Inspection on 21/04/08 for Farm Lane Care Home

This inspection was carried out on 21st April 2008.

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

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

Other inspections for this house

Farm Lane Care Home 19/01/09

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Farm Lane Care Home 17 - 25 Farm Lane Fulham Broadway London SW6 1PX Lead Inspector Ann Gavin and Sheila Lycholit Key Unannounced Inspection 21st and 22nd April 2008 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farm Lane Care Home Address 17 - 25 Farm Lane Fulham Broadway London SW6 1PX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0207 386 4180 manager.farmlane@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Bright Tendekai Gurupira Care Home 66 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (24), Old age, not falling within any other of places category (40) Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration be for: Care Home with Nursing Ground Floor - 14 Older People First Floor - 25 Older People Second Floor - 25 Older People First and Second Floor 1 Younger Adult per Floor 24th September 2007 and 10th January 2008 Date of last inspection Brief Description of the Service: 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 Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. The unannounced visit took place on 21st April 2008 from 10.15am until 6.40pm and on 22nd April from 11.10 to 4.15pm. The Inspectors case-tracked residents’ care plans and records in each of the 3 units and observed practice, including lunchtime. The Manager made himself available throughout the visits. The Inspectors spoke with residents and with staff. A tour of the building took place, which included a selection of residents’ bedrooms, the sensory room, reminiscence room, library/staff training room, assisted bathrooms and roof terrace. There were 9 vacant places at the time of the inspection and 1 resident was in hospital. The manager, residents and staff were open and welcoming to the inspectors. What the service does well: The Registered Manager has a clear commitment to developing the service. He models good practice and has shown leadership to the staff team in improving care standards. The on-line system allows senior staff to monitor residents’ care records, including daily care notes. Care UK’s clinical governance team also regularly audits residents’ records. The Manager has established good working relationships with the multiprofessional team. Signage in the form of written text and pictures is available all throughout the home to assist residents. There is an awareness and understanding of equality and diversity within the home. ‘As part of the activities of daily living, we celebrate different cultural events as they occur during the year.’ Quote from the manager Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 6 The service is provided in an excellent environment, which has been refurbished to a high standard. A variety of well- furnished communal areas are available for residents and the rehabilitation unit has a range of specialist equipment. A high standard of cleanliness is maintained in all of the units. What has improved since the last inspection? What they could do better: Limited information is available about some residents prior to their admission. None of the files looked at contained a comprehensive needs assessment and details of residents’ social history and background were particularly sparse. The Manager is aware of these omissions and is taking steps to build a fuller picture of residents’ needs and history through the introduction of personal profiles, though this work is at an initial stage. The pressure on staff at Farm Lane to take residents from hospital, in a short time frame, without a visit to the home, compromises the opportunity for residents and their families to make an informed choice regarding a residential home. Medication procedures must be followed with all medication signed for. Medication records should not have any gaps and any refusal or other reason for not giving medication must be explained. Mealtimes need to be reviewed to ensure that residents receive sufficient support. A higher percentage of staff qualified to at least NVQ level 2 needs to be achieved to ensure a higher ratio of qualified to unqualified staff. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 7 All staff must have regular supervision sessions. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Farm Lane does assess people’s needs prior to admission but assessments need to include people’s social history and aspirations. The home has a good, well equipped rehabilitation unit, which promotes independence enabling people to return home. EVIDENCE: ‘It’s a great place they really work to help you be able to go home’ Resident (rehabilitation unit) ‘We would like still to have our service user visit the home prior to being admitted as part of their selection of home. This continues to be less feasible due to the usual urgent need from the discharging teams in hospitals to have nursing home placements for service users. ‘ Extract from Annual Quality Assurance Assessment (AQAA) completed by the manager Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 10 The majority of prospective residents are referred from hospital and the staff team feel under pressure to admit them within a short time period. In many instances there is insufficient time to arrange a visit to the home for the prospective resident. The lack of time to arrange a visit to the home compromises the resident’s right to choose the service which best meets his or her needs. Staff normally visit the prospective resident in hospital or at home to undertake an assessment using the homes own format. None of the 8 records seen, in two different units, contained a comprehensive assessment of needs undertaken by a Care Manager and there was very little information about the person’s social history. The Manager is aware of the lack of background information available and is drawing up personal profiles, giving priority to residents on the dementia care unit. One person was admitted during the inspection. The assessment carried out prior to their admission was seen. It was very brief and contained no personal history or social profile. This person will eventually be transferred to the rehab unit but it may not be for a further two months. Staff must carry out a social profile of people so as to be able to offer person centred care and support. The home has a dedicated rehabilitation unit with physiotherapists, occupational therapists and a speech and language therapist. The unit is also well equipped to enable residents to work on regaining their independence in every day activities and mobility. People are admitted to the unit for a set period. The average length of stay is six to eight weeks. The residents spoken with on the rehabilitation unit were full of praise on the help available to help them to get back home. The staff were observed supporting people discretely and with encouragement. They were happy with the therapy available. ‘It is good here but I wish there was more things to do as it can get boring’ Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A comprehensive care planning system is in place, which is regularly reviewed and updated. Senior staff work closely with health care colleagues to meet residents’ health care needs. Steps need to be taken to improve the recording of medication administration. EVIDENCE: Residents’ care records are held electronically, which allows senior staff to monitor care planning and for care records to be audited externally by Care UK’s clinical governance team. The nurses complete the care plans with carers inputting into the daily notes. Records seen were up to date and regularly reviewed. As noted under standard 3 above, information about the person’s social history and social care needs tends to be sparse, though steps are being taken to compile more comprehensive profiles. A range of assessments are undertaken including Barthel (levels of independence) and Waterlow (for assessing risk of developing pressure sores). Residents’ weight is monitored, normally monthly and action taken where concerns are identified. The fluid and food intake charts for one person whose Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 12 weight was very low were looked at. These showed that her fluid intake was frequently below 1000ml per day. Referral to the dietician had been made on 2 occasions but the advice given over the phone had not resulted in any improvement. It is recommended that further advice is sought from the multiprofessional team. Her nutritional risk assessment rating should also be checked as she was assessed as low risk when this was clearly not the case and her BMI was recorded as in the normal range. The records of another resident whose loss of weight had been causing concern were looked at. These showed that as a result of action taken by staff, including seeking advice from the multi-professional team and the support of relatives, the resident was now eating normally. Although staff discussed difficulties with assisting one resident with her personal care, as on occasions she resists help from staff with changing pads, her care plan did not reflect these concerns, nor were any strategies noted to better manage her support. Medication was looked at on one unit and a number of omissions were found. A person who receives medication just once a week refused the weekly dose. No note was made of why and what the consequences were. Two people had gaps in their evening medication, one of whom was prescribed four items none of which were signed for. Another person was being given ‘thick and easy’ on prescription and the medication administration record sheet (MARS) had been ticked instead of signed for. The staff member spoken with said that they thought the medication had been given but not signed for. Staff must follow procedures for administering medication. All 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. The manager has introduced an excellent easy to use daily audit, which includes medication. These audits, on the floor with the medication errors, had not been being completed in full for the last two weeks. This unit also has not had a unit manager due to maternity leave. The current staffing arrangement is one nurse per unit of 20 – 26 people with four or five carers. This needs to be reviewed considering the ratio of qualified and senior staff and the outcome of the study of the health and care support needs of residents. The wound care records of two people were seen. These are now kept in a separate file. Each have a body chart, photograph of the wound and detailed assessments. There is close work with the tissue viability nurse. One person had two wounds one of which had healed. The records were generally well kept and up to date but one was not clear which wound it refered to. Care needs to be taken to maintain accurate records. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 13 Risk assessments seen were up to date. Risk assessments have been modified to include falls and behavioural risk assessments. One residents risk assessment seen had clear assessments for diabetes, tendency to fall and behaviour, which can be challenging. There were clear actions as to how to manage each situation and the action required to prevent any incident. A comprehensive risk assessment format has been introduced for the use of bed rails. A completed risk assessment for one resident who has bedrails was seen, showing that the pros and cons had been considered and that a system of checks implemented. The resident’s family had also been consulted. The manager is working on increasing contact with the Community Falls Group and seeking some additional training for staff in this area of prevention of falls. Residents’ wishes regarding end of life care and funeral arrangements are currently being sought, with the involvement of relatives. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Farm Lane has an excellent well equipped reminiscence room enjoyed by many residents. There is a full time and one part-time activities coordinator and an activity programme as well as one to one time with residents. The management of mealtimes needs to be reviewed to ensure that residents are provided with sufficient support. EVIDENCE: ‘ The food is lovely I really enjoy it’ (Quote from resident) ‘We plan to target staff training around the specifics of activities based care and specialists areas such as dementia care. A number of staff have already completed the Alzheimer’s societies’ “Yesterday, Today, Tomorrow” course which focuses on dementia care. We plan to continue with this but also to continually seek expertise from other professionals.’ (Extract from Annual Quality Assurance Assessment (AQAA) completed by the manager) Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 15 The staff team includes two activity officers (1 full-time and 1 part-time) who take responsibility for devising an activity programme for each resident and for organising a range of individual and group activities. The activities organiser spoke of the one to one time they spent with residents. They have devised a rolling four weekly programme of events, which is updated every few months. This programme was displayed throughout the home. The coordinator spoke of the importance given to people’s ethnic, cultural and spiritual needs. One person who loved going to pray every day can no longer go out but the coordinator arranged for other residents to join them to pray which they are delighted with. There are good links with local faith groups. During the inspection various activities were carried out with groups of people as well as one to one sessions. These are all noted in individuals care plans. However care needs to be taken to record the detail of the interaction, as many of the entries were the same each day without the actual detail to make it meaningful. The home does not have any transport at the moment, which limits the ability to go outside the home. There are a number of plans to develop one to one sessions by increasing their use of volunteers. Every volunteer is interviewed and have Criminal Record Bureau checks (CRB) in place before starting. A pat a dog service is due to be introduced. There are plans to turn the roof terrace into a sensory garden where residents can plant flowers. The home has a cook chill system for meals with a daily delivery of milk, bread and fruit. Lunchtime was observed on two of the units. A choice of dishes is provided, which residents select the day before. All food, except for sandwiches, is prepared off-site and reheated on the premises. The Manager confirmed that meals to meet residents’ cultural and religious needs can be provided, such as hahal and kosher. Dining rooms are attractively furnished and tables were set out with fresh tablecloths and napkins. On the dementia care unit where the majority of residents need some support with eating, some residents were observed to wait for up to 40 minutes before being served with the main course. Two residents had their lunch served on a coffee table in front of them, which was difficult for them to reach. Positioning should be included in residents’ eating and drinking care plans. On the first floor unit one person was not happy with the lunch provided though was not able to say why. Two plates were offered and refused the second one rejected was given to the person sitting beside them not a practise to be encouraged. This resident was not happy until just a pie was given to them and then they ate happily. This whole scenario clearly upset the people Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 16 at their table as the resident spoke with a very loud voice. One of the other residents said they were not hungry. It was felt that this situation could have been avoided by knowing the residents’ dislikes and how they communicate. It was also noted that two people on a table were left till last but nothing was said to them while they waited. One resident then had to wait quite some time after the other person received their meal. The atmosphere in the room was generally busy with no music or much interaction with the residents. Staff who were supporting residents to eat their lunch were assisting with care and sensitivity. Steps should be taken to ensure that mealtimes are a pleasant experience for all residents, that residents are seated in a comfortable position that promotes their independence and that no one waits for a long period to be served their meal. The Manager informed the Inspectors that two staff are undertaking catering training so that some meals can be prepared on site. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a system for people to make any complaints, which are all followed up. Farm Lane has a policy for safeguarding adults and all staff receive in house training. Senior staff have undergone further training with Hammersmith Social Services. EVIDENCE: Farm Lane has a complaints procedure displayed throughout the home. It also gives the local authority and CSCI contact details. All complaints are recorded within the computerised sytem. There have been three complaints since the last inspection. These were well documented with the action taken to investigate, resolve and feedback to the person. The Manager reported that, since the last inspection, approximately 30 staff have attended a workshop on safeguarding adults run by the local safeguarding adults co-ordinator. New staff complete a protection of vulnerable adults module, which forms part of an e-learning package. At the end of the e training there is a questionnaire with an assessment. Senior Staff have attended safeguarding training with Hammersmith Social Services. There have been 3 safeguarding adults referrals since the last inspection. The local authority and CSCI have been informed in line with the local multi-agency procedure. One member of staff is currently suspended while an investigation into allegations is completed. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Farm Lane provides an attractive environment, which is kept clean and well maintained. It is a purpose built, modern building, with all parts of the home wheel chair accessible. There are a range of communal areas which offer residents choice. Steps have been taken to further improve the facilities offered to residents by upgrading the hairdressing room and creating a reminiscence room. EVIDENCE: Farm Lane is purpose built and has been extensively refurbished. All rooms are single, with en suites that contain an accessible shower, washbasin and wc. A range of sitting areas are provided on each floor. In addition there is a sensory room, reminiscence room and hairdressing salon. A pleasant roof terrace offers a safe environment for residents to get fresh air and sunshine. The gardens are also well maintained Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 19 All the bedrooms are spacious and are well furnished though residents can bring in their own furnishings. They each and are furnished with all necessary equipment, including adjustable height beds. Every room is also fitted with lockable doors and personal lockable lockers. A sluice and assisted bathrooms are available on each floor. The assisted baths are not operating at the moment due to a safety alert form the company. The manager is looking to find a suitable alternative. The home has regular domestics and a laundry service. Visiting all areas of the home on this unannounced visit evidenced the good standard of maintenance and cleanliness. The home was clean, tidy and fresh throughout without any trace of unpleasant odours. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ratio of qualified and experienced staff needs to be kept under review to ensure that residents, some of whom have complex needs, receive sufficient support and attention. Staff turnover, use of part-time staff and unavoidable staff absences have led to a lack of consistent staffing over the past 12 months. There are plans to expand staff training especially in the area of dementia. A sound recruitment process is in place and staff files were found to be in good order. EVIDENCE: ‘ I enjoy working here. I like working with people I hope to do some more training’ ‘ I like the long shifts as it means I can get all my work done in one go’ ‘I find the 50 hours I sometimes need to work a week too tiring’ Quotes from staff‘ Staffing levels are designed to provide 1 RGN and 5 care assistants on the elderly frail and dementia care units and 1 RGN and 3 care assistants on the Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 21 rehabilitation unit when full. At the time of the inspection, there was 1 RGN and 5 care staff on the Dementia Care unit, where there was 1 vacant place. The Elderly Frail unit, where there were 5 vacant places and 1 resident in hospital was staffed with 1 RGN and 3 care staff. The staff normally work from 8am until 8pm. This is a very long shift for carers working with vulnerable older people with varying social and physical needs. It is hard to see how staff can maintain good quality care throughout this shift enabling residents to maximise their independence and quality of life. The home plan to move towards activities based care. The length of the shift may also impact on the quality and frequency of the recording within the daily notes which was found to be basic and not very person centred. It is recommended that the shift hours be reviewed so that rotas are created for the residents needs. The night staff work the normal 8pm until 8amshift pattern. On each unit, there is a Registered Nurse on duty during the day and night. On Tuesday and Friday of every week, this number is increased to 2 Registered Nurses on duty on each unit between 08:00 and 14:00. However the staff rota for March seen did not reflect this practise of an extra nurse during those days. On the first floor there was not a second nurse on the rota for two Tuesdays and two Thursdays of the month. The Registered Nurses a 12.5 hour shift to allow for handovers. A review of the current dependency levels of residents has recently been undertaken, which is being discussed with the local authority and the PCT who commission the service. Currently approximately 50 of care staff have achieved NVQ2. The manager explained how the assigned providers had let them down and they now have a new provider. In view of the complexity of some residents’ needs and the high number of residents with dementia, steps should be taken to achieve a workforce with a higher level of qualification and experience. Although some positive interactions were seen and the majority of staff demonstrate a caring approach, a number of staff do not have sufficient training or experience to provide person centred care to people with complex needs. Consistency of staffing has been affected over the past 12 months by staff turnover, absences and suspensions. The Manager said that a more stable staff team has now been established. Three staff files were seen. These showed that a sound recruitment procedure had been followed and all recruitment checks undertaken. The Manager confirmed that staff undertake a structured induction. The staff spoken with confirmed this. Induction records were not checked at this inspection. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 22 The key learning method used by Farm Lane, with the exception of moving and handling, fire training and food hygiene is via e- learning tool. As mentioned in the section on Daily life and Social Activities the manager has plans to increase the learning for staff in specialist areas such as dementia. The manager is also mindful of the need to increase the amount of external training available for staff. Equally for.’Continual increased input for staff in relation to managing challenging behaviour’ (Extract from Annual Quality Assurance Assessment (AQAA) completed by the manager) Staff training should include strategies for managing challenging behaviour, including refusal or resistance to care, such as use of the hoist or being assisted with changing pads. Consideration should be given to making a range of professional journals and articles available to staff, particularly regarding dementia care. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Farm Lane benefits from a Registered Manager who has a clear commitment to developing the service. He models good practice and has shown leadership to the staff team in improving care standards. There is a clear and well kept system for managing residents finances. 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 with a minimum of 25hours per week of Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 24 (Unit Manager). The Unit Managers are currently undertaking a First Line Management course at level 3. The Unit Manager for the Dementia Nursing Unit is RMN qualified’ (Extract from Annual Quality Assurance Assessment (AQAA) completed by the manager) clinical management time. ‘Each of the three Nursing units is managed by an experienced Lead Nurse There is currently one unit manager on maternity leave and cover for their post is being carried out by the deputy manager and bank staff. It is reccommended that a more stable solution is found. Annual Quality Assurance Assessment (AQAA) completed by the Registered Manager as part of the inspection, was completed in a thorough and informative way. Farm Lane 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 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 records seen were clear and well kept. Records show that a system of regular staff supervision has not yet been established. At the time of the inspection, eight staff had not received supervision during 2008. The Manager confirmed that senior staff have received training in supervision and that at least 6 sessions a year should take place for all staff. Generally record keeping is of a good standard. Two PCs are available in each unit for staff to update electronic notes. In view of the length of the day shift worked at Farm Lane, consideration should be given to making 2 entries during the day where a resident’s condition is fluctuating or unstable. There are two maintenenance staff employed in the home, who are responsible for maintaing standards in health and safety. The health and safety records were checked during the inspection. All the record keeping was clear and individual records easy to find. They were up-todate, showing that equipment is regulaly serviced and checked. There was a planned fire alrm test during the first day of the inspection and a staff member was observed checking the fire doors and reporting any faults. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X 2 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 4 4 3 3 3 4 4 4 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 OP5 Regulation 5 Requirement Prospective residents and their families must be offered the opportunity to visit Farm Lane and to receive information about the service before choosing to move to the home. A comprehensive needs assessment must be undertaken before a decision is made to offer a place at the home. The management of mealtimes should be reviewed to improve the experience for residents and to ensure that sufficient support is provided. The ratio of qualified to unqualified staff should be increased to reflect the complex and high care needs of residents. Staff must be provided with supervision sessions on at least 6 occasions a year. All medication must be given as prescribed and all medication signed for. No gaps must appear on the MARS (medication administration records). All entries for refusal of medication and any other variants must be DS0000064137.V362131.R01.S.doc Timescale for action 30/06/08 2. OP3 14 30/06/08 3. OP15 16 30/06/08 4. OP27 18 31/07/08 5. 6. OP36 OP9 18 13 30/06/08 01/06/08 Farm Lane Care Home Version 5.2 Page 27 explained. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP8 OP15 OP30 OP30 Good Practice Recommendations It is recommended that further advice is sought regarding the low fluid and food intake of one resident. The resident’s positioning for eating and mealtimes should be included in the eating and drinking care plan. Consideration should be given to making a range of professional journals and articles available to staff, particularly regarding dementia care. Staff training should include strategies for managing challenging behaviour, including refusal or resistance to care, such as use of the hoist or being assisted with changing pads. 5. that OP 27 It is recommended that the shift hours are reviewed so rotas are created for the residents needs. Farm Lane Care Home DS0000064137.V362131.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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