Inspection on 17/06/08 for Farmhouse Rest Home

This inspection was carried out on 17th June 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 Rest Home 12/01/10

Farmhouse Rest Home 02/11/09

Farmhouse Rest Home 12/10/09

Farmhouse Rest Home 28/09/09

Farmhouse Rest Home 19/08/09

Farmhouse Rest Home 17/08/09

Farmhouse Rest Home 09/06/09

Farmhouse Rest Home 02/08/06

Farmhouse Rest Home 23/01/06

Farmhouse Rest Home 15/08/05

Farmhouse Rest Home 10/11/04

Farmhouse Rest Home 10/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ Lead Inspector Sue Kinch Unannounced Inspection 17th June 2008 09:50 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 Rest Home DS0000048027.V365325.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 Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farmhouse Rest Home Address 87 Water Lane Totton Southampton Hampshire SO40 3DJ 023 8086 8895 023 8086 8865 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) Richard E Kitchen Mrs Elizabeth Kitchen Mrs Jean Hunt Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user may be accommodated under 65 years of age. D.O.B. 27/12/1941. 2nd August 2006 Date of last inspection Brief Description of the Service: 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 rear 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 home’s fees are the Hampshire Rate of £385 a week for a shared room and £420 for a single room. Farmhouse Rest Home DS0000048027.V365325.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. The inspection visit took place for eight hours following a review of the information held by the commission about the home, information received since the last inspection and details provided by the manager in the Annual Quality Assurance Assessment (AQAA). We also had information in eight surveys from relatives and people living in the home in the home and health and care professionals. We had verbal feedback from several of the seventeen people living in the home on the day of the visit and from relatives. Three staff and the manager were spoken with during our visit. Some records were viewed, care practices observed and areas of the home seen. What the service does well: We found that the home continues to provide a warm friendly atmosphere for people living in the home. One person said that they had been in several places and that this was the best. A relative said that they had recommended the home to others. Another relative said They are kind, helpful and very caring’ and said that they are good at seeing to their relative’s needs. The home provides a range of activities including sing-a-longs which are popular, discussions, and activity sessions with someone coming in to lead the sessions and visits to chat groups and the pub. People are supported to continue with their interests. They say that they can choose if they want to join in activities or use their rooms and are encouraged to have visitors who feel welcomed to the home. Food is provided in a relaxed and supportive way taking individual needs into account and offering choice. Comments were received about the variety and the manager has consulted people about meal times leading to giving medication out after as some people did not want to have it at mealtimes. People living in the home and visitors know what the complaints procedures are and mostly feel able to raise issues and are confident that they will be addressed. Regular improvements are made to the physical environment resulting in homely, comfortable, clean and hygienic surroundings with a pleasant atmosphere. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 6 The home has a stable and caring staff team recruited by a process involving the necessary pre employment checks. A programme of training is in place to provide staff with regular opportunities for learning and assessment including to NVQ levels 2 and 3. The manager is experienced, is approachable and involved in meeting the needs of people living in the home. She plans improvements and addresses health and safety issues. What has improved since the last inspection? What they could do better: Some areas for improvement have been identified and requirements have been made as follows: Further work is needed to ensure that a full care assessment, including information from relevant others, is undertaken for everyone wishing to live in the home and to ensure the home can meet their care needs. The manager must ensure that all the care plans, daily records, risk assessments are up to date and guidance for staff is clear such as with working with aggressive behaviour, short and long term health needs. All incidents in the home affecting the well being of the people living there must be reported to CSCI and when this includes harm to others must be reported to the nearest social services office under the adult safeguarding procedures agreed with the local authority. Other areas for improvement, below, have been identified in the report. Medication is well managed for people living in the home but guidance must be individualised for ‘as required medication’ when necessary. A review of where hairdressing takes place, the storage of the care plans and position of the manager’s office would improve the privacy and choice of some people. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 7 Risk assessments addressing the risk to people and reasons for locking any external doors should be in place including consultation with relevant others and should be kept under review. Where appropriate clear plans must be in place for freedom of movement for those able to go out alone. 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 Rest Home DS0000048027.V365325.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 Rest Home DS0000048027.V365325.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): 3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further work is needed to ensure that a full care assessment, including information from relevant others, is undertaken for everyone wishing to live in the home and to ensure the home can meet their care needs. EVIDENCE: The manager says that a comprehensive assessment is completed and people are offered to spend a day at the home to see how it operates before admission. She said that care managers are involved and other assessments obtained such as from the hospital nursing team. Improvements to the assessment include a mental capacity assessment ,a personal profile to help with complex needs and physiological requirements.These are being added to the assessment process. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 10 The manager said there there have been five admissions to the home in the last 12 months and we sampled two of the recent pre-admission records. We found insufficent evidence of assessment before admission in both. In one file we found that the assessment had taken place on the day of admission. An initial care plan had been undertaken at the same time but risk assesssments were to be completed. The manager said that the person had already had some day-care at the home on previous occasions and had considered her needs but had not recorded them. For a second person, the manager said was admitted in an emergency, there was a letter from a doctor and and the manager had a page of written information from a relative and an admission form had been completed. However the assessment and care plan was dated three weeks after the admission. A care manager had been involved but an assessment had not been obtained. In surveys most people or relatives said that they had enough information before moving into the home. Two out of eight said they did not have a contract although one thought a relative could have one . One person said The manager came to visit me in hospital so that I could see the home and meet the staff and other people she arranged to pick me up and take me there, which was nice of her. We talked and discussed my needs, my friend was also with me for support. I was given the option to stay at the home, to see if I liked it, I did not feel pressured, it was my decision. Another said mum was offered to come in and spend a day at the home, to see if she liked it, as she was worried at first, on going into a home, she thought they were institutions. She soon realised that she would be able to continue her daily life, but with help with the things she couldnt manage. One recently admitted person said that they had visited before coming to the home,had chosen to come and had the help that they needed. The home does not provide intermediate care. Farmhouse Rest Home DS0000048027.V365325.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An individual approach is taken to meeting the needs of people living in the home and involvement in care planning is encouraged. This would be enhanced by more rigorous updating of care plans and records of meeting needs, further risk assessment and clearer guidance for staff on some issues such as working with aggressive behaviour and short and long term health problems. A review of where hairdressing takes place, the storage of the care plans and position of the manager’s office would improve the privacy and choice of some people. Medication is well managed for people living in the home but guidance must be individualised for ‘as required medication’ when necessary. EVIDENCE: Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 12 In surveys people of living in the home and some completed by relatives, they said that they usually or mostly had the right support that staff listen and act on what they say and are available when needed. However, one person felt that at times staff congregated in the areas just off the lounge sometimes when supervision could be provided. One person said I must say I never have to say anything, Jean or a member of staff telephone me, to discuss various topics.’ They said that the home’s concerns were for the person’s best interests and said ‘ I feel very confident with the home as a whole. Seven respondents answered a question about medical support and said that they received it as needed. Some relatives spoken with were mostly very positive about being told of health issues and were confident that the home would follow up health issues. One was not sure that full support with dentures was always given. A health care professional, in a survey, was also positive about the support given with health care and a care manager about support with personal care. A continence advisor visited the home to meet with the manager on the day of the inspection. We sampled care plans and noted that these have been written for each person and are reviewed regularly. They take account of some of the tasks that people can manage for themselves. The manager said that people, or relatives when possible, are actively involved in planning their care. However, the manager said that she is developing the care plans to include a wider range of issues and is gradually changing all care plans to this more comprehensive format. One of the new style care plans was viewed and included more information about the wishes of the person than others and more details about how needs would be met. We saw that the care manager had signed that care plan to say a review had been completed in July 2007. In another care plan guidance for dealing with aggression was looked for by us as staff spoke of aggression from that person towards staff and records indicated that aggression had also been towards some residents. Although some details of how to deal with the aggression were in the initial care plan, and there was evidence of medication reviews, a risk assessment had not been undertaken regarding aggression following a specific incident. The manager said that staff were to try and find out what the problem was or to distract by taking the person for a walk. Clear detailed guidance was not recorded, nor was details of the level of supervision needed. A staff member spoken with was not confident in dealing effectively with the behaviour. (This Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 13 matter is referred to further in the complaints and protection section.) In a further day-to-day record we noted an incident that occurred in August 2007 when another resident was aggressive. The initial care plans had some details of how to deal with the aggression but a risk assessment had not been completed following the incident. Although the manager said that the person’s behaviour was less aggressive now it was advised again that following such incidents risks are evaluated. The care plan for another person was viewed and the person’s high support needs were discussed with a member of staff. The care plan was not in a lot of detail, but had been reviewed. We found, from separate discussions about current needs of that person with a staff member and the manager, it was not up to date regarding mobility, activity, feeding, continence and oral care. The mobility risk assessment had not been reviewed since February 2006 and was out of date, as it did not refer to current equipment needed. Day to day records were reviewed for that person and although indicated that a pressure sore was detected and a comment for referral to a district nurse was recorded on 7/6/08,there was no subsequent entry in that record. A staff member said that a health professional had been involved and the person had received bed rest. None of this was recorded and the outcome of the bed rest was not noted and the care plan had not been altered to indicate how care should be provided during that time. Advice was given to ensure that when reviews of care plans take place the information on the day-day records is taken into account. Care practices were observed during our visit and it was noted that staff supported people with day-to-day issues of lost hearing aids and glasses. They showed caring and friendly approaches to people living in the home. They were polite and respectful and people asked said that they were respectful and cared. The manager showed us a file of information for night staff on the ground floor. Care plans are held securely but are not easy to access. They are on the second floor in the managers office which staff access through a used shared bedroom affecting the rights to privacy of the people sharing the bedroom. During the inspection the same room was being used for staff training. We also noted that another person’s bedroom is used for hairdressing. The manager thought that this could be rectified in time with developments to the home but a short-term solution is needed so that people have control and choice over their rooms. The manager is aware of the Royal Pharmaceutical Society guidelines, although was advised of a more recent updated version. She has a medication policy for staff administering it, she said they have completed a training Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 14 course in medication. A staff member confirmed that they had to have training in this before doing medication and some certificates were viewed for some staff trained. The manager said people living in the home are able to administer their own medication if they wish through a risk framework.This was not assessed at this inspection. Medication being given out at lunchtime was administered in line with national guidance and signed for after being given individually. Advice was given to ensure that all medication records and as required guidance is clear including information such as if people are able to make their own decisions and if it has been stopped. This information was missing.The manager agreed to address this. Drugs in the home are held in a locked cupboard. The manager said that the home did not currently hold any controlled drugs and was advised that any drug now required to be held in the home and stored as a controlled drug would need to be stored in a proper Controlled Drugs Cupboard under the Misuse of Drugs (Safe Custody) Regulations 1973. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home enjoy a range of activities regularly organised in and out of the home taking individual needs into account, receive visitors and enjoy good meals that they like. Independence would be enhanced by ensuring that those people able to go out alone are able to do so freely. EVIDENCE: In the surveys people living in the home and relatives indicated that activities are provided and five said that they could always take part in them. Two said sometimes. Staff and residents spoken with were positive about the activities and stimulation provided in the home. Some people go out to a chat group once a week and one person spoke of going out on the bus for outings. People were making choices about what they wanted to do during the morning and sat in various places through out the home. Some were engaged in knitting, watching television, receiving visitors, using the garden area, and sitting in the foyer. Some people had daily papers and some were watching television. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 16 The home has a relaxed friendly atmosphere. Staff said that they have time to sit and talk with the people living in the home. They know what people enjoy and tried to meet individual needs. Several people enjoyed seeing the hairdresser during the day we visited and the entertainer, who does activities twice a week with people, ran a session during the afternoon. People spoke about regular sing-a -longs in the home and one person although not keen on any of the activities, said they enjoyed watching. The manager also said that some people liked to go to the pub sometimes. Relatives spoke of activities provided and that the home celebrated birthdays and Christmas well. Another visitor confirmed that a lot of the activities are regular. A visitor to the home brought a dog for some of the people to see which some people were interested in. Whilst gathering information about the inspection a visitor to the home had expressed concern about dogs roaming freely, the manager said that some of the people in the home are keen on animals and others are not and they are kept under strict control when brought into the home. Visitors said that they were made to feel welcome at any time that they visited the home and they were noted to be positively received during our visit. They said they were always given refreshments. One visitor took their relative out for the afternoon. The manager’s approach was encouraging towards family contact and use of the community. She hopes to have a minibus to aid this. In the files viewed there was evidence that people had been asked about their daily preferences including routines. People are able to make various choices. One person had chosen to get up a lot later than the others. We noted people chose where to sit, where to have lunch and what to have for lunch. The manager referred to the home as a secure unit but does not have risk assessments in relation to this. The external doors are locked but the manager said that some people are able to go out if they want to but needed to ask. Plans need to be in place to give those not at risk free movement. The manager agreed to address this issue. The manager said she has completed a survey regarding meals and made improvements. In six surveys the people living in the home or relatives said that the food was usually or always liked. Most of the comments we received at the inspection about food were good. Staff members and the manager were noted to take a lot of time considering the individual preferences of people at lunchtime and providing a choice of Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 17 foods. Some people were helped to eat and staff sat with them to do this while other staff checked on choices. A higher staff level was needed to meet needs at lunchtime and during our visit this was provided. One relative said I have been at the home when meals are served; they have a fabulous choice, also very plentiful’ on observations. I can fully recommend the varying choices, plenty of luxurious snacks are also given out, which Ive also been offered. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 18 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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home know how to raise issues and concerns and mostly feel that they will be addressed. Although training is provided for staff in awareness of protecting elderly people from abuse, local adult protection procedures need to be used actively to ensure that incidents are followed up fully, risks assessed and guidance in place to enhance protection. EVIDENCE: The manager said that they need to continue to update staff regarding The Mental Capacity Act and protection of vulnerable people and has identified more training needed in these areas. The home has not made any adult protection referrals in the last twelve months. However, we noted a recent incident that was recorded in the home but not reported to us or under the adult safeguarding procedures. Details about how the matter had been followed up for two of the people involved were not recorded. The manager was advised to report the matter and following the visit we alerted Hampshire Adult Services. Verbal and written information showed that staff do have to deal with physical aggression towards themselves and towards other people living in the home Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 19 and have received some training in understanding challenging behaviour but there is not enough detailed guidance of what to do in some situations that they deal with and there is insufficient recording of incidents. Staff said that they have training and guidance about the risks of abuse and protecting adults. They showed awareness of what abuse is and of their role in reporting concerns.The manager said that staff are given courses to follow that result in assessed tests and this includes adult protection. In staff files sampled, there was evidence of adult protection training. We have not received any formal complaints about the home in the last twelve months and neither has the manager. In the survey responses of eight people living in the home and relatives they said that they know who to speak to if they are not happy and know how to make a complaint. People spoken with at the home said that they are able to raise issues directly if they need to and are confident that they would be addressed. One concern was raised with us as the person felt unable to raise with the home. This concerned dogs in the home,some staff approaches and staff congregating in an area off the small lounge. These issues were raised with the manager during the inspection and are reported on in other sections of the report. One visitor to the home said that the staff and the manager are always willing to tell them if their relative is troubled by anything. Another said I have always spoken to Jean, she is always readily available, although I have no concerns, the staff are on hand if Jean is not available, very warm and friendly home. One person said I am very happy here and another My mother is extremely happy at the Farmhouse Im very pleased I chose this home. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 20 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a warm, friendly, comfortable environment for people to live in which is clean, hygienic and regularly improved. EVIDENCE: At the last inspection we noted that the home had been making ongoing improvements to the physical environment. The manager says that they have continued to make improvements and include:sink taps fitted with regulators which have had further adjustments; hallways stairs and landings redecorated ,improved lighting in these areas; assisted baths in some en suite facilities ; some new matresses and the redcoration of residents rooms are ongoing. She has written plan for more improvements to the home. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 21 In our survey six out of seven responses indicated that the home is always fresh and clean and another said usually. On the day of our visit the home was clean although the cleaner was off work but the manager said that another member of staff would be doing the cleaning. Two people were happy to have their rooms viewed and these looked comfortable clean and items checked were in working order. In one room the water temperature was checked and was at a safe temperature,a window restrictor was in place, the call bell worked and staff answered it promptly.We noted that there are various other adaptations about the home including rails,raised toilet seats and a chairlift. All looked secure and the chairlift was working. The manager showed that there was a list of tasks identified for repairs and maintenance. Staff and visitors said that when things did not work they were promptly fixed, although the manager said that this had slowed with the new reporting system. We noted that there were a number of items about the home and external area that detracted from an otherwise attractive home including an old, telelvision, crates and large cardboard boxes.The manager was aware of the need to have it sorted out. The manager reported that a risk assessment had been carried out in respect of the laundry room and a lock fitted to reduce risks for people who wander. The home has magnetic doorlocks and a coded entry system.( Choice and control issues are addressed in the daily living section above). The manager said she has upated infection control procedures.Hand gel disinfectors are located at the entrance to the building.The manager said that they use the essential steps to assess their infection control management and have no current action that it still needed . We were also told that all staff are trained in infection control. A staff member confirmed that they and the right equipment for personal care and infection control proecedures and another confirmed to be undergoing more training. An infection control training session was being carried out with two staff during our visit. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a regular reliable staff team and people living there are offered a service from an increasingly trained staff team recruited through thorough recruitment processes. EVIDENCE: Staffing arrangements allow for three care staff to be on duty in the morning and two in the afternoon. One of the staff members does the cooking and normally a cleaner is working at the home. Two carers were available for the shift and the manager said that a new member of staff had not started work and she was the third person on shift that morning. Two other staff members were doing training and assisted at lunchtime. Staff said they had enough time to do tasks and had time to sit and talk with the residents. Where one person at times needed two staff for support, staff said that they could usually provide this and have staff available for the other residents. The manager said that the staff level is altered depending on the needs of the resident group. It was noted that in a care plan viewed the staff level for monitoring behaviour was not specified. When this has been reviewed - a Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 23 review of the deployment of staff may be needed. The vast majority of comments from people living at the home, relatives and others felt that the staff are meeting needs and spoke favourably about their attitudes and caring approaches. Two less favourable comments were made and were brought to the manager’s attention. She said that she does monitor staff approaches and address issues when she identifies them. The manager reported that she has fairly stable and supportive staff team. Since the last inspection one new member of staff had been recruited and commenced employment. Recruitment records for this showed that appropriate checks had been made. The manager also said that a resident had been involved in the process. The manager reported that five out of thirteen staff have a National Vocational Qualification (NVQ) level 2 or above with two more staff undergoing level 2 or 3. The home has recently obtained a new training package which the manager wishes to use to improve the training levels. Staff and the manager spoke of the system of reading ,responding to questions and undertaking a test for some of the training and we saw evidence that this is already in use. There is also evidence that staff are attending taught courses in the home such as fire and infection control and out of the home such as medication and dementia awareness . Discussions about training were held with two staff both of whom had positive attitudes to it and were involved in some ongoing training. Four staff files were looked at for evidence of training and these showed that staff received training including, health and safety related issues (such as infection control, fire,first aid) and medication, dementia ,challenging behaviour and abuse awareness. The manager showed a strong commitment to training and was able to demonstrate that adequate progress had been made to meet the requirement in the last inspection report dated 2nd August 2006 . This was that she must ensure staff receive the training required to do their job including dementia care.The manager promotes individual needs but is aware of the need to include equality and diversity in training. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a manager with good knowledge of their individual needs who addresses health and safety and the quality of the service with consultation. But more monitoring is needed to ensure that the service can demonstrate that all needs are met. EVIDENCE: The manager has worked at the home for many years and has been in post for four years. She said that she has four units to complete for NVQ level four in management. She said that she uses care magazines to update herself. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 25 Positive reports were received from people living in the home, staff, relatives and visitor about the manager. These included about the manager knowing and caring about the people and being approachable. Some relatives said that they would recommend the home. Staff said that they have occasional staff meetings, regular handovers, some supervision and annual appraisals. Those spoken with felt able to talk to the manager if necessary and able to air views. The manager reported that she is open to suggestions, that the home has a quality monitoring system that involve stakeholders including people,in the home and others every six months and she has good feedback.She has a number of completed forms that had been returned to her. She said that as a result people living in the home are involved in interviewing for staff and changes have been made to mealtimes. She says that she listens to people on a one to one basis and plans to work to developing quality assurance. In the AQAA she provided information about improvements planned for the home which we saw evidence of .She is also wanting to move forwards and develop person centred care. In respect of quality assurance and monitoring incidents, we have received communication from the home of accidents and disease in regulation 37s since the last inspection. However, we noted that we have not been told of at least one aggressive incident affecting the well-being of people living in the home (this has been reported on in the section on complaints and protection) and adult protection procedures have not been followed. We have also made other requirements and the current quality assurance system had not identified these needs. We noted that regulation 26 visits are being carried out by the owner of the home. We sampled records which were in place for the last three months. The manager said that she reviews the policies and procedures annually.They were last reviewed in 2007. The manager said that the home does not hold any personal money for people living in the home and relatives tend to deal with this due to the varying levels of dementia. Relatives spoken with confirmed this. In the AQAA she demonstrated knowledge of records needed if money is held . The manager says that she takes an active interest in the health and safety of all whom live and work in the home. She uses risk assessment ,observations and updating contracts. She says that maintenance contracts are in place and are maintained in line with regualtions. We noted that the gas service was completed on 3rd March 2008. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 26 We noted that risk assessments were recorded as reviewed in July 2007. But risk assessments are needed in relation to the locked doors of the home.( this is reported on in more detail in the section on Health and Personal Care). A requirement was made following the last inspection to ensure that all staff attend fire drills so that they are aware of procedures to follow in case of fire. At this inspection we noted that since then a number of drills had occurred and training sessions had been held and attended by staff. The manager confirmed that this included guidance about evacuation and the sounding of bells. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 27 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14 Requirement Timescale for action 17/07/08 2. OP7 15 3. OP18 37 Full assessments must be made including information from relevant others and the people to receive the service before an admission is made so that at all times people coming to the home know that their needs will be met. All care plans, daily records, risk 17/07/08 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. All incidents in the home 17/07/08 affecting the well being of the people living there must be reported to CSCI and when this includes harm to others must be reported to the nearest social services office under the adult safeguarding procedures agreed with the local authority. This is to ensure that appropriate action is taken. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 29 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 Refer to Standard OP7 Good Practice Recommendations Care plans should be readily accessible by staff without compromising the privacy of people living in the home. Farmhouse Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Rest Home DS0000048027.V365325.R01.S.doc Version 5.2 Page 31 - 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. 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