Inspection on 12/10/05 for Farmhouse Residential Rest Home

This inspection was carried out on 12th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Farmhouse Residential Rest Home 13/05/08

Farmhouse Residential Rest Home 13/06/07

Farmhouse Residential Rest Home 17/05/06

Farmhouse Residential Rest Home 20/07/05

Farmhouse Residential Rest Home 09/02/05

Farmhouse Residential Rest Home 29/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Farmhouse Residential Rest Home Farmhouse Care Limited Talke Road Red Street Newcastle ST5 7AH Lead Inspector Norma Welsby Announced Inspection 12 October 2005 9:30 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 Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 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. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Farmhouse Residential Rest Home Address Farmhouse Care Limited Talke Road Red Street Newcastle ST5 7AH 01782 566430 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) Farmhouse Care Limited Mr Sukhvinder Singh Kandola Care Home 21 Category(ies) of Dementia (3), Old age, not falling within any registration, with number other category (21), Physical disability (8) of places Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That a suitable manager is appointed and makes application to be approved as the registered manager within 3 months of the date of registration That the manager pursues the registered managers award by 2005 Date of last inspection 20th July 2005 Brief Description of the Service: The Farmhouse is a private care home situated in Red Street in Newcastle. Mr Sukvinder Kandola and Mr Pargan Dhadda, who purchased the home in September 2004, own the home and operate under Farmhouse Care Limited. Mr Dhadda is the Responsible Individual. There is a home’s manager, Miss Sara Wright, who has submitted an application to be approved, but at the time of this inspection The Farmhouse did not have a Registered Manager in place. The home is registered for 21 older people, 8 of whom may have a physical disability and 3 may be mentally frail. At the time of this inspection the home was occupied by 20 long stay residents and there was one vacancy, about which enquiries had been received. During this inspection, the Inspector made an assessment of the dependency of the residents and it was felt that 5 or possibly 6 residents were mentally frail and just 2 were physically frail and routinely, though not exclusively, used a wheelchair. The Inspector discussed these findings with the Responsible Individual, Mr Dhadda along with the possibility of the home applying for a variation to its categories of registration. There are 19 single bedrooms and 1 shared bedroom, occupied by a married couple. Communal facilities are located on the ground floor, consisting of a central lounge and diner, with adjacent kitchen and a smaller lounge at one end of the building. There is also a small designated smoking room. A shaft lift provides access to the bedrooms on the first floor and there is also a staircase. Since the change of ownership there has been a rolling programme of redecoration and refurbishment, which has improved standards and will continue to do so. There are plans to build a conservatory at the rear of the property that will improve the provision of communal space and the Inspector looks forward to receiving these details in the near future. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Ms Norma Welsby and Mr Peter Dawson undertook this Announced Inspection. Throughout the day of the Inspection, residents were extensively consulted and made a positive contribution to the inspection process. Residents were complimentary about food, cleanliness of the home and the caring staff team, but there were issues of concern raised in respect of staff turnover and staff being so busy that at times they were unable to respond quickly to expressed needs. Generally, the findings of this inspection, which focussed on specific standards, were satisfactory. The most significant area of concern, however, was the management of medication and specifically the home’s stock and storage arrangements, which were totally unsatisfactory. There were improvements to some of the areas inspected, including residents’ written care plans and staff files, but in both areas further and sustained improvements are necessary and the Inspector still has serious concerns in respect of recruitment procedures. The Inspector also noted a door wedge being used by one resident who uses a wheelchair. The reasons for this were evident. However the Inspector advised that a door wedge contravenes fire safety regulations and should be removed. The Inspector advised the Responsible Individual to consult with the Fire Officer as a matter of urgency about the provision of a mobile door guard. The Farmhouse has now been under new ownership and management for just over 12 months and while the Inspector recognises the improvements made during this period there is a need for a more robust and cohesive approach to improving standards and promoting the rights and quality of life for residents. What the service does well: The Farmhouse provides a homely and comfortable environment and throughout the period of this inspection there was a relaxed and friendly atmosphere. Staff were observed to be responding appropriately to the needs of residents and for the most part residents spoke positively about staff. The Inspector received many compliments from residents about the quality and range of home cooked meals. Both lunch and teatime meals were Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 6 observed and residents were seen to have good portions, food was nicely presented and the mealtime seemed an unhurried and sociable experience. What has improved since the last inspection? What they could do better: The management of medication is an area that the home must improve. An immediate requirement was made about this finding. Staff recruitment procedures must be robust and evidence appropriate safeguards have been carried out, including two written references, POVA and CRB checks. The staffing structure of the home, namely the provision of Assistant Managers/Senior Carers, to cover and lead shifts when the Manager/Deputy are not on duty would be a significant improvement and the Inspector has made this a requirement of this inspection. Risk assessment must be in place in respect of bedroom radiators not guarded and thermostatic control valves must be fitted on bedroom radiators to enable residents to control their room temperature. The provision of a safe garden would be a significant improvement to the home’s facilities and could be achieved when the proposed conservatory is constructed. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 7 The provision of additional domestic hours and the review of night staff domestic duties should be undertaken in the light of issues raised during a recent complaint. 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. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 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 Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable. The Inspector found that there was a serious shortfall in the home meeting Standard 3. Since the last inspection the home had committed an offence under the Care Standards Act 2000 by admitting 22 residents when it is registered for just 21 residents. EVIDENCE: Following an anonymous complaint the Inspector undertook an unannounced visit to the home on the 20th of September and found that the home was over occupied. The needs of residents had not been properly considered and there was considerable evidence that neither the residents’ needs had been met appropriately nor had individuals’ rights been respected. The CSCI is still in consultation with the Responsible Individual, Mr Pargan Dhadda about what action it may take in respect of this offence. During this Announced Inspection the importance of very thorough preadmission assessment was again emphasised by the Inspector. Evidence of the assessment should be available on the individual’s care plan file. A discussion also took place in respect of the home’s categories of registration Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 10 and the Inspector would urge the Responsible Individual to apply for a variation to the home’s categories of registration to cover the additional residents who have a mental frailty. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 There have been some improvements to care planning, which must be sustained. An inspection of the management and administration of medication revealed serious concerns. EVIDENCE: The home is changing and improving the care plan format. This is a time consuming process but several residents were seen to have the new format. The new format is comprehensive and seen to include: Photograph of resident, general risk assessment, pressure sore risk assessment, sleeping assessment, weight chart, health care record sheet with known diagnoses, choices, including rising/retiring and bath times, likes and dislikes including food preferences. There were also recorded details of residents’ wishes upon death. The information contained some past history and a sheet giving basic information, including date of admission, next of kin etc. There were some gaps in some records seen of the new format, but clearly good progress is being made from a previously inadequate system of care planning information. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 12 Reviews are carried out monthly and some seen on the new format. They are basically a monthly summary of care and outcomes. The dates did not comply with present date e.g. there was review from 30.9.05 to 30.10.05, but the information was relevant and adequate. Medication to the home is supplied by Boots Chemists, Newcastle in MDS (blister packs) form. This system replaced the previous Nomad system some 4 months ago. The system was inspected and found to be very unsatisfactory. There were gaps on MAR sheets for some medications particularly where prescribed PRN, mostly paracetamol. There were gaps relating to other medication also. One resident self-administers insulin from pen located in the fridge, it was not clear whether this was handed to him or he helped himself, there were many gaps for this on the MAR sheets. Some medication was prescribed to administer “2 or 4 three times per day” this was simply signed, apart from 2 instances where the administered dose had been recorded on the sheet. This does not allow calculation of administered/remaining medications. Tablet numbers are recorded at the start of the 4-week MDS cycle, it is nevertheless impossible to check the required remaining numbers of tablets at a given time for the reason just stated and the fact that medication not in the system is not recorded as part of those numbers. At the end of the cycle remaining medication in the MDS is not recorded – tablets are then taken from the blister packs and put into a communal bottle for return to the pharmacy. The purpose of this is difficult to understand but staff indicated it had just become established practice. Checks on several items made did not correspond with the number of tablets at the start of the MAR sheets, less the numbers administered and the number of remaining tablets. It can only be assumed that the initial “start” number was incorrect, medication having been brought from previous period? Returns to the pharmacy were investigated – the last entry for returns was 12.1.04, which is wholly unacceptable. There were instances of medication in the drugs trolley that were not on the MAR sheets. There were 19 tables of Lorazepam prescribed for resident in June 2005 which were not on current MAR sheet and presumably not being given. There were items of Co-proxamol and Co-dydramol in the drugs trolley that were not on MAR sheets. – All these items must be removed from the Medication trolley immediately, listed and returned to the pharmacy. Some prescribed medication was being treated as PRN an example was CoCodamol prescribed 1 or 2 to be given twice per day, but few had been given. This should be reviewed with the GP with a view to possible PRN prescription. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 13 Medication required to be administered daily are located in the drugs trolley on the ground floor, the above comments relate to that trolley. There is a further medication trolley on the first floor that houses some PRN medication (which if currently prescribed should be in the main trolley). This trolley also houses stocks of medication and there were many items of unused medication of varying ages that had not been returned to the pharmacy. There is an abundant stock of paracetamol in particular e.g. there are 4 boxes (100 each) prescribed for one resident, there are several boxes for other residents. Stocks should be reduced immediately and some returned to the pharmacy. To summarise: The medication system is confusing, open to misuse and potentially dangerous. All medication not on MAR sheets must be removed from the main medication trolley, listed and returned to the Pharmacy immediately. On variable dose prescriptions, the actual number of tablets given must be recorded. All unused medication must be listed in the returns book, signed by staff, returned to the pharmacy immediately and always countersigned by the Pharmacy. All medication requires urgent review with the relevant GP and this should be not less than 12 monthly thereafter. Where more than 4 medications are prescribed the recommended review time is 6 months. The count of medication must be recorded for all items on the MAR sheets, checked regularly by staff and must always equate to the current numbers recorded in the system. A count of medication and recorded returns to the pharmacy are vital to complete the audit trail of medication. It is reported that all staff, except one, have had training in medication administration. The existing system suggests that further training is required. The Registered Person must contact the Pharmacy immediately and request a review in the home of the MDS system and to seek advice from the pharmacy on the issues raised above. This home does not have a safe system of medication administration in place at this time. – This is required under Regulation 13(2). Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 The Inspector found evidence of residents being able to pursue daily routines suited to their preferred lifestyle; however, specifically this must include individual choice about rising and retiring times. The home has improved the provision of social opportunities and activities. Without exception the provision of meals and refreshments in the home was complimented. EVIDENCE: Extensive consultation with residents confirmed to the Inspector that residents were able to exercise choice and personal autonomy in their daily lives. Observations throughout the day confirmed this with residents moving from communal areas to spending time privately in their own bedrooms. Significantly however there was evidence of more rigid routines in respect of rising and retiring times based more around staff rather than residents’ needs and poor institutionalised practices that have developed but which have not been challenged. This had been the subject of a recent complaint and fortunately there had been some improvements made but this must be sustained. The home employs an activity assistant for 6 hours each week and this has improved the range of activities and social opportunities, along with input from independent organisations providing specialist activities such as a Newcastle Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 15 Borough Council Scheme providing a Movement to Music session. When asked several residents told the Inspector that they were satisfied with the provision of social care in the home. The Inspector consulted several residents about the quality, quantity and variety of meals provided at The Farmhouse. Consistently, the Inspector was told that there had been improvements during the past 12 months and several residents said they were very satisfied. The Inspector also observed lunch and tea on the day of this Inspection and both meals were satisfactory, as was the relaxed and unhurried way in which courses were served. Residents were observed to be chatting freely and staff were also engaging in a friendly rapport with residents, all of which contributed to a enjoyable mealtime experience. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a written complaints procedure, which was on display in the reception. There have been two recent complaints that have been made against the home. Both of these complaints, which were made direct to the CSCI were taken seriously and acted upon by the Responsible Individual. EVIDENCE: The Inspector noted that the written complaints procedure on display needs two amendments. NCSC needs to be changed to CSCI and the procedure should clearly state that complainants may contact the CSCI as any stage of their complaint and not just if dissatisfied with the home’s own investigation/action. The Inspector asked the Responsible Individual to make these amendments. Two recent anonymous complaints made direct to the CSCI against The Farmhouse have revealed serious issues. The first allegation referred to the home being occupied by 22 rather than its registered numbers of 21. This complaint was upheld and the home was found to have committed an offence under the Care Standards Act 2000. The second complaint referred to specific medication having gone missing and to residents being got up from 5am in the morning. Both aspects of this complaint were upheld. The missing medication has been reported to the Police. The Responsible Individual has taken action to address the above and the CSCI are continuing to monitor the situation and are still considering what action it may take in respect of the home exceeding its registered numbers. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 There have been steady improvements made to the physical environment during the past year. The provision of a safe garden would improve facilities and should be actioned when the planned conservatory is built. On the day of this Announced Inspection, all parts of the home accessed by residents were found to be clean, pleasant and hygienic. EVIDENCE: The rolling programme to improve the appearance and comfort of the environment has continued, most recently specifically in respect of upgrading bedrooms. There are plans to build a conservatory onto the existing dining room and this will address the shortfall for communal space, both in respect of sitting and dining facilities for 21 residents. The Inspector has emphasised the importance of the home, being registered for residents with a mental frailty, to provide an enclosed safe garden and has urged the Responsible Individual to address this need when the conservatory is built. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 18 The Farmhouse employs a Domestic Assistant between 8am/3pm each Monday to Friday. The Inspector inspected all parts of the home and was satisfied with the standards of hygiene and cleanliness. The only exception to this being the laundry room, which was still in need of upgrading to bring it up to the required standard. Several bedrooms were inspected and only one had a mild malodour. Each bedroom was nicely presented with matching duvet covers and curtains. Recently, it has been raised that night staff, who are responsible for specific domestic tasks, may be overburdened and the Inspector and the Responsible Individual had a discussion about this, especially in reference to the recent complaint about getting residents up from 5am, with the outcome that the Inspector made a recommendation that the home should have an increase in its weekly domestic hours and reduce the burden on night staff. The rolling programme to guard radiators and associated pipe work has continued, with radiators in communal areas having been covered. The Inspector was told that the next phase of the programme was to cover radiators in the bathrooms and toilets and then to move onto bedrooms, many of which are partly guarded by open mesh covers. The Inspector emphasised the importance of ensuring that detailed risks assessments were in place in respect of resident vulnerability and where necessary a more suitable guard be fitted to bedroom radiators as a matter of priority. The Inspector noted the following concerns and raised them with the Responsible Individual on the day of the Inspection: 1 Bedroom 3 on the first floor was excessively hot and the radiator should be fitted with a thermostatic valve. 2 Bedroom 4 in C block should have one of the two radiators removed to enable the safer positioning of the bed, according to the resident’s known preference. 3 Kitchen windows that are held open for ventilation should be fitted with fly screens. 4 The Oxford Mermaid bath hoist should be repaired, where rust has become apparent under the seat. 5 Open items in the fridge such as sauces, jams etc should be labelled/dated. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Staffing levels have recently been amended and confirmed to the Inspector by the Responsible Individual as providing three staff on duty throughout the day, sometimes with the Home’s Manager as supernumery. These levels are satisfactory, but to fall below them would present a risk to the health and safety of residents. The staffing structure of the home remains unsatisfactory and in the light of recent events must be addressed. Recruitment procedures have improved, but there was evidence that even within recent months inadequate safeguards have been taken. EVIDENCE: While the Inspector had previously been told that the home was staffed with three care staff during the day, it was ascertained that at times prior to this Inspection there had only been two staff on duty. Residents had told the Inspector that at times staff were too busy to respond to the needs promptly and this may well have been at times when the home was inadequately staffed. The Responsible Individual and the Home’s Manager acknowledged this and it was confirmed that at all times in the future, while occupancy and dependency remained the same, there would be 3 carers on duty throughout the day, (8am – 10pm). A copy of the rota was sent to the Inspector confirming the above staffing levels. The Inspector was also told that the home was due to introduce having one day carer start at 7am rather than 8am, to assist night staff at this busy time and the Inspector acknowledges this as an improvement. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 20 The staffing structure of the home, with just a Manager and Deputy means that during several shifts, especially evening and weekend, there is not a senior person on duty, leading the shift, supervising standards and generally taking overall responsibility. It had been a recommendation of the previous inspection report that the home should take action to rectify this situation, but this had not been addressed. Recent events in the home had exposed this vulnerability and this was thoroughly discussed with the Responsible Individual. It is a requirement of this inspection that the staffing structure of the home be reviewed to ensure that a designated person is on duty throughout each day and night. The Inspector examined a sample of staff files and while there had been some improvements, some aspects remained unsatisfactory. Information needs to be securely and logically filed. For both staff recently appointed and for those in post for several months or years, there were examples of only one written reference rather than two and some either had no CRB or one that had been pursed during a previous appointment. This matter was discussed with the Home’s Manager, who advised that she had recently done an audit of staff files and had applied for POVA and CRB checks. One member of staff specifically cited, confirmed this to the Inspector. Furthermore the Inspector has consistently asked for access to the Home Manager’s file, but has been told by the Responsible Individual that this has been mislaid. In the light of this response the Inspector has been unable to confirm that in respect of the appointment of a Home’s Manager, the Responsible Individual and Directors of the Company followed correct and thorough recruitment procedures. During conversations with the Responsible Individual, the Inspector has received the impression that neither written references nor a CRB check were done prior to appointment. This matter will be further discussed with the Responsible Individual and the CSCI will need to consider what action it may take if there has been a breach of this regulation. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The Home’s Manager has been in post for 12 months and an application to be approved as the Registered Manager has been submitted to the CSCI. Unfortunately, the CSCI has experienced several difficulties in trying to process this application. EVIDENCE: The Inspector acknowledges that there have been improvements made in the home during the past 12 months. Several residents and a visitor consulted during this inspection confirmed this opinion. Notwithstanding this, there have been serious issues raised, such as the home having exceeded its registered numbers. Other issues of a confidential nature have also come to light but cannot be reported in this public report. The CSCI has been in constant communication with the Responsible Individual and is awaiting his formal proposals for the future conduct of the home. In the meantime the CSCI will Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 22 continue to monitor the management of the home and the standards in general and will take further legal advice about what action it may take. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x x x x X x x Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 9 Regulation 13(2) Requirement The home must address each of the concerns relating to the mismanagement of medication, raised in detail under Standard 9 of this report. Staffing levels must be maintained at 3 care staff on duty throughout the day. The home’s staffing structure must be reviewed to provide a senior person on duty throughout the day and night. Robust recruitment procedures must be in place and followed in respect of every appointment. Residents’ rights and choices must be respected at all times, including rising and retiring times. Risk assessments must be in place in respect of bedroom radiators that are only partially guarded or unguarded and action prioritised. The complaints procedure must be amended. Timescale for action 12/10/05 2 3 27 27 18 & 19 18 & 19 12/10/05 30/11/05 4 5 29 7 18 & 19 15 12/10/05 12/10/05 30/11/05 6 25 13 & 23 7 14 22 15/11/05 Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 25 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 19 27 19 4 Good Practice Recommendations A safe, enclosed garden should be provided that can be freely accessed and used by all residents and particularly mentally frail residents. Domestic hours should be increased and night staff domestic duties should be reduced. The home should address each of the issues raised under the Physical Environment section of this report. Consideration should be given to applying for a variation in the home’s registration categories, as discussed during the inspection. Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Farmhouse Residential Rest Home DS0000060611.V252010.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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