Inspection on 13/01/06 for Farnworth Care Home

This inspection was carried out on 13th January 2006.

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

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

Other inspections for this house

Farnworth Care Home 30/09/09

Farnworth Care Home 18/08/09

Farnworth Care Home 13/10/08

Farnworth Care Home 17/01/08

Farnworth Care Home 28/11/06

Farnworth Care Home 28/04/06

Farnworth Care Home 27/07/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Farnworth Care Home Church Street Farnworth Bolton BL4 8AS Lead Inspector Stuart Horrocks Unannounced Inspection 13th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 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. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Farnworth Care Home Address Church Street Farnworth Bolton BL4 8AS 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) 01204 578555 Abbey Healthcare (Farnworth) Limited Mrs Marie Mungins Care Home 120 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (62), of places Physical disability (20) Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 120 service users, to include: Up to 20 service users in the category of PD (Physical Disabilities under 65 years of age); Up to 62 service users in the category of OP (Older People); Up to 38 service users in the category of DE(E) (Dementia over 65 years of age). The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 27th July 2005 2. Date of last inspection Brief Description of the Service: Farnworth Care home is owned by Abbey Healthcare Limited, a company that also owns a number of other care homes. The home is purpose built with 4 units, which cater for up to 120 people with a variety of needs. There is an older persons residential care unit on the ground floor and also a younger adults care unit for people with physical disabilities. The first floor unit offers care to older people who require nursing care whilst the second floor unit provides care for older people with confusional illnesses. The home is just off the main street in Farnworth and is close to bus stops. The home is pleasantly situated in its own grounds with surrounding gardens and there is ample car parking to the front of the home. The accommodation is provided on three floors in 120 single bedrooms. All bedrooms have an adjoining toilet, sink and shower. Two passenger lifts provide access to the upper floors. There is a dining room and two lounges on each floor and each floor is provided with bathrooms. There is a garden and patio area to the rear of the home that can easily be reached from a ground floor lounge. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and it took place over two days on the 13th and 16th of January 2006. The visits were started at 09.30 and 09.00 respectively and the inspection lasted for a total of fifteen and a half hours. The time was split between talking to the manager and checking records, and looking around the home, watching what was happening and talking to residents, visitors and other staff. Seven residents, six visitors and twelve staff were spoken with. A number of “comment cards” were given out during the inspection. These allow residents, relatives and visitors to comment briefly upon various aspects of the services provided by a care home. Three of these had been returned at the time of writing this report; two were complimentary about the care and services provided by the home whilst the third expressed a number of concerns about a variety of care practices. The local Social Services Department and the local CSCI office had recently had a number of concerns raised directly with them about the various aspects of the care, services and responses provided by the home. A worker from the Social Services Department and a Regulation Manager from the CSCI was jointly investigating these concerns at the time of this inspection. In view of the concerns mentioned above this inspection focused on those Standards that directly have an effect on the care provided to the residents. These Standards included Standards 7 ands 8 (Health and Personal Care), Standard 12 (Social Activities), Standards 27 and 30 (Staffing Levels and Training) and Standard 31 (Management of the Home). Other Standards were also inspected but the main focus was on those Standards mentioned above. What the service does well: What has improved since the last inspection? Some progress has been made by the manager and the staff to make sure that the things, which needed improving from the last inspection, have been done. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 6 These include making sure that the home’s staff are aware of the home’s adult protection procedures with the staff having signed a record to state that they have read and understood this procedure. The Statement of Purpose (a document that explains what the home does) and the Service User Guide (service user information guide) are now available as separate documents although one of these documents is still rather overlong. 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. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 7 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 Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. Written information is generally available that helps prospective residents to make a decision about whether they wish to live at the home. The above key Standard 3 was not examined at this inspection. It should however be noted that this standard was met at the time of the previous inspection (July 2005). Farnworth Care Home does not provide intermediate care services (key Standard 6). This standard does not therefore apply. EVIDENCE: Standard 1 was assessed on the last inspection. For full comments please refer to the inspection report of 27th July 2005. A requirement of the above inspection in relation to Standard 1 was that the home must make the Statement of Purpose (a document that explains what the home does) and the Service User Guide (service user information guide) available as separate documents as required under this Standard. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 9 Both of the above documents are now available separately and they both contain all of the required information. However the Statement of Purpose is contained within a “Service User Handbook” which is somewhat overwhelming in the volume of information given. The inspectors strongly recommend that the content of this document be reviewed in an effort to make the information more accessible. The manager must make sure that all of the residents are given a copy of the Service User Guide. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. The home’s present care delivery systems are insufficient to ensure that the residents’ health, personal and social care needs are being properly met, therefore the residents are at risk of being provided with an inadequate standard of care. The medication arrangements need to be improved so making sure that medicines are properly handled. EVIDENCE: Health and Personal Care Ground Floor Residential Unit. (Currently 32 residents accommodated). The care files of three residents were looked at. These contained details of the health, personal and social care needs for each resident. The information in these files is generally well laid out and is easy to follow. The staff said that they knew each residents needs by reading the care plans, which are readily available to them. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 11 Each file contained a care plan that was laid out on a need by need basis. There was also a care plan index that provides a quick reference or summary of the residents care needs. Risk assessments for pressure sores, falls, manual handling, nutrition and where necessary the safe use of bed rails were in place. A record was available that showed that the residents were being weighed regularly. A “Daily Allocation Record” was also available the purpose of which is to record when things such as mouth care, bathing, showering and nail care had been given to residents. Day and night care and progress reports were also available. A record was available of visits to the residents by health care workers such as GP’s, nurses and opticians etc. With regard to the above-described information (Ground floor care unit) the inspector makes the following comments: Some care plan summaries identified care needs that were not dealt with in the actual care plan. Those care plans checked had been reviewed at the required monthly intervals. The risk assessments were regularly being reviewed and updated but where increased risk was identified this was not always being addressed in the care plan. Some residents had not had a safe manual handling risk assessment completed. The “Daily Allocation Record” had not been completed regularly therefore there was little reliable information about such things as bathing and nail care etc. The day and night progress reports had been completed regularly but these gave little description of the actual care provided. A resident with a pressure sore was being treated for this condition by the local community nurses who were recording treatment and progress reports. There was virtually no reference to this in the home’s care notes nor was there any reference to the provision of pressure relieving equipment. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 12 Health and Personal Care First Floor General Nursing Unit. (Currently 20 residents accommodated) The care files of three residents were looked at. These contained details of the health, personal and social care needs for each resident. The information in these files is generally well laid out and is easy to follow. The staff said that they knew each residents needs by reading the care plans, which are readily available to them. These files contained all of the records and information as those described above for the ground floor care unit. With regard to the above-described information (First floor care unit) the inspector makes the following comments: Care needs identified in the summaries were dealt with in the actual care plan. Those care plans checked had been reviewed at the required monthly intervals. The risk assessments were regularly being reviewed and updated and where increased risk was identified this was being addressed in the care plan. All residents had had a safe manual handling risk assessment completed. The “Daily Allocation Record” had been completed regularly therefore there was information about such things as bathing and nail care etc. The day and night progress reports had been completed regularly and these did give quite a good description of the actual care provided. The home’s staff was regularly recording the progress and treatment of pressure sores and there was reference to the provision of pressure relieving equipment. Health and Personal Care Second Floor Dementia Care Nursing Unit. (Currently 13 residents accommodated). The care files of two residents were looked at. These contained details of the health, personal and social care needs for each resident. The information in these files is generally well laid out and is easy to follow. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 13 The staff said that they knew each residents needs by reading the care plans, which are readily available to them. These files contained all of the records and information as those described above for the ground and second floor care units. With regard to the above-described information (Second floor care unit) the inspector makes the following comments: Care needs identified in the summaries were dealt with in the actual care plan. Those care plans checked had been reviewed at the required monthly intervals. The risk assessments were regularly being reviewed and updated and where increased risk was identified this was being addressed in the care plan. All residents had had a safe manual handling risk assessment completed. The “Daily Allocation Record” had been completed fairly regularly therefore there was some information about such things as bathing and nail care etc. The day and night progress reports had been completed regularly and these did give quite a good description of the actual care provided. The inspector was informed that none of the residents living on this unit had a pressure sore. As mentioned under the first part of the “Summary “ section of this report a number of concerns about the care provide at the home had recently been made to the local Social Services Department and to the local CSCI office. One of the three “comment cards” returned to the CSCI also expressed a number of concerns that included: Medicines being left with residents without water being provided for the resident to take the medicine and that the medicine trolley is being left unattended. Residents not being washed before going to bed and when getting up, residents not being taken to the toilet regularly with the result that they are walking around in an unclean condition and that residents are not being bathed regularly. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 14 That the care staff are spending a lot of their time in the smoking room, which leaves the residents unsupervised and that this time could be better used to provide stimulating activities for the residents. That at mealtimes that food is not first cut up for residents who cannot see properly and that those residents who need assistance to eat are not given such help. The comments made above are typical of the concerns recently made to both the CSCI and to the local Social Services Department, where it appears that these adverse remarks mainly refer to the care provided on the ground and second floor care units. The inspectors discussed these issues with many of the staff working on these two units who fairly readily acknowledged that they were having problems in meeting all of the care needs of the residents. The staff felt that some of the difficulties they were having in providing a good standard of care was due in part to insufficient staffing levels. They gave an example of this on the second floor unit where they said that not enough staff were available at mealtimes to assist all of those residents who needed help with eating. The inspectors are also of the opinion that staffing levels on the first and second floor units are inadequate with this negatively impacting upon care standards. Please see standard 27 (Staffing) where requirements have been made. The inspectors consider that further staff training is necessary which will improve the standard of care being provided to the residents living on these two care units. Please see standard 30 (Staff Training) where requirements have been made. The inspectors also consider that a more effective the management structure will improve the level of staff supervision, which will in turn improve the standard of the care provided. Please see standard 31 (Management & Administration) where requirements and recommendations have been made. Medication Arrangements Ground Floor Residential Unit. The medicines are provided in pre-filled blister packs with pre-printed prescription/recording sheets also provided. Medicines are safely and securely stored and those staff who give out medicines on this unit have been trained in this task. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 15 Up to date records are kept of medicines received and given out but the record for the disposal of medicines was not being regularly used. Some prescription sheets for the giving of medicines are currently filled in handwritten by the unit’s senior staff. The safety of this method relies on the staff making sure that the right name and amount of the medicine is written on the prescription sheet, in order to ensure that right details are entered the staff must ensure that two people witness the prescription, which they both must sign. Medication Arrangements First Floor General Nursing Unit. The medication arrangements on this floor are identical to those used on the ground floor. The medicines were found to be safely and securely stored and Registered Nurses only give out medicines on this unit. Up to date records are kept of medicines received, given out and disposed of therefore ensuring that medicines are handled properly. Medication Arrangements Second Floor Dementia Care Nursing Unit. The medication arrangements on this floor are identical to those used on the ground floor and first floor care units. The medicines were found to be safely and securely stored and Registered Nurses only give out medicines on this unit. Up to date records are kept of medicines received, given out and disposed of therefore ensuring that medicines are handled properly. Medication Arrangements General. As mentioned under an earlier in this section of this report one of the respondents who returned a “comment card” stated that they had seen that medicines were being left with residents without water being provided for the resident to take the medicine and that the medicine trolley was being left unattended. The staff must assist residents properly with the taking of medicines, they must make sure that a drink of water is provided and they must not leave an unlocked medicine trolley unattended at any time. Requirements are therefore made to this effect. The inspectors are also aware that other issues regarding one particular resident’s medication have been raised with the local Social Services Department, these issues are subject to separate enquiries and they will therefore be commented upon separately. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. The home presently offers only a limited and irregular amount of leisure activities, which are insufficient to keep the residents interested and stimulated. The above key Standards 13 and 14 were not examined at this inspection. It should however be noted that these standards were met at the time of the previous inspection. EVIDENCE: At the time of the previous inspection the home then employed a worker who was in the process of developing and running a programme of social and leisure activities for the residents living at the home. No written plan of such activities was available at the above time and a requirement was made that such a plan must be put together and that it must be displayed throughout the home. At the time of this inspection no activities worker was employed, although the inspector was told that the home was attempting to recruit a person to fill this vacant post. A programme of leisure activities was displayed throughout the home, but the inspector’s enquiries revealed that relatively few activities were being provided. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 17 Discussion with the care staff on all three units showed that they do provide the residents with some recreational activities when and if they have the time to spare from their caring duties. Liesure activities are therefore not happening regularly and the displayed programme is also not followed. The registered person must therefore make sure that the residents are regularly provided with stimulating, meaningful and fulfilling social and recreational activities and that this would be better enabled if a worker dedicated to this task was employed. The registered person must also ensure that when residents do take part in recreational activities that this is written down so that resident participation can be monitored. The home uses a three weekly menu that offers a choice of food. Warm food is available at all mealtimes. Some of the residents that that the inspectors spoke with were satisfied with the food provided whilst others were less satisfied. Some said that the food was not always hot and others said that that same food seemed to be offered regularly. A relative of a resident did comment that fresh fruit was not often available. The inspectors saw a meal that was provided, the food appeared to be hot but it looked rather bland and to be lacking in colour As mentioned under Standard 16 (Complaints) a number of complaints have been made to both the CSCI and the local Social Services Department The inspector is aware that within these complaints a number of concerns have been raised about the food provided, about staff not assisting residents with eating and about the dining facilities. These complaints are presently being investigated. The home’s manager should however take note of the adverse comments made above and should, in the meantime review the provision of food and the dining facilities to ensure that the requirements of Standard 15 are met. . Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home’s written complaint procedure is sufficient to make sure that complaints will be properly dealt with. Protection of vulnerable adults guidance is available but further staff training in this subject is still needed to ensure that residents are protected from abuse. EVIDENCE: The home has a straightforward complaints procedure, which is displayed in the home and is also available in the resident’s information guide. However as stated under Standard One the registered person must make sure that all of the residents are provided with a copy of this information guide. A complaints file is kept which records the details of any complaints made, of any action needed to deal with the complaint and of the final outcome. Three complaints that have recently been made directly to the CSCI are presently being looked at. One of the above complaints had initially been investigated by the home, but the complainant was not satisfied with the home’s response so they then raised their concerns with the CSCI. The inspector is also aware that the local Social Services Department had recently had a number of concerns raised directly with them about the various aspects of the care, services and responses provided by the home. A worker from the Social Services Department and a Regulation Manager from the CSCI was jointly investigating these concerns at the time of this inspection. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 19 During the course of the first day of the inspection a relative of a resident spoke to the inspector to say that she had complained to the manager on that morning to express a number of concerns about the standard of care that her relative was receiving. It was agreed that this person would contact the CSCI directly if they were not satisfied by the manager’s response. The other relatives that the inspector spoke with also said that they would have no anxiety about raising concerns with either the manager or the staff although some said that they were “generally satisfied” with the care provided. The residents spoken with said that they would generally feel comfortable about raising concerns and that they would “talk to Marie” (the then manager) or to the staff if they had any worries. Discussion with staff showed that they were aware of the home’s complaints procedure. The home has Abuse Policy and Protection of Vulnerable Adults guidance. These documents refer to and to some extent rely on the Department of Health “No Secrets” book (detailed guidance on dealing with abuse) and also on an “Understanding Abuse” work book. Both of these give a lot of information about understanding, recognising and dealing with suspected abuse. A requirement of the previous inspection was that the Registered Person must ensure that the staff are fully aware of the homes adult protection procedures and the staff must sign a record to state they have read these documents.Looking at records showed that this requirement has been dealt with. A further requirement of the previous inspection was that the Registered Person must make sure that the staff was provided with training in Adult Protection procedures.Examination of records showed that approximately ten staff had recently been given this training with further training to be arranged for other staff in the near future. The Registered Person must ensure that all of the staff are provided with training in Adult Protection issues. Discussion with many of the staff showed that they were aware of the different sorts of abuse and they also understood what they should do if they suspected that someone was being abused. A recommendation of the previous inspection was that the Registered Person should obtain a full copy of the local inter-agency Adult Protection Policy so that local guidance is followed should an abuse situation arise.This recommendation has not been addressed and it is therefore repeated. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above key standards were not examined at this inspection. It should however be noted that key standards 19 and 26 were assessed as being satisfactory at the time of the last inspection. The inspectors did spend some time walking around the building whilst talking to residents, visitors and staff. The home is decorated and furnished to a good standard and it was seen to be well maintained to both the inside and the outside. EVIDENCE: Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28.29 and 30. The numbers of staff provided on the ground and first floor care units are insufficient to make sure that the residents are given a proper standard of care therefore the residents are at risk of being provided with an inadequate level of care. The procedures for the recruitment of staff are not robust and they do not provide the safeguards to offer protection to the people living in the home. Staff training is generally insufficient to ensure that the resident are cared for properly therefore the residents are at risk of being provided with a less than adequate standard of care. EVIDENCE: Staffing Levels Ground Floor Residential Unit. (Currently 32 residents accommodated) Examination of staff duty rotas showed the following staff provision: 8am to 8pm one senior care assistant plus three care assistants. 8pm to 8am two care assistants. The inspectors’ discussions with the staff about the above staffing provision on this unit showed that in the their opinion that this level of staffing was insufficient to fully meet the residents care, health and social needs. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 22 Information received from residents’ relatives also indicated that the residents’ needs were not being fully addressed. The concerns expressed by these relatives are subject to ongoing enquiries. Staff morale on this unit was generally good with the staff saying, “that we work well together as a team”. Staffing Levels First Floor General Nursing Unit. (Currently 20 residents accommodated) Examination of staff duty rotas showed the following staff provision: 8am to 8pm one Registered General Nurse plus three care assistants. 8pm to 8am one Registered General Nurse and one care assistant. The inspector’s discussions with the staff about the above staffing provision on this unit also showed that in the their opinion that this level of staffing was insufficient to fully meet the residents care, health and social needs. Information received from residents’ relatives also indicated that the residents’ needs were not being fully addressed on this unit also. The concerns expressed by these relatives are also subject to ongoing enquiries. The staff moral on this unit was not as good as that on the ground floor unit. They said that they “got on with each other”, but that they felt stretched and at times overworked in trying to do their day to day work. The staff also said that they had no proper time available for breaks including meal breaks. The comments made by the staff of the above two units about the inadequacy of staffing levels and taking into account the concerns expressed by relatives and also the inspectors’ findings regarding the meeting of residents needs (See Standards 7 and 8 for the above units) were of sufficient concern for the inspector to issue an handwritten immediate requirement notice to the manager that the staffing levels must for both of these units must be reviewed with any necessary action taken by Friday the 20th January 2006. It should also be noted that the inspectors’ and the home manager were of the opinion that the ground and second floor care units would be better run if each unit had a manager dedicated to this task (please see Standard 31). Staffing Levels Second Floor Dementia Care Nursing Unit. (Currently 13 residents accommodated) 8am to 8pm one Registered Mental Nurse plus two care assistants. 8pm to 8am one Registered Mental Nurse and one care assistant. The inspectors’ discussions with the staff about the above staffing provision on this unit showed that in the their opinion that this level of staffing was Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 23 generally sufficient to fully meet the residents care, health and social needs. The staff did however say that there was sometimes an occasion when the overnight staffing provision may be insufficient. The staff also pointed out that in order to meet the requirement to have a Registered Mental Nurse on duty for 24 hours per day the home is at times having to use the services of a staffing agency to fulfil this requirement. Staff moral on this unit appeared to be high; they said that they “enjoyed their work” and that as stated above that they did generally have the time to see to the residents properly. The inspectors are of the opinion that the staffing levels on this unit are sufficient to meet the needs of the residents accommodated at the time of this inspection. However staffing levels must be increased as and when resident numbers increase and in view of the comments made by the staff the adequacy of the overnight staffing levels must also be monitored. The home is required to have 50 of the care staff with NVQ level 2 qualifications or above by the end of 2005. At this time 27 of the staff hold this qualification, although a further 7 staff are doing this training (with three others waiting to register) which will bring the number to just below the required percentage. The manager will however need to be mindful that as resident members go up so will the numbers of staff and that NVQ training will need to cover this increase. Looking at three staff files showed that staff recruitment was not safe or reliable. The above records were not consistent in their contents. One file did not contain a current CRB check whilst another was not obtained until 4 months after the person had started employment. Two of the files gave no indication of POVA first checks having been undertaken. There were however references, health declarations as well as job descriptions contained within these records. There was no evidence to suggest that any staff had been given a GSCC set of guidelines when they commenced employment or as part of their induction programme. The Registered Person must make sure that all staff are safely and properly recruited. The training records held for staff were incomplete. There was clear evidence available that staff training is taking place but this is not always updated. The inspector suggests that the development of a staff training matrix would assist the manager in seeing what training had been completed, the date it had been completed and what other training the staff needed to be completed. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 24 The home has a basic training plan, which is updated on a three monthly basis. The current plan covers the months of November and December of 2005 and also January of 2006. There is also a collective staff training record however this had not been updated to reflect some of the recent training that had been undertaken. There are also individual training records, however these were not comprehensive and had also not been updated. The records did show that one of the senior care staff on the residential unit had been trained and in writing and reviewing care plans but that neither had been trained in needs assessment. This training must to be included in the training programme for the senior care assistant at the home. Both of the senior care staff on the residential unit have completed NVQ assessment at Level 2 or above and they have received training about giving out medicines. None of the staff had been given training about tissue viability though the manager informed the inspector that she had contacted the local Tissue Viability Nurse to organise training for the staff. The manager has also contacted drug companies to see if they could also provide any training in this area. As yet nothing has been organised. The manager informed the inspectors that all staff working on the residential unit have received medication training though this could not be evidenced from looking at the staff training files. Dementia Training for the care staff has been organised for 8th February 2006. None of the staff has had training about caring for residents with a physical disability as the inspector was told that the home no longer intends to accommodate residents with this condition. A number of staff have been given training about the protection of adults from abuse and the inspectors were informed that further training in this subject is being organised as part of a new training partnership that the home has entered into with Bolton Social Services Department. The inspectors were informed that the services provided by the above described partnership will cover new staff induction to the job training and that further training will include health and safety, safe moving and handling, training in the use of lifting hoists, first aid, food hygiene, dealing with residents care needs and caring for residents with specific needs. The inspectors were told that sessions of the above training would be run at the home every two weeks. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 25 The new partnership will also provide staff with the opportunity to undertake NVQ assessment. Progress with the above-described staff training arrangement will be monitored by the CSCI. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. An acting manager is presently running the home, this person must apply to the CSCI for approval and registration so that their competence can be assessed and verified. The management structure of the home does not presently appear to be sufficiently robust to undertake this management task; therefore various aspects of the residents’ care needs are not being fully addressed. The registration status of the home needs to be clarified with regard to the accommodation of people with physical disability care needs, otherwise the home may breach the original registration conditions. The system which allows residents, their relatives and other interested people to comment about the quality of care provided by the home needs to be fully operated so that their views can be heard and if necessary acted upon. Proper progress must made in providing the staff with formal supervision; otherwise the staff may not be fully supported and supervised. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 27 Regulations 26 and 37 must be complied with so that the CSCI is kept fully informed about operation of the home and of any significant events occurring. Not all of the staff have been given the required health and safety training, which continues to put residents at potential risk. The above key Standards 35 was not examined at this inspection. It should however be noted that this standard was met at the time of the previous inspection. EVIDENCE: At the time of this inspection the Registered Manager had resigned their post and was due to terminate their employment at the home on Friday the 20th January 2006. The inspectors had therefore contacted the Responsible Individual of the company about this situation and had been informed in writing that an acting manager had been appointed who was to take up this post on Monday the 23rd January 2006 (since confirmed that this person is in post). The inspector’s discussions with the manager showed that the running of the home was a considerable and demanding task for one person to do. Both the manager and the inspectors were of the opinion that this task would be better accomplished if the manager had a deputy who could assist with these duties. It was also considered that both the manager and the deputy should not be involved in providing day-to-day care but should be able to give all of their time to the running of the home. A requirement is therefore made to this effect. The inspectors and the home manager were also of the opinion that the ground and second floor care units would be better run if each unit had a manager dedicated to this task. A requirement is also therefore made to this effect. As stated under Standard 30 (Staff training) the inspectors were told that the home no longer intends to accommodate up to 20 residents with a physical disability as originally registered. The Registered Person must clarify this situation and if necessary must rectify this by applying to the CSCI for a variation to the home’s registration. The Registered Person is reminded that under the terms of the current registration the home must not accommodate more than 62 people in the category (OP) Older People (Currently 52 accommodated). A requirement of Standard 33 is that care homes must use quality assurance systems that are largely based on seeking the views of residents to measure their success in meeting the home’s aims and objectives. At the time of the Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 28 last inspection such a system was in place but it had not been brought in to use A requirement was therefore made that residents quality assurance surveys must be undertaken regularly with a report of the findings and of any action taken produced and made available. At the time of this inspection there was little evidence to suggest that this requirement had been dealt with. The inspectors were told that such a survey had been done in December 2005 and that about ten survey document had been returned but only four could be found which were from visitors and these were undated. There was evidence that internal quality monitoring had been done which covered areas such as medication,care plans, staffing, standards of care, cleanliness and complaints.However these records only covered the months of October and November of 2005. The above described shortfalls must be dealt with and the inspector has made requirements to this effect. Regulation 26 of the Care Homes Regulation 2001 require that where the registered person is an organisation a responsible person from that organisation must visit the home at monthly intervals to make sure that the home is running properly and that a report is made of every visit with a copy sent to the local CSCI office. There was evidence suggested that only one such visit has been undertaken. The above described shortfall must also be addressed and the inspectors have made a requirement to that effect. A requirement of Standard 36 is that the care staff of a home must be given the opportunity to meet with their line manager at regular intervals to discuss their work, development and possible training needs. From discussion with staff and from looking at records the inspectors were only able to confirm that about five of the care staff had received formal supervision as described above. The Registered Person must therefore ensure that all of the care staff are provided with formal and recorded individual supervision at regular intervals as required under Standard 36. All of the equipment in the home such as the fire alarm system, the gas system and lifting hoists was new when the home first opened in February 2005 and has therefore not yet reached the stage of requiring annual Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 29 servicing. The Registered Person is reminded that such servicing will however need to be done from February 2006. The details of accidents are properly written down and the manager checks these monthly so that she can keep an eye on how many accidents are happening and on who they are happening to. The home is safely maintained with fire precautions tests being done at the recommended weekly intervals. Regulation 37 of the Care Homes Regulation 2001 requires that care homes must report certain events such as accidents to residents and the death of residents to the local CSCI office. None of these notifications have been received since September 2005 although the manager and the home administrator were adamant that these had been sent out. The inspectors therefore require that such notifications backdated from September 2005 are sent to the local CSCI office and continue to be forwarded thereafter. A requirement of the previous inspection was that all staff must be provided with the health and safety training as specified under Standard 38.2. This training covers safe moving and handling,fire safety,first aid, food hygiene and infection control. Looking at records and talking to staff showed that a number of the staff had done moving and handling and fire safety training,but that the provision of training in the remaining subjects listed above was erratic. The above described requirement is therefore repeated. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 30 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 X 2 Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 31 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standar d OP1 OP7 Regula tion 5 15 Timescale for action The Registered Person must ensure that 17/02/06 existing and prospective residents are given a copy of the Service User Guide. The Registered Person must ensure that 10/02/06 care needs identified in care plan summaries are also shown in the residents’ actual care plans. The Registered Person must ensure that 10/02/06 records are kept of when residents are provided with personal care (e.g. bathing, hair washing). The Registered Person must ensure that 10/02/06 progress reports actually describe the care provided to residents. The Registered Person must ensure that 10/02/06 when risk is identified that this is addressed in the residents care plan. The Registered Person must ensure that 17/02/06 all residents undergo a safe manual handling risk assessment. The Registered Person must ensure that 17/02/06 the progress and treatment of pressure sores is recorded in the residents care notes. The Registered Person must ensure that 17/02/06 handwritten medicine prescription records are checked and signed by two members of the staff at all times thus ensuring their accuracy. DS0000060318.V278007.R01.S.doc Version 5.1 Page 32 Requirement 3 OP7 17 4 5 6 7 OP7 OP8 OP8 OP8 17 13 13 17 8 OP9 17 Farnworth Care Home 9 OP9 13 10 OP9 13 11 12 OP9 OP12 13 16 13 OP12 13 14 OP18 18 15 OP27 18 16 OP27 18 17 OP27 18 18 OP27 18 The Registered Person must ensure that staff properly assist residents with the taking of medicines including providing residents with water for the taking of medications. The Registered Person must ensure that staff do not leave an unlocked medication trolley unattended at any time. The Registered Person must ensure that the available record for the disposal of medicines is used at all times. The Registered Person must ensure that the residents are regularly provided with stimulating, meaningful and fulfilling social and recreational activities The Registered Person must also ensure that when residents do take part in recreational activities that this is written down so that resident participation can be monitored. The Registered Person must ensure that all of the staff are provided with training in adult protection procedures. (Previous timescale of 30/09/05 not met) (Immediate Requirement Notice) The Registered Person must review the adequacy of day and night time staffing levels for the ground and second floor care units to ensure that sufficient staff are provided to meet all of the care needs of the residents. The Registered Person must ensure that as resident numbers increase on the second floor care unit that day and night time staff numbers are also increased. The Registered Person must give consideration to the appointment of a full time deputy manager to assist the manager with the task of running the home. It is also recommended that both of these people should not be involved in providing day to day care but should be able to devote all of their time to the management of the home. The Registered Person must also give consideration to the appointment of a full time unit managers to the ground DS0000060318.V278007.R01.S.doc 10/02/06 10/02/06 10/02/06 28/02/06 28/02/06 17/03/06 20/01/06 10/02/06 28/02/06 28/02/06 Farnworth Care Home Version 5.1 Page 33 19 OP28 18 20 OP29 19 21 OP30 18 22 OP30 17 23 OP30 18 24 25 OP30 OP30 18 18 26 OP31 39 27 OP33 24 28 OP31 26 and second floor care units therefore enabling these units to be better run. The Registered Person must ensure that staff NVQ training continues to be provided so that the residents are provided with a proper standard of care. The Registered Person must ensure that staff are safely and properly recruited with all of the required checks being completed before staff are employed. (Previous timescale of 30/09/05 not met) The Registered Person must ensure that new staff are provided with structured induction training (e.g. Skills for Care format). (Previous timescale of 31/10/05 not met) The Registered Person must ensure that comprehensive staff training records are maintained and that these are kept up to date. The Registered Person must ensure that care staff are given training in needs assessment and also in the writing and reviewing of residents care plans. The Registered Person must ensure that care staff are given training in the prevention of pressure sores. The Registered Person must ensure that specific training is provided for those staff caring for those residents with dementia care needs The Registered Person must clarify the home’s registration in relation to the accommodation of residents within the category of physical disability and if necessary apply for a variation to the home’s registration status. The Registered Person must ensure that quality-monitoring systems are introduced including the use of regular residents quality assurance surveys with a report of the findings and of any action taken produced and made available. (Previous timescale of 31/10/05 not met) The Registered Person must ensure that monthly Regulation 26 visits are done DS0000060318.V278007.R01.S.doc 17/03/06 10/02/06 17/03/06 28/02/06 28/02/06 28/02/06 17/03/06 28/02/06 17/03/06 28/02/06 Page 34 Farnworth Care Home Version 5.1 29 OP36 18 30 OP38 37 31 OP38 18 regularly with a report produced and with a copy sent to the local CSCI office. The Registered Person must ensure that 17/03/06 all of the care staff are provided with formal and recorded individual supervision at regular intervals as required under Standard 36. The Registered Person must ensure that 17/02/06 the local CSCI office is promptly notified in writing of all significant events as required under Regulation 37.The manager must also forward copies of such notifications that have occurred since September 2005. The Registered Person must ensure that 17/03/06 all of the staff are provided with the health and safety training as specified under Standard 38.2 (safe moving and handling,fire safety,first aid, food hygiene and infection control) (Previous timescale of 31/10/05 not met) 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 Refer to Standard OP1 OP12 Good Practice Recommendations The Registered Person should review the overall content of the “Service User Handbook” with a view to making the contents more accessible. The Registered Person should give consideration to the appointment of a full time social activities worker therefore ensuring that the residents are regularly provided with stimulating and fulfilling activities. The Registered Person should review the provision of food and the dining facilities to ensure that the requirements of Standard 15 are met. The Registered Person should obtain a full copy of the Bolton Social Services Adult Protection Policy so that local guidance is followed should an abuse situation arise. The Registered Person should give consideration to the development of a training matrix that can be used to show DS0000060318.V278007.R01.S.doc Version 5.1 Page 35 3 4 5 OP15 OP18 OP30 Farnworth Care Home any gaps in staff training and also to show when training needs to be updated. Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Farnworth Care Home DS0000060318.V278007.R01.S.doc Version 5.1 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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