Random inspection report
Care homes for older people
Name: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ zero star poor service 09/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sue Kinch Date: 1 2 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ 02380667071 02380868865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Richard E Kitchen,Mrs Elizabeth Kitchen Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Conditions of registration: 20 0 The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection 0 9 0 6 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Farmhouse is a registered care home providing personal support and accommodation for up to twenty older people who may have dementia. The home comprises of ten single and five shared bedrooms, eleven of which have en-suite facilities. Communal space includes two lounges and a dining room. Car parking and a small, enclosed patio can be found at the front of the property. The home is privately owned by Mr and Mrs Kitchen and Mrs Jean Hunt is the registered manager. Farmhouse is situated in a residential area on a main road close to the centre of Totton. The homes fees range from £504-£520 a week. Care Homes for Older People Page 3 of 12 What we found:
The last key inspection of this service was on 9th June 2009. The rating following that inspection was zero stars, meaning outcomes for people who live in at Farmhouse Rest Home are poor. The report from that inspection is in the public domain and available on our website. We carried out a random inspection on 19/08/09 and noted that further work was needed to show compliance with the requirements that we had made about care plans and risk assessments. Two inspections have also been carried out by a pharmacy inspector who has reported separately. We carried out a further unannounced random inspection on 12th October 2009. The reason for this visit was to monitor compliance with the Statutory Requirement Notice (SRN) issued to the home dated 17th July 2009 with the date of 31st July 2009 as the date for completion. The requirement had been restated with the original timescale in the random report of 19/08/09. The requirements of the SRN are recorded below with the details of our findings which were verbally provided to the registered provider Mrs E Kitchen. Requirements were to: (i) Ensure that there is a system in place to ensure that any identified risks to service users are clearly documented in their care plans. (ii) Ensure that where a risk had been identified ,there is a clear action plan in place which will provide staff with the guidance they require in order to ensure that the risk to the service user is minimised or eliminated. (iii) Ensure that when there is a change in a service users needs this change is fully documented in their care plan. We viewed four sets of care plans, risk assessments, daily records and some medication records. Records for three of these people had also been viewed at the last inspection in August 2009. In all files we found that more work is needed to show compliance with the requirements that we have made. There is a new system of care planning in use in the home and we found them in each of the four care plans viewed. We noted that they covered a range of care needs for each person and these were in three care plans each entitled physical care(personal care), mental health and physical health (doctor/ chiropodist/ optician /dentist). There was some evidence that some of the staff are reading them and signing to say that they have done so. There is a system of monthly reviews for these care plans although these had not taken place in September 2009 and people were last reviewed in August 2009. There are also some risk assessments which some staff have signed as read and these include some action plans in relation to the risks identified by the management. We noted though that the care plans do not identify enough information about each person to show that they are person centred or telling staff about peoples individual wishes, preferences, hobbies, interests and routines.
Care Homes for Older People Page 4 of 12 From reading the daily records for people, talking to staff and the manager, we noted that the care plans did not fully reflect the care needed or identify risks that had arisen. Some examples follow: We noted that staff told us several people were supported to use continence aids. However, this was either not referred to at all in the care plan or not recorded in enough detail for staff to have clear guidance about individual preferences and needs day and night. This means that needs may not be met in a way that people want or need it. We noted that in some daily records staff found that after an agency staff had recently been on duty, on one occasion two people had not received continence care. For one person we noted that the as required guidance for staff to follow related to medication that had stopped but was still in the medication records. Information about another medication was not available and details of a third medication were insufficient for staff to make consistent decisions about when to use it. For one person although a fall had led to a hospital admission, on return to the home a risk assessment for mobility had not been drawn up, support with mobility was not recorded in the care plans and decisions made about a temporary change of rooms, had not been recorded or mentioned in the care plan. We also noted that in two of the samples of plans viewed, where difficult behaviours had been identified as needing to be supported, the information was not in sufficient detail to offer effective support that works for individuals, to offer adequate emotional support or to provide enough information about what may trigger behaviours. One only referred to asking the person to go to their room to calm down. Another was slightly more detailed but not specific about the negative behaviours that are displayed. We also noted from discussion with Mrs Kitchen that she was not able to produce any information to show that a safeguarding referral was made about an incident of aggressive behaviour, as advised following our last visit in August 2009. For another person, in the August 2009 review, there was a record of bruising found and this was attributed to the actions of another person in the home. We did not find that this had been referred under safeguarding or the risk subsequently included in a risk assessment following the incident. We made another referral to social services after this visit on 12/10/09. For another person there is a requirement in the care plan for staff to record if that persons mental health deteriorates but no information about what signs may indicate this or what may help that person. For the same person some matters had arisen in a recent review but the information had not been added to the care plan. Staff also spoke about the person being at risk if they moved about the home alone but we did not find a risk assessment for mobility for this person, just a reference to the person using a frame. We noted in the files viewed that there is little evidence of the involvement of people in their care plans. For one person there was a mental capacity assessment by a care manager about money management but no other decisions made with or about people were seen in the records sampled. Care Homes for Older People Page 5 of 12 In the afternoon of this visit some staff were involved in fire training by an external provider. The owner had arranged care for people living in the home to be provided by the new manager who was not fully familiar with the needs of the people in the home. Although he had access to staff doing the training should support be needed, this was not an adequate plan to meet peoples needs. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 3 26 Reports of the monthly visits 30/09/2009 of the Registered Persons are to be forwarded to CQC. This is to demonstrate that management practices in the home are routinely monitored and issues addressed to improve the service to people living in the home. 2 3 14 People moving into the home 09/07/2009 must be provided with assurance that their specific needs can be met before moving in. This is to ensure that the home can meet assessed needs. 3 7 15 All care plans, daily records, 17/07/2008 risk assessments must be up to date with clear guidance for staff such as for when working with aggressive behaviour, or meeting all short and long-term health needs. Staff giving medicine to 21/09/2009 resident must be trained and deemed competant in handling medicine 4 9 13 Care Homes for Older People Page 7 of 12 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action so that safe practices are followed and the resident are protected from any risk of mismanagement around medicines. 5 9 13 to obtain a controlled drugs 20/11/2009 cupboard that complies with the Misuse of drugs Act 1973 and its amendments to comply with the law 6 9 18 The manager ensure that 09/07/2009 staff are competent before they are involved in administration of medication, and provide any additional training assessed as needed. This is to ensure that people living in the home are supported by correct medication procedures. 7 10 12 The registered person must 09/08/2009 ensure that the dignity and privacy of all people living in the home is maintained. . 8 23 37 Incidents occurring in the home must be reported to the relevant authorities so that procedures such as the local safeguarding procedures are followed. This is to ensure that people living in the home are offered protection. 12/09/2009 Care Homes for Older People Page 8 of 12 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 9 29 19 The manager must ensure 30/06/2009 that there is full evidence of employment checks available in the home including written references , employment gaps, and testimonials about why people left previous care employment. This is to ensure that people living in the home are safeguarded by the recruitment process. 10 29 19 You must have evidence of a 30/06/2009 POVA first check or a fully completed CRB check before people start working in the home. This is to ensure that the safety of people living in the home is safeguarded 11 30 18 The registered person must have clear records to demonstrate that staff are trained in relevant skills including infection control,adult protection and specific needs such as mental health and alcohol dependence. this is to ensure that staff have the skills required to meet needs. 30/07/2009 12 33 24 The manager must review 09/10/2009 information received in quality audits of the home and through consultation and ensure that it informs a plan for development and is made
Page 9 of 12 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action available to people living in the home or their representatives. This is to ensure that people are consulted and know that their views are taken into account. Care Homes for Older People Page 10 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
