9 tablets, again one signature only was found when the control drugs were being accepted. Staff must follow procedures for administering medication. All Care Homes for Older People Page 14 of 36 Evidence: medication must be signed for. Medication records should not have any gaps and any refusal or other reason for not giving medication must be explained. These continual errors in medication are unacceptable. It is hard to see how one registered nurse, can hold responsibility for administering all medication to 26 residents, carry out normal nursing duties to meet residents health care needs along with managing a unit with all that involves including supervision of staff. The role of the unit managers is covered more fully in the staffing section. The deputy manager and unit managers continue to monitor and audit medication and the errors found were not unknown to them. With the increasing dependency levels the whole way of administering medication needs to be reviewed. The Pharmacist from the PCT arrived during the inspection as part of an initiative to provide support to the home to improve the handling of medication. In addition to auditing medication, the Pharmacist was planning to observe the administration of medication and to make recommendations for improvements. Three care plans on the dementia care unit were looked at. Plans seen were generally up to date and regularly reviewed, although some areas of care planning were overdue for review. Profiles and social history of residents are still sparse, giving staff little understanding of the persons previous life and interests. A degree of repetition was seen in some care plans, with the wrong name being used on occasion. Staff must ensure that care plans are personalised and based on each residents individual needs. Risk assessments had been completed for moving and handling, falls and bed rails where used. Staff were taking steps to minimise injury to residents who had a history of falling out of bed by using a mattress to break any fall. Accident reports showed that this strategy was working well, with a number of residents found safely on the mattress by their bed with no injuries. One resident was being cared for on a floor mattress because no other way of caring for her safely could be found. This involved staff in a lot of bending and lifting. Staff were regularly monitoring her sleeping position and hoped that she would be able to be cared for in a bed, with or without rails shortly. Staff were observed to speak with residents respectfully, though one relative who visits daily commented that the manner of some staff could sometimes be better. One resident who was in his pyjamas and dressing gown at 5pm was seen wandering into other residents rooms. This was clearly causing some distress to two female residents Care Homes for Older People Page 15 of 36 Evidence: who were also in their night clothes. Records showed that end of life care, including residents religious, spiritual and cultural needs and wishes, had been discussed with them or with their families. Care Homes for Older People Page 16 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Farm Lane has good recourses to a reminiscence room and 1 full and 1 part time Activities Coordinators. The range and level of activities and person centred care could be developed making sure that peoples preferences are noted and acted upon. Evidence: Our catering services meet the needs of different cultures. As the home uses a cooked chilled system of food service delivery, service users are able to order meals as per their cultural or ethnic needs. We now also have a regular review of our menu dietary content with the food suppliers and involvement from their dietician. Extract from the Managers AQAA Annual Quality Assurance Assessment Reviewing care plans on three units showed that on the whole residents routines are noted in their care plans, including preferred time of getting up and of going to bed. The preferred times of getting up and going to bed did not appear so much on the care plans of the first floor, which should be addressed. The visitors book, discussion with staff and observation show that visitors to the home, especially families and friends visit regularly. The homes location and the welcome Care Homes for Older People Page 17 of 36 Evidence: given by senior staff to families and friends encourage regular contact. A number of relatives were seen on the units during the inspection, some of whom visit almost daily. Staff were seen to welcome relatives and to make time to update them about the residents condition. The home has 2 Activities Coordinators, one of whom is part-time. A programme of activities is available and the December schedule showed that a range of activities, including religious and non-religious events took place. The social activities area of care plans are completed by the Activities Coordinators. Plans looked at were very similar in content and in some cases used the wrong name. One plan which had not been updated for two months did not reflect the residents current condition and abilities. One other care plan seen spoke of how the person reads the Metro everyday they would prefer the Express but has to make do with the Metro till further notice This same plan speaks of how the person enjoys music but does not specify what type of music. This lack of personal information was repeated in most of the care plans seen. Almost everyone had the same sentence that they will enjoy visiting the library on the third floor. The Manager said that he is planning to include the Activities Coordinators in training on dementia and advanced care planning. Mealtimes observed on the dementia care unit were better managed than at the previous inspection. Each table was served in turn and residents sitting away from the dining area or in their rooms were positioned comfortably. The assistance of the two Activity Coordinators was needed to ensure that residents received sufficient support to eat, as 10 residents needed assistance and others needed prompting. In addition a number of people were unwell and were in their rooms. Adjustable tables have been purchased to assist residents who sit in an arm chair or in their room to eat and there were seen to be well used. Mealtimes were also observed on the first floor. Here also residents now have their meals served at the same time per table. All the care staff were in attendance during meal time. Staff were observed supporting residents discretely, one carer was sat beside a resident assisting them with their meal going at their pace and talking with the resident encouragingly. One of the residents became upset and carers responded appropriately making the resident comfortable and reassuring them. One staff member who had just started working at the home was assisting someone Care Homes for Older People Page 18 of 36 Evidence: with their meal by standing in front of them which is neither appropriate to the resident nor the carer. The inspector suggested they sat beside the resident so that they can have direct eye contact and a relaxed and more restful way of supporting them with their meal. New staff must spend time shadowing experienced staff so that they can model good practice for the benefit of the residents. Records show that the weight of residents is monitored, with weight normally checked monthly. Records show that the advice of the Dietician or Speech and Language Therapist is sought where there are concerns. The low weight of one resident was continuing to cause concern. Staff were observing to prompt her with food supplements during the inspection. Appropriate advice and intervention had been sought and her family were aware of the continued deterioration in her health. Another resident on the first floor was able to increase their weight by reviewing their diet and for example adding the cream of the milk to their porridge. Food and fluid charts are kept for residents whose intake is low. A summary is completed for all residents being monitored so that action can be taken where intake falls below the threshold. There were some gaps in the monitoring sheets, which were ascribed to agency staff not being aware of the need to complete them. The chef spoke of the cook chill system for meals with a daily delivery of milk, bread. Fruit and fresh vegetables are delivered every two days. A choice of dishes is provided, which residents select the day before. Pureed food comes ready prepared. All food, except for sandwiches and the week day breakfast of porridge, cereals, is prepared off site and reheated on the premises. At weekends residents are offered a cooked breakfast. The chef also confirmed that meals to meet residents cultural and religious needs can be provided, such as hahal and kosher. The Manager said that they are still looking at whether the kitchens would support food being prepared on the premises. Dining rooms are attractively furnished and tables were set out with fresh tablecloths and napkins. The first floor unit must look into being able to secure tablecloths to the table so that residents can enjoy their meals on well presented and homely table with table cloths. It was observed that tablecloths were taken off for meal times and replaced after meals. The rational was because that some residents pull at the cloths. It is recommended that this is reviewed. Care Homes for Older People Page 19 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Farm Lane has a clear system for people to follow if they wish to make complaints. Staff receive training in safeguarding adults. Evidence: Farm Lane complaints procedure is displayed throughout the home. It has contact details for both the local authority and the CSCI. They also have a suggestion box in the reception area for any one to place their comments. All complaints are recorded within the computerised sytem. The last recorded complaint was in September 2008. This was an incident about someone food not being labelled correctly when left in the fridge and had received the wrong food as a consequence. The action taken to investigate, resolve and feedback to the person was documented and resolved. A discussion with the Manager about recording residents every day concerns was held. The Manager could consider developing a way to monitor residents low level concerns Staff complete safeguarding training through e learning and by means of workshops which are run in the home, normally by the Manager. Staff spoken to said they had completed the on line learning. Care Homes for Older People Page 20 of 36 Evidence: There have been 9 safeguarding adults referrals since the last inspection. In each case the local authority and CSCI have been informed in line with the local multi agency procedure. The Manager has ensured that all situations have been dealt with in depth and speedily. The monitoring of incidents and accidents raised some concerns and was spoken about with the Manager and Deputy Manager. Specifically about the number of unexplained minor injuries reported, which might have been caused by poor handling. The Managers were aware of these through their monitoring of accidents and incidents. Records show that a debriefing took place with staff, who were reminded of moving and handling techniques and told not to rush when supporting residents. Senior staff will continue to monitor incidents. Staff and relatives were observed standing supporting residents who were in bed, with eating their meals. The manager should consider the provision of stools for both staff and relatives when they are supporting a resident to eat in bed. To ensure residents are supported in a dignified, safe way, for both resident and carer and allowing for a relaxed and more personal care. Care Homes for Older People Page 21 of 36 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. Farm Lane has good spacious accommodation, which is clean, pleasant and accessible to all. The building is cleaned to a good standard and is well maintained. The Manager has plans to redecorate a range of the communal areas. Evidence: As the home continues to have a number of communal areas, we plan to make better use of the less frequently used areas as we did with the conversion of the reminiscence room. One of the current ideas is to have a room themed on different parts of the world where service users can experience a bit of their own culture within the home. This will be done with an added aim that it will get service users to tell more about the past and thus build a better picture of whom they are. Extract from the Managers AQAA Annual Quality Assurance Assessment Farm Lane provides an attractive and pleasant environment, in a location close to local services and public transport. Many of the residents previously lived in the area and relatives and friends are able to easily visit. Farm Lane is a purpose built care home which opened in 2005. It has all single spacious ensuite rooms with accommodation over three floors. Care Homes for Older People Page 22 of 36 Evidence: The home is accessible with specialist equipment such as hoists, electronic baths, and pressure relieving equipment available throughout. There is also a loop system in the communal lounges for those who are hearing impaired and wear hearing aids. Each room has a good standard of furniture and residents can bring in their own items and personalise their rooms. Although each resident can have their room decorated before they move in the quick turn around from referral to admission usually does not allow for this. Farm Lane has a sensory room, reminiscence room and hairdressing salon. A roof terrace offers a safe environment for residents to get fresh air and sunshine. The gardens are well maintained Each floor has a large lounge and a selection of sitting rooms. These smaller sitting rooms are looking drab with furniture that needs cleaning, covering or replacing. The manager says that had looked into steam cleaning the furniture but was advised that these cannot clean effectively enough. He has plans to redecorate and look at upgrading the lounges, which will be enhanced by comfortable furniture making them more homely. Hot water was not available in some en suites and bathrooms during the inspection. A contractor had been contacted and was planning to visit in the next few days. On the two days of this inspection all parts of the home were clean, pleasant and hygienic. The home has good hand cleaning facilities with hand cleaning dispensers in place throughout the home. Care Homes for Older People Page 23 of 36 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. The level of trained staff needs to increase to fully met peoples needs. A review of the role of the unit manager and the numerous tasks they undertake needs to be carried out to ensure that residents healthcare and medication are delivered safely. Evidence: Dementia Care Mapping has now been commissioned. This will entail a detailed mapping of our service and most importantly provide thereafter, dementia specific training for our staff. Extract from the Managers AQAA Annual Quality Assurance Assessment The dementia care unit and elderly frail unit are staffed from 8am until 8pm by 1 RGN, which includes the Unit Manager, and 5 care assistants. An additional RGN is on duty on Tuesdays and Fridays from 8am until 2pm so that the Unit Manager can assist with the GPs visits. The workload of the Registered Nurses,Unit Managers is high particularly on days when they are the only Nurse on the unit. Unit Managers are allocated 12 hours per week for managerial tasks, though the Doctors visits are included in these hours. There is little time to supervise care staff or to check on the general well being and Care Homes for Older People Page 24 of 36 Evidence: condition of residents. A number of concerns highlighted in this report such as errors in administering medication, lack of regular supervision and lack of detailed recording in daily notes are likely to be caused, at least in part, by the current rotas, which provide only 1 Registered Nurse for each unit on the majority of day shifts. The Manager should ensure that peoples health care, medication are safely and fully met by the addition of a registered nurse from 8 to 2pm on the first and second floor. This will enable residents overall care and staff supervision needs to be met. Apart from the lack of time to perform their roles the Unit Managers have also had little training. One session was given to specific training this needs to increase in order that staff have the appropriate management training to carry out their role. The Manager must ensure that all Unit Managers have appropriate management training to facilitate them in carrying out their role in supporting both residents and staff Night staffing consists of 1 Registered Nurse per unit, 2 Care Assistants for the two larger units and 1 Care Assistant on the ground floor, rehabilitation unit. The files of 4 recently appointed staff were looked at. Each file was in good order, showing that a sound recruitment procedure had been followed. All recruitment checks, including Criminal Record Checks and POVA First checks had been completed. Staff complete much of their core induction training by means of e learning. Speaking with staff it was clear that not everyone felt it a good way of learning. One staff member felt that you just had to tick the right box and it did not challenge you enough and it lacked the individuality gained through direct teaching methods. An added difficulty in e learning is accessing the computers. There are only 2 computers on each floor with the nurse, carers and the activity staff needing to access them to record their work. The busy office is not conducive to learning especially when colleagues are waiting for the computer. The Manager should consider the use of specified computers and areas for learning or the addition of extra terminals. Little progress has been made in increasing the percentage of staff who have achieved NVQ2, although the Manager is hopeful that the appointment of a new training agency will lead to more staff completing the award. One of the staff spoken with has been in the home for a year and said they were waiting to start their NVQ 2. Another staff member, who came to the home with NVQ level 2, said they were now waiting to Care Homes for Older People Page 25 of 36 Evidence: begin their level 3. Twenty three of the forty eight care staff have achieved NVQ2. Ten staff are enrolled on the course. To compensate for the lack of accredited training for care staff, the Manager and Deputy Manager have introduced an in house training programme of regular workshops, case reviews and seminars. Speaking with care staff highlighted the fact that there is no career structure for carers. The introduction of senior carers would enhance the experience of the residents and encourage staff. It remains a recommendation that that the long twelve hour shifts are reviewed so that rotas are created for the residents needs. Training records show that Registered Nurses have had the opportunity to update their training, with workshops which have included medication, syringe drive, osteoporosis, and feeding and swallowing. The Manager said that they have been looking into various training packages specifically on dementia. Training for staff at all levels in dementia care had just been authorised and should be delivered shortly. A discussion was held with the Manager about the situation of access to the home and the hours of the receptionist who works Monday to Friday 9am to 5 pm with an additional person working part time on Monday, Thursday and Friday within the same hours. After 5pm all telephone calls are put through to the nurses on each of the floor waiting for whoever is free to take it. Equally any visitors after 5pm have to wait till a staff member answers the bell and lets them in. The Manager could consider reviewing the times of the reception beyond 9 to 5 Monday to Friday to enable enabling relatives and visitors to gain easier access and to ease the pressure off the registered nurses. Care Homes for Older People Page 26 of 36 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. The Registered Manager and Deputy Manager work hard to promote good standards of care and nursing practice. An internal training programme to improve staff skills and competence has been developed. The management structure at Farm Lane needs to be reviewed in view of the increasingly high needs of the residents and to support the current managers enabling them to consolidate their development plans for the home. Evidence: Farm Lane is led by an experienced Registered Manager who has a Diploma in Dementia Care and has completed the NVQ 4 Registered Managers Award. He has worked both within residential and nursing care settings. The Deputy Manager has RGN qualifications and is now working full time as clinical lead. However when a Unit Manager is off the Deputy still covers for them. At one point the deputy was covering for a Unit Manager on a long term basis this is not acceptable. The level of dependency of the residents admitted to Farm Lane has steadily increased Care Homes for Older People Page 27 of 36 Evidence: since the last inspection. The management structure of the home needs to be reviewed. The Unit Managers need more training and more hands on support in order to fully function as their role would suggest. The Provider needs to review the management structure within the home so that the plans for improvement and development created by the Manager and Deputy can be implemented. Supervision records show that the frequency of supervision has increased, though not all staff are having the minimum of 6 sessions a year. Supervision to staff must be held on a regular basis. The Manager said that they are also looking at peer supervision to work alongside individual supervision. Notes of supervision vary, with some very good recoding and some notes that did not provide an adequate account of the session. It is recommended that supervision sessions include looking at learning points from recent training and a discussion of key working. A number of the daily notes seen on the Saturn system did not provide sufficient information about care and support provided to each resident. In discussion one of the Unit Managers agreed that daily notes, which she countersigns, are often inadequate but said that she often does not have time to correct the entries or to add more information. Work must continue to develop the standard of the daily notes and care plans to ensure they are relevant and person centred. The administrator manages the records of those residents who require assistance with managing their money. A safe is available in the home for safekeeping and records of all transactions maintained. The home has a policy for managing residents money, valuables and financial affairs. All residents have lockable drawers in their rooms to keep their money securely. The financial records of four people were seen.They were clear and well kept. One persons record stated that they did not have any money and there was no note of what monies they were entitled to. It was not clear who was going to follow this up with Social Services or relatives. This was a particular situation as finances are normally clarified at admission.This is an important task. A procedure for following up residents finances when they need clarifying must be established to ensure that each resident has the right money available to them. The health and safety records were checked. All the record keeping was clear and individual records easy to find. They were up to date, showing that equipment is regularly serviced and checked as per requirement. The home employs two maintenance people who take the lead in this. The home has been experiencing problems with the water system with cold water only Care Homes for Older People Page 28 of 36 Evidence: being available in two residents rooms and the main bathroom. The Manager has been following this up and the engineers were due to visit that week to resolve the problems. Residents were able to access hot water in another bathroom There was a planned fire alarm test on the morning of the first day of the inspection. The staff check all doors closures and that the alarm sounds clearly. One half of a fire doors into the dining room on the first floor did not close as it had been obstructed by a trolley. Staff must make sure that fire doors are free from obstructions at all times. The Manager holds regular open events for residents and relatives. In December, he introduced a coffee morning as an informal way to discuss issues in the home for both residents and relative. The Manager plans to continue with these as it was so successful. The Manager is very aware of the need for continual assessment and quality assurance. Farm Lane have an annual resident satisfaction questionnaire which is given to all residents and their relatives/advocates. The Annual Quality Assurance Assessment, AQAA. required by the Commission was completed thoroughly with excellent information. Due to technical problems this was not received until after the inspection. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 36 18 Staff must be provided with supervision sessions on at least 6 occasions a year. 30/06/2008 Care Homes for Older People Page 30 of 36 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 recording of daily notes needs to reflect the support offered to residents with the timing and explanations made of any support which is different from the care plan so as to provide continual and personalised support to each person. 31/03/2009 2 7 15 The Manager must continue to develop the care plans so that they are specific to each person detailing their preferences and the way they wish to be supported. 31/03/2009 3 9 13 All medication must be signed for without any gaps on the MARS medication administration records. There should be two signatures for all control drug administration and disposal in the control drug book 31/03/2009 Care Homes for Older People Page 31 of 36 to ensure the safety of residents at all times 4 12 15 Ensure that peoples 31/03/2009 preferred bed times are recorded in each persons care plan and any variations to the timing is recorded and explained. to ensure that residents right to choice is adhered to 5 14 16 Care should be taken to 31/03/2009 ensure that residents preferred activities are noted and acted upon. Consideration could be given to expanding the activities available for residents and developing activity based care should take place. to ensure that residents personal choice and dignity is maintained at all times 6 19 23 The Manager must forward a 31/03/2009 plan of redecoration and reordering of the home especially the lounges so as to create a greater sense of home for the residents. The Manager must ensure that all Unit Managers have appropriate management training to facilitate them in carrying out their role in supporting both residents and staff 8 27 18 The Manager should ensure that peoples health care, 31/03/2009 31/03/2009 7 27 18 Care Homes for Older People Page 32 of 36 medication are safely and fully met by the addition of a registered nurse from 82pm on the first and second floor. This will enable residents overall care and staff supervision needs to be met. 9 30 17 The Manager must ensure 31/03/2009 that the number of staff who have achieved or are working towards the NVQ 2 is improved in order to meet the needs of the residents and meet the required standard 10 31 18 The provider must review the management structure at Farm Lane in view of the increasingly high needs of the residents and to support the current managers to consolidate their development plans for the home. 11 35 16 Procedure for following up residents finances when they need clarifying must be established to ensure that each resident has the right money available to them. Supervision sessions must be provided to staff at least 6 times a year.The previous timescale set was not met 31/03/2009 31/03/2009 12 36 18 31/03/2009 Care Homes for Older People Page 33 of 36 To give staff the appropriate support so that they can meet residents needs. 13 38 23 All staff must keep the fire 31/03/2009 doors clear at all times so as to ensure the safety of all. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 People should have the number of their room stated in their contract as a matter of good practice. The Manager should continue to monitor the admission process, in particular visits by prospective residents and their relatives, to ensure that good practice is maintained. The unit on the first floor must look into ways to keep the table cloths on the table during mealtimes and not remove them in order to enhance the experience of the residents. The Manager could consider developing a way to monitor residents low level concerns The Manager should consider the provision of stools for both staff and relatives when they are supporting a resident to eat in bed. So that residents are supported in a dignified, safe way, allowing for more relaxed, unhurried, personal care The Manager could consider reviewing the times of the reception beyond 9 to 5 Monday to Friday to enable enabling relatives and visitors to gain easier access and to ease the pressure off the registered nurses. It remains a recommendation that the shift hours are reviewed so that rotas are created for the residents needs. The possibility of a career structure for carers with the introduction of senior carers could be considered as a further way of enhancing residents experience of care. The Manager should consider the use of specified Page 34 of 36 2 5 3 15 4 5 16 18 6 27 7 8 27 27 9 30 Care Homes for Older People computers and areas for learning or the addition of extra terminals. 10 36 It is recommended that supervision sessions include looking at learning points from recent training and a discussion of key working. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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