This inspection was carried out on 19th August 2009.
CQC found this care home to be providing an Poor service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.
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 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 9 0 8 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 02380868895 02380868865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Richard E Kitchen,Mrs Elizabeth Kitchen 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 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
Care Homes for Older People Page 2 of 11 Brief description of the care home 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 11 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 at The Farmhouse Rest Home are poor. The report from that inspection is in the public domain and available on our website. We carried out an unannounced random inspection on 19th August 2009 attended by Sue Kinch and Carole Payne. The reason for this visit was to monitor compliance in relation to the Statutory Requirement Notice issued to the home dated 17th July 2009 with the date of 31st July 2009 as the date for compliance. The requirements of the statutory notice are recorded below with the details of our findings which were verbally provided to the Registered Provider area manager at the time of our visit. In the Statutory notice the home was required 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 has 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 three sets of care plans, risk assessments, daily records and some medication records. Records for one of these people had also been viewed at the last inspection in June. In that record we found that work is still needed to demonstrate that needs are fully met. There had been consultation with other health professionals since the last inspection and an element of the care plan had been amended. However, immediate guidance, other than contacting health professionals, telling staff how to help the person if the persons mental health deteriorated was not provided. It stated in the care plan that in the event of a deterioration in mental health clear guidance for the care team was included in the risk assessment. The risk assessment referred to recording and providing support, reassurance and TLC but did not refer to the specific symptoms known to have previously occurred, and how staff might reassure the person. From further observations of the records for the above person we noted that in the care plan it stated that the person was able to self medicate but that staff were to administer medication. There was no risk assessment in relation to this showing that the person/or representative had been consulted or any reason recorded as to why that person was not able to administrate their medication. We also found that whilst the above care plan included many areas of care needed, the
Care Homes for Older People Page 4 of 11 review form last completed on 4/8/09, only covered six areas of care and recorded no change in all six areas. This did not include a review of health needs although from observations of the daily records there were several entries regarding recent tests being carried out. The entries in the daily records did not include details of what the person had been told, what the problem was and how the person should be supported although at the last inspection the manager told us that the person needed re assurance which was regularly given. Other aspects of the care plans were not in enough detail. For example exactly how the person was to be encouraged to socialise and how this was to be monitored was not recorded although identified as an issue. Overall the records did not give a complete picture of how the persons needs were being planned to be met or monitored. Another example was about use of continence aids. In the care plan there were no details about the persons wishes in respect of this, frequency of changes or how the person liked to be supported and how independence is maintained. Two other sets of records, not viewed at the last inspection in June, were viewed and we also found additional evidence that the requirements had not been met. In both we noted that the risk assessments reviewed in March 2009 indicated they were at risk and posed a risk of verbal or physical abuse to others. In neither care plan was there reference to considering reporting such matters under safeguarding procedures or full details of action in place to protect them. In daily records for one person we noted that in the sample viewed there was one staff entry where they noted that the person had slapped another person who then poured tea over them. Another person had had their arm twisted. There was no evidence that the care plan had been reviewed following this. The Care Quality Commission had not been informed in a regulation 37 notice and a referral was not made to social services. This was discussed with the area manager during our visit who agreed to complete the notice and inform social services. A requirement was made in the report of the inspection of 17th June 2008 regarding reporting incidents. At our inspection of 9th June this requirement had been met. However, we have now made another requirement in respect of this at the end of this report. In the records for the above person we noted that in the care plan reviewed on 20th March 2009 it recorded no falls since admission but in the daily recording we noted that a fall had occurred since then. It was not recorded in the accident record and there had not been a subsequent risk assessment with revised guidance for staff. We noted further evidence of health matters not being followed up. The outcome of a urine sample noted in the daily records, was not recorded, bowel movements were recorded on one sheet with no details in the care plan about why this was needed. A medication for this person was recorded in daily notes as altered in June 2009 but the medication record for that date was missing. As the actual dosage was not recorded in the daily records it was not possible to check that alterations were accurate. Further observations of medication sheets showed that medication for anxiety had been missed on several occasions. The individual outcome sheet for the brief monthly reviews of care had last been completed in July 2009 and since November 2008 indicated that there had been no change for that person, clearly not reflecting the changing needs of that person. We also note that the Registered Person and area manager arrived at the home during our visit with new recording sheets for recording details of health needs and outcomes which were to be inserted into all care plan files. We were told that a recent in house review of care records that week by the Registered Person and area manager had
Care Homes for Older People Page 5 of 11 identified gaps. We were also informed that the Registered Person had now recognised that there were short falls in the care plans and intended to get them up to date as soon as possible. However, the home had failed to do this in the timescale set by us putting people at risk of not receiving the care that they need. 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 11 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 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. 2 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. The registered person must 09/08/2009 ensure that the dignity and privacy of all people living in the home is maintained. . 3 10 12 4 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. Care Homes for Older People Page 7 of 11 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 This is to ensure that people living in the home are safeguarded by the recruitment process. 5 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 6 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. 7 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 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. 30/07/2009 Care Homes for Older People Page 8 of 11 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 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 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 9 of 11 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 10 of 11 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 11 of 11 - 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!
