Inspection on 13/05/08 for Farmhouse Residential Rest Home

This inspection was carried out on 13th May 2008.

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

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

Farmhouse Residential Rest Home 13/06/07

Farmhouse Residential Rest Home 17/05/06

Farmhouse Residential Rest Home 12/10/05

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Farmhouse Residential Rest Home Farmhouse Care Limited Talke Road Red Street Newcastle Staffordshire ST5 7AH Lead Inspector Keith Jones Unannounced Inspection 13th May 2008 09:00 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.V364806.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. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farmhouse Residential Rest Home Address Farmhouse Care Limited Talke Road Red Street Newcastle Staffordshire ST5 7AH 01782 566430 01782 564424 farmhousecare@yahoo.co.uk 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 Care Home 21 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (21), of places Physical disability over 65 years of age (5) Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2007 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. The home’s manager is Miss Rachel Straw who has recently been approved as the Registered Manager. The home is registered for 21 older people, 5 of whom may have a physical disability and 6 may be mentally frail. At the time of this unannounced key inspection 19 people who use the service occupied the home. During this inspection, the Inspector made an assessment of the dependency of the residents and it was felt that current dependency levels are commensurate with the home’s 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. Plans are also in hand to provide an enclosed safe garden, which will improve the home’s facilities and be of special benefit to residents during the summer months ahead. The fee chargeable for the service at The Farmhouse is from £368.00p £390.00p per week. The fee information included in this report applied at the time of inspection and the reader may wish to obtain more up to date information from the care service Farmhouse Residential Rest Home DS0000060611.V364806.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 the people who use this service experience adequate quality outcomes. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. We considered that the information given to us confirmed that people were presented with the service they needed, and that the service was of a satisfactory standard to ensure peoples’ safety. The unannounced inspection was conducted with the acting Care Manager and senior care staff. The last inspection report was discussed, and it was noted that outstanding requirements and recommendations from that visit had been dealt with. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA) and 12 survey returns, mainly complimentary, with some constructive comments: “I am really happy with all aspects of my dad’s care at the Farmhouse”, “Recent changes in staff and management made all the difference – its amazing – the air is different, residents are happier, meals seem to be very good, and a participation in activities.”, “Not only do they care for my cousin, but are always concerned for the well being of my wife and myself, who are elderly, and always treat us very well indeed when visiting”. We also received comments about the home’s services, especially the friendliness of the staff and the quality of food, and all comments were shared with the management, protecting writers’ confidentiality. On the day of inspection there were 19 service users in residence. There were three service users who were case tracked, which confirmed the establishment of a comfortable and caring home. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with a number of service users, relatives and members of staff. Service users and staff took an active role in the inspection process, and contributed to the subsequent report. Throughout the entire inspection a sense of homeliness and familiar confidence pervaded into all aspects of daily activity expressed by those people met. A review of the administrative arrangements confirmed improving practice and an increasingly effective management. A full verbal report was offered at the end of the inspection to the acting Care Manager and her deputy. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 6 Potential service users and their representatives are able to gain information about the service from the Statement of Purpose and Service User Guide. Our inspection reports can be obtained directly from the Provider, or are available on our website at www.csci.org.uk What the service does well: What has improved since the last inspection? The Home has demonstrated a commitment to caring for the elderly with good care standards, which need to be maintained. In addressing requirements and recommendations made at the last inspection. Significant improvements have been made to procedures and practices surrounding the administration of medicines, although further work is needed to meet the standard in total. Changes in management has resulted in a significant review of procedures and establishment of solid practice, especially with the service users and families involvement. There have been some tangible improvements in the provision of furnishings, and to the fabric of the environment, although much remains to be done. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Farmhouse Residential Rest Home DS0000060611.V364806.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 Farmhouse Residential Rest Home DS0000060611.V364806.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): 1,2,3,4,5 and 6 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service, and on the examination of the homes policies, procedures, practices and discussions with management. Adequate admission processes are in operation and information is made available to people who may use the service to enable them to make an informed choice about the suitability of the service and it’s ability to meet their needs. Prospective service users and their relatives are able to visit and assess the quality, facilities and suitability at any reasonable time, to meet with staff and management. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose, and Service User’s guide present a description of the home’s aims and objectives, philosophy of care and terms and conditions, which are discussed with service users and relatives prior to admission. It offers people the opportunity to make an informed choice about where to live. However there is a need to update both documents to take on board changes that have occurred. The Guide needs to include up to date information on fee ranges. It is envisaged that a large print, Braille and audio version will be prepared shortly. A pre-admission assessment, carried out by the Provider/Care Manager or deputy, appreciated any special needs of the individual, including cultural, social or personal needs, which are fully discussed and documented. This assessment initiates the process of care, each individual having a plan of care based on personal needs and a daily living process. The Home demonstrated through case tracking of three individuals, that the assessor explained this information to ensure a clear understanding is established. The assessor also makes a judgement as to the suitability of each prospective service user using the same criteria. Letters to confirm acceptance were seen to be adequate. A relative indicated how pleased the admission turned out for his cousin, “very pleased with the whole admission, the home has met all her needs. The staff are very friendly and always helpful”. The Registered Provider has a high profile of attendance on a daily basis – offering direction, administration, management and general support. Contracts were examined, and showed adequate content, which requires an additional confirmation of room number offered at assessment. There were no people assessed or referred solely for intermediary care at the time of inspection. Farmhouse Residential Rest Home DS0000060611.V364806.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 The quality in this outcome area is adequate This judgement is based on the examination of three care plans, discussions with people who use the service, staff, managers, general observations and examination of the home’s medication system. Admission and care planning processes capture the full and individual needs of people who use the service, to ensure they receive the care they need. Medication systems need further improvement and development to make sure that they are effective and safe. EVIDENCE: Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 12 There was evidence to show that a review of the care process has produced a satisfactory standard of meeting care needs. The pre-admission assessment represents the foundation for an informative care planning process. A new care record is being introduced at the present, which on available evidence shows a more structures system that should help to maintain working records. We case tracked three people’s care files, and identified a system of sufficiently detailed information on the individual, their life style and needs. Events and contacts, procedures and actions, were measured on a daily basis and reviewed monthly. Risk screening on an individual basis was seen to be effective, especially on mobility, weight, nutrition and fluid intake. There was one person who, although assessed with a level of independent living, still needed a clear monitoring of his fluid balance and need to promote fluids. The policy of the home is to maintain service users own doctor support wherever practical; otherwise service users are registered with the local surgery. District nursing services are also received, and the Home has an established, and positive, professional rapport. Discussions with service users confirmed their acceptance and confidence in the overall standard of care and service given. “ Everybody here is really kind”, ”I saw the district nurse last week, it was really nice” were some of the comments offered on the tour of the home. Evidence of communication sheets in care files indicated family involvement in care planning and review. There was evidence that suitable equipment was deployed effectively. Carers were seen to interact with residents with purpose and compassion. The facilities and bedrooms were presented to facilitate privacy for the individual, which included medical examinations and personal care procedures, being performed in private. All bedroom doors had had a personal identifier mounted. It is planned to adopt themed corridor displays to facilitate familiarisation. Bathrooms and toilets require a method to signal engagement or free, to maintain privacy and dignity. The administration of medicines generally adhered to procedures to maximise protection to service users. The Medicines Administration Record (MAR) sheets were generally found to be administered effectively. The acting Care Manager had addressed the issues raised at the last inspection, although further attention is required. The acting care manager was reorganising the system of receipt and disposal of drugs, with new suppliers at the time. A system of accountability to facilitate an audit trail was discussed for immediate implementation. There were no residents self-medicating at the time of inspection. Each service user has the opportunity of their own lockable facility in their bedrooms on request. There is no homely medicines practice in the home. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 13 The storage of medicines in use, sited in the manager’s office was secure and adequate. The home is replacing the pharmacy supplier, and is in a degree of flux with excess storage problems. We found a significant stock held in the unsecured loft awaiting collection from the old pharmacy. Immediate removal was organised that afternoon. A new stock from the new supplier was insecurely held in the loft, and was placed under lock and key immediately on inspection. The controlled drug management has to be reviewed with the provision of a wall-bolted metal cabinet situated in the office. A controlled drug register is to be obtained. We conducted case tracking of three individuals, in which we identified that service user’s drug regime were appropriate for their needs. The Statement of Purpose states that the wishes concerning arrangements after death would be discussed, and respectfully carried out, ascertained as soon as possible, either at pre-admission or shortly after admission. A North Staffordshire National Health Service resuscitation policy was discussed, and be appended to the appropriate procedure. We were impressed with the confidence and closeness within the home of staff, service users and visitors, and the mutual respect that prevailed. Farmhouse Residential Rest Home DS0000060611.V364806.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 The quality in this outcome area is good This judgement is based on discussions with service users, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. The home had has a relaxed and welcoming atmosphere. People are encouraged to continue with their individualised lifestyles. Staff interact with people in a positive, polite manner. A good catering service is provided which offers a varied choice of wholesome food. EVIDENCE: In discussions with service users and staff we identified a relaxed atmosphere in which people’s needs were respected. A routine exists to establish a framework for managing the home, not as a regime to comply with, but for a point of familiarity. Several service users expressed their appreciation for the freedom they enjoyed, with the security that there are routine events to the day they could relate to. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 15 The Home is considering appointing a part time activity staff member. Organised activities took place throughout the day and included bingo, exercises, games, beauty and hairdressing sessions with occasional trips to the locality. An activity board was prominent with games, Music for Health sessions on reminiscence. Bingo, cards and quizzes are features. During the course of the inspection we saw staff interact with service users in a positive and polite manner. Activities are a key element in the socialisation approach to care, with visitors encouraged to be involved in a partnership style with care staff. The home provided an Anglican service on a regular basis, and a local Methodist minister is making arrangements for sessions. An Roman Catholic priest attends on request. No other religious or spiritual needs were acknowledged. Those service users’ rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. Personal identifiers on bedroom doors have improved familiarisation throughout the home. The standards of catering offered an excellent service, to which service users spoken to were complimentary of all aspects of quality. A menu on a four weekly cycle offered a wholesome, varied and suitable choice. A very pleasant lunch was served during inspection, with choices available, served in a dining room adjacent to the lounge area. People interviewed confirmed that that the quantity and quality food provided was good. “I’ve always enjoyed my meals here”, “I love the standards of cooking, and the cooks are great”, are two comments of many made by service users. Three meals were provided daily, with hot and cold beverages and snacks available throughout the day. Care staff sometimes take up catering duties in the absence of the cook. A birthday list was prominently placed in the kitchen. Case tracking identified nutritional and hydration needs of each individual. One lady had a degree of self-reliance but had shown signs of confusion at the time of inspection. She enjoyed a good lunch and was seen to drink well. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. It was confirmed that the cook knew each service user, and some of the relatives. Diversity was discussed with the cook, who indicated an awareness in meeting individual needs. There were no special needs at the time. Diabetic diets were seen to be catered for. One lady had nothing but praise for the attention she gets with her diabetic needs. “Every meal is great”, “My diabetic requirements are always attended to”. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 16 Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. Farmhouse Residential Rest Home DS0000060611.V364806.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, 18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Generally, peoples’ complaints are listened to and acted upon. Individuals’ legal rights are protected. Systems and procedures protect people from harm and abuse. EVIDENCE: Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. We examined the complaints policy and records, there were few complaints, which would be better dealt with through a ‘record of concerns, complaints and allegations’, to record residents and families concerns in a meaningful and effective manner. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 18 The overall policy of openness and transparency was acknowledged, after criticism over the Provider’s handling of a recent complaint. All service users had received information on the procedure to complain, including reference to the Commission for Social Care Inspection (CSCI), evidenced through the Service User Guide. The policy and procedure for handling issues of abuse (safeguarding) was examined, and found to be effective, although in need of review to encompass change and past experience. One incident of financial abuse by a member of staff, was fully investigated. Appropriate action was taken with approval by Social Services and CSCI. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, which has been enhanced with an annual training for all staff. All staff were suitably checked through application to the Criminal Records Bureau. A thematic questionnaire was deployed at this inspection on “Safeguarding”, in which opinions and issues were discussed with service users, staff and managers. Answers from questions about awareness were: “They have always said if I wasn’t happy I can speak to the Matron” “I feel safe here, but I don’t like people coming into my room”. “Don’t feel frightened, I feel safe”. “I was told what to do when I came in”. “I would tell whoever’s in charge or the Matron” “Feel very secure and safe”. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,23,24,25,26 The quality in this outcome area is adequate This judgement was based on discussions with service users, staff and a tour of the premises. The home is internally well appointed to meet the needs of an elderly population of service users, although there is a need to upgrade external facilities to ensure a safe and comfortable environment. The internal environment is fit for purpose, well maintained, comfortable, clean and allows people to personalise their private space. Some aspects need improvement to increase accessibility and prevent the risk of accident in outdoor space. EVIDENCE: Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 20 A tour of the Home indicated that the internal premises were generally fit for purpose, clean warm and tidy. Internal communal and personal rooms being satisfactorily maintained. However we found the surrounding garden areas are poorly maintained, and considered to be unsafe for general recreational use. Most of the garden furniture and sheds are rickety and unsafe. The rear patio area has several areas in need of risk assessment, to ensure effective safety standards. A perimeter fencing is needed to ensure privacy and security. A service user stated “A better fencing at the rear to keep residents safe”. The attached ‘residency’ building, presently used as a store, is poorly maintained, in an area littered with debris and unwanted equipment, each unsafe and offering a poor presentation. The gravel path/driveway is uneven and overgrown. A new security system has been installed to maximise safety. “The home is safer with new alarms and door security”. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home, except in the main lounge to dining room connection, where a steep, and unsafe ramp is in place. Plans are in place to rectify the problem. On admission the Provider or Care Manager assesses each individual service users’ needs for equipment and necessary adaptations. A letter confirming those arrangements was seen in each case file. Efforts had been made to provide a homely atmosphere and the décor in most areas of home was found to be of a good standard. The home provided two lounge areas that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where residents were able to interact with fellow residents, or to entertain their guests. A compact, homely dining area was clean and conducive to enjoy a good meal. Toilets were located on both floors and were in close proximity to bedrooms and communal areas. Of the three bathrooms one was being used for storage on the first floor. As there are no en-suite rooms this utility is to be renewed, and offered for purpose. We saw that bedrooms were well maintained to meet service user’s personal preferences. On inspection, most bedrooms were highly personalised, with some displaying service user’s own furniture, and most with personal belongings. Some of the original furniture is in need of renewal. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the Inspection. Room 17 had been vacated and presented staleness, in need of address. Double bedrooms are presently used as single occupancy areas. Service users spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Numerous floral displays enhance Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 21 the presentation. A newly installed, and effective call system was tested; care staff reacted readily to tests. The acting care manager expressed a willingness to meet any reasonable demand for special needs. A locked facility and lockable bedroom doors are available in each bedroom. However we considered that the locking mechanism did not facilitate effective dementia care needs, or allow privacy with easy escape option. The kitchen was inspected, and found to present a well equipped and organised area. A recent Environmental Health inspection showed no major problems. All fridges and freezers were well maintained and checked daily by the kitchen staff. The kitchen was clean and considered secure, although a cleaning schedule was not in place. It was agreed that evidence in a scheduled plan of cleaning would reflect the observed good standard. Access to the kitchen should be for catering staff only, with suitable over clothing for visitors. The laundry was well organised, equipped to a good standard. Red Alginate linen bags are available to meet cross infection control procedures. There is a provision of suitable linen skips to accommodate infected waste material. Notices regarding chemical handling in the areas that store chemicals should be openly displayed, and would be enhanced with posters clearly displaying information. Residents’ belongings were seen to be handled piecemeal in an organised process, with no evidence of communal usage. Sluice facilities are suitable to assist in control of infection. The heating arrangements throughout the home are by central heating with guarded radiator convection, providing an ambient temperature. Ventilation was found to be satisfactory although there are no restrictors applied to any window, and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Portable Appliance Testing was noted as being done on a six monthly cycle, last done December 2007. A more responsive maintenance needs to be established to meet new situations as they arise. A recent fire report identified five areas of concern, to which the Provider is presently addressing. An upgrade of the fire alarm system, smoke alarms to selected areas, (although there remains one area in the loft storage area outstanding), Carbon Dioxide extinguishers to be deployed in selected areas, and ineffective cold smoke seals. External emergency lighting to be assessed and adapted. Fire equipment was inspected and seen to be serviced and up to date. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff, although two rooms were seen to be in need of attention, one having become vacant. An attic space that has had some upgrading work, yet to be completed, was being used for storage. The access was secure by locked door, the stairwell Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 22 very risky, with a loose banister rail, and temporary lighting. The area, although used only by staff, is hazardous and poorly laid out, with no smoke alarm, and one freestanding extinguisher only. A development plan for 2008/09 was submitted by the Provider shortly after the inspection. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 23 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 and 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service, and on the examination of staff files, working rotas and discussions with staff. Staffing levels need review to make sure that adequate staff are provided to meet the needs of people who use the service whilst also meeting the domestic and catering requirements of the service. Recruitment processes are consistent and robust, protecting the people who use the service from harm and abuse. EVIDENCE: There were 19 service users in the home on the day of the inspection. Off-duties were provided and examined; staffing levels were seen to be satisfactory. The daily care staffing rota showed adequate balance between skills, experience and numbers to provide a good standard of care. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 24 Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice and Code of conduct. The staffing establishments were examined and found to be satisfactory in meeting the staffing notice. An average coverage was seen to be: From 28/04/08 – 11/05/08 Morning – Afternoon – Night 1 Senior 3 carers 1 Senior 3 carers 1 Senior 1 carer There is 21 hours/week housekeeping staff, insufficient to meeting present and future conditions. Although the home presents a very clean and odour free environment, it takes care staff a considerable effort at the expense of care time with people. The home is advised to increase housekeeping by 20 hours, to include laundry duties. There is no laundry staff, duties normally done by care staff. There are times when there is insufficient catering staff to cover, which has traditionally been done by care staff, - extra domestic hours will alleviate this duty pressure. Although The Farmhouse is a large, old building there is no consistent maintenance support, reliant on external contractors to job task. Our observations of staff on duty conveyed a very positive impression of their competence and care of service users of The Farmhouse. Four members of staff were interviewed, who confirmed the appropriate staffing levels, conduct and training of staff. Those spoken with on the day of inspection showed satisfactory standards, and an enthusiasm for their work. We examined four staff files, which showed consistency of general application of procedure in appointing staff. The procedures for recruiting and appointing staff were seen to be satisfactorily check listed. Staff had sufficient evidence of clearance with references; letters of appointment, and contracts, with thorough checks are made of CRB and POVA records. Staff training was discussed and was found to have been improved in meeting regular and compulsory training needs. Seven staff have National Vocational Qualification (NVQ) level II, four undertaking NVQ training, and four with a suitable First Aid Certificate. Induction was seen to be consistent, within a training programme arranged for 2008/09. There was evidence to show that a formal supervision process has been introduced, although as yet to be considered an established practice to encompass all staff. Staff meetings have been regularised at monthly intervals, Minutes were presented for the April 2008 meeting. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 25 Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 26 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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager is trained and experienced to lead a team of staff, although not yet registered with CSCI for manager of The Farmhouse. The ethos of the home is based on openness and respect. People who use the service can be assured that the home is run in their interests. Financial interests of people who use the service are safeguarded. Some improvement is needed concerning documentation and procedures to further promote the safety and welfare of people using the service. The home generally promotes the health, safety and welfare of people using the service, but needs some further reviews of some documentation and procedures. There is a confidence apparent in the interaction of residents, staff and management; that demonstrated a highly positive relationship that pervades throughout the Home. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 27 EVIDENCE: The acting manager has the required qualifications and experience, brought in from another home in the company, to stabilise a difficult situation following the resignation of the previous registered manager, and two demanding incidents. She has in the three months, achieved a reorganised and reenergised staff, solid procedures, and monitoring improved practices. She has demonstrated her competence to run the home and meets its stated aims and objectives. Her application for registration with us has resulted in an interview for ‘fit person’ status in early June 2008. We were impressed by the openness, professional and pleasing confidence in the observed interactions of staff, relatives and service users. The relationships were seen to be of mutual trust and respect. Appropriate risk assessments are in place for service users, through enhanced care planning and recording. We conducted a random examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were found to be generally well maintained, accurate and up to date, ensuring that the service users’ rights and best interests are safeguarded. Health and safety notices can be seen throughout the home. The process would be enhanced with a room catalogue of risk assessment to update the present room based risk reports. The health and safety of service users and staff are promoted with safe storage of hazardous substances, servicing of electrical, mechanical and gas appliances, and regulation of the water system, each record examined, and found to be satisfactory. The accident book was seen and found to be in order for staff, service users and reporting arrangements to Riddor. The acting care manager was advised to institute a three monthly analysis of accidents and maintain a record in care files. Financial records and administrative procedures relating to the handling of monies of three people using the service were inspected and were found to be well ordered and maintained. An annual recorded audit by the Provider was advised. Staff meetings are held monthly, and minuted. Relatives and service users meetings are planned for each three months, due to start in May 2008. Questionnaires were sent out in February 2008 but the results were held by the Providers, although the verbal account indicated a valuable exercise, to be repeated each 12 months. Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 28 Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 2 3 3 3 2 3 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 2 3 3 3 3 2 2 3 Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Requirement To increase medication safety, and protect people who use the service from harm, regular reviews of the medication system to ensure adequate audit trail from receipt, administration and return of medicines to suppliers, must be undertaken. Action must be taken to comply with the Fire Officers report of the 01/04/08 to maintain essential fire prevention and security and keep people who use the service safe. . The Registered Provider must ensure that adequate ancillary staffing levels must be maintained at all times in order to ensure the care needs of people using the service are appropriately met. Timescale for action 01/06/08 2 OP19 23 (4) (a) 01/06/08 3 OP27 18 01/07/08 Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 31 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 OP12 OP1 OP2.1 OP8 Good Practice Recommendations That the Service User guide contain information regarding the up to date fees charged. Statement of Purpose and Service users Guide will need to be updated, and made freely available. That the contracts offered to service users contain the agreed room number allocated prior to formal admission. Establish the practice of implementing a fluid balance monitoring regime for service users at risk, to enable essential hydration, and catheter control routines Secure a suitable metal; wall (rag) bolted container, for Controlled Drugs, and a suitable CDA register. Review and develop the range of activities available to people using the service through the provision of an activity co-ordinator A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. To take steps to safeguard service users who wish to use the garden and patio areas, in maintenance of gardens, fencing, pathways and appropriate disposal of unwanted equipment. The Registered Provider should refurbish the bathroom presently used as a storage area on the first floor. That COSHHE laminates be displayed in all areas involving the use of hazardous chemicals, to complement existing procedure sheets. That staff supervision is established to meet all staff’s needs, arranged on a two monthly cycle. DS0000060611.V364806.R01.S.doc Version 5.2 Page 32 5 6 OP9 OP12 7 8 OP16 OP19 9 10 OP21 OP26 11 OP36 Farmhouse Residential Rest Home 12 OP38 Ensure cleaning record in the kitchen is kept up to date, to evidence the observed good standard of cleanliness in the kitchen areas. To limit access to the kitchen area to authorised staff only in maintaining essential hygiene standards. To replace the steep ramp in the connecting stair between lounge and dining area, to ensure safe passage at all times. To install a suitable locking mechanism to bedroom doors to facilitate easy escape from room, whilst maintain desired privacy. To install window restrictors to all windows throughout to minimise potential harm to service users. That PAT testing is completed at the appropriate time for all new electrical appliances, before use by service users. Make secure the banister rail to the stairway leading to the loft storage area. That a three monthly analysis of accidents and incidents is established to monitor possible correlation of events and causes. 13 14 OP38 OP38 15 OP38 16 17 OP38 OP38 18 OP38 Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI Farmhouse Residential Rest Home DS0000060611.V364806.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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