Inspection on 28/04/06 for Farnworth Care Home

This inspection was carried out on 28th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 13/01/06

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 Grace Tarney Unannounced Inspection 28th April 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.V289580.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.V289580.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 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.V289580.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. 13th January 2006 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. The accommodation is provided on three floors in 120 single bedrooms. Two passenger lifts provide access to the upper floors. There is an older persons residential care unit on the ground floor. 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 also registered to care for 20 residents with physical disabilities who are under pensionable age, however management have told the CSCI that they do not wish to provide this care and they will be applying to change their registration. The home is just off the main street in Farnworth and is close to bus stops, local shops and the market. There is easy access to the nearby motorway network. The home is pleasantly situated in its own grounds with surrounding gardens and there is ample car parking to the front of the home. All bedrooms have an adjoining toilet, sink and shower. 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. A copy of the last inspection report is available in the managers’ office. The provider informed the inspector that the fees within the home ranged from £500 to £600 per week, although the home did accept residents funded by social services. This information was received on the Inspection date of the 2nd of May 2006. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place. Two Inspectors spent 2 full days at the home and then visited for a further 2 hours early one morning. The Inspectors visited all the units in the home. During this time they looked at care records to ensure that the health and care needs of the residents were being met. They also looked at how many staff were provided on each shift to make sure the residents needs were being met, and also looked at how management recruit and supervise their staff. To make sure that the home and the equipment in it was safe, the Inspectors looked at the maintenance and service records of the equipment within the home. They also looked at how the management handle the residents’ spending money. One Inspector then looked around the building at the bedrooms, bathrooms toilets and sitting areas to check if they were clean and well decorated. She then visited residents in their own bedrooms to check out the care that was being provided for them. Both Inspectors also spent time talking to the residents who were sitting in the dining room and lounge areas. In order to get further information about the home the Inspectors also spent time speaking to 8 residents, 5 relatives, the activities organiser, 9 care assistants, 2 of the laundry staff, 4 of the qualified nurses and the acting manager. What the service does well: Before residents went into the home, the nurse manager or one of the senior nurses or carers visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. Some residents spoke very highly of the staffs attitude, kindness and their understanding of their needs. One relative told the Inspector that the unit manager on the Dementia unit was “a good gaffer” also that the domestic was “excellent” and that “everything she does is above and beyond the call of duty” Another relative said, “ She (the unit manager) is excellent”. “It is a good place.” “People are well looked after”. One relative told the Inspector that she was very satisfied with the care provided. She said that she is always made welcome and the staff keep her informed of any concerns that they may have, around her relatives’ condition. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 6 The residents were living in a very clean, pleasant, spacious and suitably adapted environment. Enough staff were on duty to meet the needs of the residents. The staff made sure that the residents were clean, comfortable and appropriately dressed. What has improved since the last inspection? What they could do better: The care plans on the residential unit need to give a much clearer picture of the residents’ health and social care needs. The menus need to be more varied and appropriate, especially for the evening meal. The whole system for the serving of meals needs to be reviewed. Management need to put a system in place whereby they can measure the quality of the service that they provide. Management must make sure that they have a safe system in place to control any cross infection. Please contact the provider for advice of actions taken in response to this Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 7 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.V289580.R01.S.doc Version 5.1 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 Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. The system for ensuring that all prospective residents had a detailed assessment undertaken prior to admission to the home gave an assurance both to residents, relatives and staff that a resident was only admitted if the home could meet their needs. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Inspection of three resident care files identified that assessments had been undertaken prior to admission. Before any resident was admitted to the home an assessment of their needs was undertaken, either by a senior member of the staff from the home or from the professional i.e. care manager requesting their admission. The assessment documents of residents on the residential and nursing and dementia units were looked at. They were detailed and gave a clear indication of the residents’ needs and their capabilities. The assessments looked at the physical, mental and social care needs of the residents as well as the involvement if any, of their relatives. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 10 It was seen that some care manager assessments were kept separately in the administrators’ office. These should be kept with the care plans so that they can be referred to at all times. Standard 6 does not apply. The home does not provide Intermediate Care. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 & 8. Quality in this outcome area is adequate. Although there had been an improvement in the care plan documentation, the care plans on the residential and dementia units did not fully reflect the support needs of the residents. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Nursing unit: Inspection of one care plan identified that there was involvement of the district nurses in relation to this residents’ care and this was written down in the care plan. The care plan for this resident identified that a care plan to deal with her pain relief had been put in place. A detailed care plan for pressure sore prevention was also in place. Staff were regularly looking at any changes in her condition and were writing down when they had assessed it and if there were any changes, what they did about it. . It was identified by the home staff that this resident was losing weight and a care plan was in place to try to prevent further weight loss. She was now being weighed regularly as the home had provided a hoist that has scales attached. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 12 The staff looked at whether or not there was any risk in relation to this resident developing pressure sores and if she was at risk due to problems with her diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails. They also looked at and they wrote down, how this resident was to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. A visiting social worker told the Inspector that she felt there had been an improvement within the home. She was pleased with the fact that the staff on the unit were managing to get her client to eat properly. Residential unit: Inspection of one care plan identified that there was the involvement of the district nurses in relation to this residents’ care. The staff assessed if there was any risk in relation to this resident developing pressure sores. Their findings were written down. The staff also looked at if she was at risk due to problems with her diet and fluid intake. They looked at and they wrote down, how this resident was to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. This resident had diabetes. There was not enough information in relation to how to care for her diabetes and what problems staff would need to watch out for. The care plans did state that her “blood sugar was to be monitored” but it did not state how often it was to be monitored and what to do in the event of the blood sugar levels being either too high or too low. There was no evidence to show that the staff knew what “normal & safe” blood sugar levels should be. There was an eating and drinking care plan and this did state that the residents food was to be “sugar free” and she was to have three well-balanced diets per day. A discussion with staff showed that they didnt have a lot of understanding about what a person with diabetes should eat. There was a professional visit record in the care file. This did document that this resident required eye testing because of her diabetes. There was not enough information about the care of her skin and the importance of the involvement of the chiropodist to keep her feet and nails healthy. The care plan also detailed the fact that the district nurse was aware of a break on this residents’ right heel. This was documented on the 3rd of March 2006 but there was no further reference to this break on her heel. A discussion with the care staff identified that there was no break at present. The care plans must be up to date so that a true record of a residents’ condition is always in place. The record of when this resident had a bath or shower was not filled in properly. It was written down that she had been given one bath in February none in March and one in April. It was obvious from visiting this resident in her room that she was a practising Roman Catholic and she told the Inspector that she received Holy Communion Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 13 every week The staff spoken to were unaware that this was happening and there was no reference to this in the residents care plan. Despite this residents’ daughter being a regular visitor there was no evidence to show that either the daughter or the resident were involved in the drawing up of the care plan. To ensure that an accurate and agreed care plan is in place the resident and/or their families should be involved. There was only a small amount of information about the residents’ previous life, and what her interests or hobbies were. This resident told the Inspector that she had been ill during the night and that the staff had looked after her very well. They had called the GP that morning. A discussion with staff identified that one resident was of Eastern European nationality. There was no information written down about what language she spoke and if she was able to speak and understand English. Staff told the Inspector that her English was good. There was also no information about what her religion was. A discussion with staff identified that one resident was a Jehovahs Witness. There was no information in relation to the religion in her care plan. Staff did inform the Inspector that friends from the Kingdom Hall did take her out to services. This was not recorded. The staff spoken to had limited knowledge about the beliefs of Jehovahs Witnesses. There was no evidence to show that this resident had been involved in drawing up her care plan. From the care plans inspected it was evident the residents were weighed at least on a monthly basis and any weight loss identified and acted upon. A visiting social worker told the Inspector that she felt there had been an improvement within the unit generally. Dementia unit. Inspection of 2 of the care plans showed that they did not give enough detail about what action was being taken to address any identified problem. In view of the fact that the majority of the residents on this unit were not able to make decisions about what they like to wear, it is also important that staff find out this information from their family or friends and then write it down in the care plan. The staff assessed if there was any risk in relation to the residents developing pressure sores. Their findings were written down. The staff also looked at if they were at risk due to problems with their diet and fluid intake. They looked at and they wrote down, how the residents were to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. Staff also looked to see if the residents had a history of falling and if they had, they looked at ways of reducing the risks of further falls. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 14 Inspection of 1 care plan showed in the daily report of the 9th of February 2006 that the resident had a pressure sore measuring 1 cm by 1 cm. Nothing had been written about it since. The care plans must be up to date so that a true record of a residents’ condition is always in place. Inspection of the other care plan showed that this resident had been prescribed nutritional supplements because of an identified weight loss. This resident was being weighed on a weekly basis so that his weight could be carefully monitored. This resident was also at risk of falling and a good care plan was in place to address this There was a care plan in place in relation to the fact that it had been agreed by the residents’ family and GP that her medicines could be given in her food. The care plan however did not state that at times the medicine was given in this residents’ tea. Inspection of the care files identified that the residents had access to health care professionals, such as dentists, opticians, chiropodists and district nurses. The district nurses were visiting the home on the day of inspection. The Inspector spoke with one of the district nurses who she said that she felt there were no issues on the residential floor in relation to communication of practice. She stated that she always informed the senior care assistant on duty about any progress or concerns before she left the unit. Equipment necessary for the prevention and treatment of pressure sores was readily available within the home. Throughout the home it was identified that there were no washing bowls for the residents. When asked to talk through how the staff wash those residents who are cared for in bed, it became apparent that staff walk in and out of the en-suite with a face cloth. This is not an acceptable practice. The CSCI pharmacy inspector undertook an inspection of the medication system throughout the home, on the 11th and 13th of April 2006. A separate report in relation to the findings of the inspection is available. An area of concern was identified however on the residential unit. The Inspector saw that one resident had a bottle of tablets on her bedside table. This bottle was not labelled but on questioning the resident it was identified that the tablets were paracetamol. The resident told the Inspector that she occasionally took these tablets for pain. The Inspector explained to the resident and to the staff that, to ensure the safety of everybody on the unit tablets must always be kept in the locked drawer in the residents room. Also in view of the fact that the tablets were unlabelled they should be returned to the pharmacy and a further supply of Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 15 paracetamol tablets obtained. The staff on the unit complied with this requirement. Farnworth Care Home DS0000060318.V289580.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 13 14 &15 Quality in this outcome area is good. The home enables residents to exercise as much personal freedom and choice as possible and find enjoyment with the wide range of activities that are now available. The basic dietary needs of the residents were catered for but offering a more varied menu and improving the way that the meals are served could improve mealtimes considerably This judgment has been made using available evidence including a visit to this service. EVIDENCE: Residents on the residential unit told the inspector that they can get up and go to bed when they want to. They said that they could please themselves about where they want to spend their day. The home has recently employed a very experienced full time activities organiser. She has put in place a weekly activities calendar for all the units within the home. Activities such as, table and floor games, reminiscence, aerobics, sensory experiences, relaxation and memory quizzes are now being provided. Several outings have also been arranged such as visits to the Trafford Centre, the Blue Planet Aquarium, Chester zoo and Martin mere have been arranged. She is also making sure that certain “ special” days such as the Grand National and Saints Days are celebrated. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 17 The activities organiser has just started to keep records of who attended group activities and also records of individual 1-1sessions with the residents. The 11sessions include such things as outings to the local shops, and aromatherapy hand massage. All activities and outings were widely displayed on all floors of the home so that the residents, relatives and staff were aware of what was “going on”. She also arranged a residents and relatives support group that met on the 13th of April 2006. This meeting was held to discuss the activities that will be provided and to request volunteers to assist with the day and the evening trips out. Fund raising was also discussed, although some funding has been made available by the home. The residents and relatives who spoke to the Inspectors were aware that activities were now taking place. Two relatives told the Inspector that they were so pleased that “things were beginning to happen”. Residents can see visitors in one of the several communal areas or in the privacy of their own bedroom. Many residents chose to sit in their rooms. One resident said that she always stayed in her room and also had her meals there. This was her choice. A discussion with the residents, relatives and care staff confirmed that the residents were able to receive visitors in private and that they were able to choose whom they do and do not see. Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. The Inspector dined with the 3 of the residents on the residential floor. The tables were nicely set and there were individual milk jugs and sugar bowls. The residents were unsure about the menu being served. One resident said that because it was Friday she assumed it would be fish. There was a choice of menu: it was either fried fish or poached fish. There were chips and peas. Some of the residents were served gravy on their fish. This did not seem appropriate but the residents did not seem concerned and accepted what was placed before them. There was no bread-and-butter served. The Inspectors’ meal was of ample portion and was served hot. It was identified however that the residents had to wait a long time before their meal was served to them. The system for the serving of meals seemed to be extremely slow. Residents said that the meals are quite often served cold. The dessert was sponge and custard. Residents said that it was very nice. One carer however placed the residents dessert in front of her before she had finished her main course. The residents told the Inspector that if they didnt finish their meal for whatever reason, it was just taken away from them. Some residents spoke positively of the food and others did not. Two of the residents told the Inspector that quite often staff would go out to the local bakery and purchase meat pies or anything that they fancied, for them. The menus were not displayed in the dining room. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 18 An inspection of the menu for the evening meal identified that on some days it was extremely sparse. The menu stated for one-day, “fried egg”. The Inspector was informed that soup and sandwiches are always provided as a choice. This was not documented on all the menus. All the residents spoken to throughout the home were happy with the breakfast that was served. A discussion with the staff and residents identified that milky drinks are available. It is essential that the residents are made aware that they can have milky drinks such as Horlicks and drinking chocolate as well as tea or coffee. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 19 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 & 18. Quality in this outcome area is good. The complaint system in place enabled the residents and relatives to feel that their views were listened to and acted upon. Although there is a need for further training the staff had a good knowledge and understanding of adult protection procedures thereby reducing the possible risk of harm or abuse. This judgment has been made using available evidence including a visit to the service. EVIDENCE: There is a detailed complaints, suggestions and compliments procedure. A discussion with residents and relatives indicated that there was a general awareness of how to make a complaint. The staff also knew what to do if someone complained. The complaints procedure was displayed on the corridor on each unit and attached to the Service User Guide that was available in each bedroom. It was easy to understand and gave an assurance that complaints would be responded to within 28 days. A complaints file was kept in the main office and there was also a monthly complaints monitoring form. Since the last inspection in January 2006 inspection one complaint has been made directly to the home. It was recorded and dealt with properly. No complaints have been made to the CSCI during this time although some area of concern, expressed by community nurses, have been relayed to the Inspectors. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 20 There were policies and procedures in place in relation to what to do in the event of any allegation of abuse to a resident. The home also had a recent copy of the Bolton inter-agency adult protection procedure with copies of this document being available on each floor of the home. There was also a policy in place to protect anybody who wanted to “whistle blow”. Information obtained from staff training records showed that 10 staff have been provided with adult protection training but further training is to be undertaken. A discussion with 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. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 21 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): 19,21,24,25 & 26. Quality in this outcome area is good. The residents were living in a clean pleasant environment but there were safety and infection control issues that need to be addressed. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The lounge and dining areas throughout the home were clean, well decorated and suitably furnished. The designated smoking lounge on the residential unit had a damaged carpet: cigarettes had burnt several areas of the carpet. The Inspector was informed that when the resident who smokes, leaves the home in the next few weeks the carpet is going to be replaced. There was no bad odour in the home. Grab rails to aid mobility were in place along each corridor. Each bathroom had a toilet and wash hand basin and the bathrooms were decorated to a high standard. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 22 Toilets were within close proximity of communal spaces. Each toilet and bathroom had a lock on the door to ensure privacy and the facilities were all clearly marked. An inspection of several of the bedrooms on the nursing, dementia and residential units identified that they were clean, spacious and suitably furnished. Each bedroom had a lockable space and an overriding door lock. The en-suite toilets and showers were suitably adapted. The bedroom doors on the dementia unit were kept locked during the day. This was to prevent residents going into other residents’ bedrooms. The relatives spoken to by the Inspector were happy with this arrangement. One resident, at the residents’ and familys request had her door locked at night for the same reason. It was identified that every member of staff had a master key. Most of the bedroom doors on the units were kept closed. Some of the doors were wedged open at the request of either a relative or resident. If these doors are to be kept open they must be fitted with magnetic catches that are connected to the fire alarm system Staff hand-washing facilities, such as liquid soap and paper towels were not available in the bedrooms on the dementia and residential units and were available only in certain bedrooms on the nursing unit. Not all of the bedrooms had individual clinical waste bins. The Inspector was informed that these clinical waste bins have been ordered and will be kept in the en-suite rooms where clinical waste is generated. The laundry area was clean, well equipped and looked very well organised. Protective clothing was available for all laundry staff and red alginate bags were available for heavily soiled laundry. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome is adequate. The residents were cared for by sufficient numbers of staff that were safely recruited. Although ongoing training needs to be provided, the majority of staff had the knowledge and skills to meet the residents’ needs. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Nursing unit. Inspection of the staffing rotas, a discussion with the qualified nursing staff and two relatives identified that there was sufficient staff on duty to meet the needs of the residents. One relative stated that he was very happy with the care provided, and stated that the home was much better. The nursing unit was running on 2 qualified nurses and 4 care assistants throughout the day and 2 qualified nurses and 2 care assistants throughout the night. This was in accordance with the immediate requirement form issued on the 10th of March 2006 and was adequate. During the early morning visit of the 16th of May 2006 the inspectors found that the staffing remained adequate. Residential unit: Between the hours of 8 to 2 a.m. there were 5 care assistants on duty and between the hours of 2 to 8 p.m.4 care assistants on duty. For the night time hours between 8pm to 8am there were 3 care assistants on duty. For the 23 residents on the unit the staffing was adequate. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 24 During the early morning visit of the 16th of May 2006 the inspectors found that the staffing remained adequate. An inspection at the duty rota however identified that several of the day staff were working in excess of 60 hours per week. This was due to sickness. Dementia unit: Between the hours of 8 a.m. to 8 p.m. the unit worked on 1 qualified nurse and 3 care assistants. Between the hours of 8 p.m. to 8 a.m. there was 1 qualified nurse and 1 care assistant on duty. Following concerns previously raised by a relative the Inspector discussed the staffing levels in place during the night. Staff informed the Inspector that the problem times were between 8 p.m. to 12 midnight. The Inspector was informed that residents go to bed more or less when they want to, so between the hours of 8 p.m. to 12 midnight if staff are busy putting some residents to bed some other residents are left unsupervised. An immediate requirement form was issued that required one member of staff from the nursing unit to be placed on the dementia unit each night between the hours of 8 p.m. to midnight. As dependency/ numbers of residents increased on the dementia unit or nursing unit then 1 extra carer must be recruited to work at 8 p.m. to 8 a.m. on the dementia unit. This amended staffing had to be put in place with immediate effect (on the evening of the inspection). During the early morning visit of the 16th of May 2006 the inspectors found that this had been complied with. The staff on the dementia unit felt that it was a great help to have an extra carer on duty between the hours of 8 p.m. to midnight. Of the 36 care staff employed 12 are recorded as holding an NVQ 2 (6 of these also hold NVQ 3), therefore 33 of the care staff are currently trained to NVQ Level 2/3. The acting manager told the Inspector that 6 other staff are currently undertaking NVQ assessment at level 2 with Bolton College with 6 others to be put forward for this training shortly. The personnel files of four recently employed staff were inspected. All were in order and these staff had been properly and safely employed. References had been undertaken and they had been subjected to a Criminal records check (CRB). A “Training Calendar” was in place covering March to September 2006. This covers a range of training topics. Training records were in place in individual staff files. Of the four staff files checked only two had any entries made and these were for the “in house induction” to the home. There was also a “see at a glance” training schedule or matrix in place for the care, domestic and kitchen staff. These showed training had been undertaken in the following areas: Moving and Handling. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 25 Fire Safety. First Aid. Food Hygiene. Infection Control. Health & Safety. The home has made good progress in relation to providing the required training for its nursing and care staff. A large amount of the training has been undertaken during the month of April 06. They will need to continue to provide further training and to keep the training records up to date Farnworth Care Home DS0000060318.V289580.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 35 36 & 38. Quality in this outcome area is adequate. The lack of arrangements for the reviewing of the service provided, means that the home is not able to know if it is delivering a quality service or not. A satisfactory accounting system was in place that ensured the residents’ financial interests were protected. Overall the home was safe and very well maintained although some current practices did not promote and safeguard the health, safety and welfare of the people using the service. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Standard 31 could not be inspected, as presently the home does not have a registered manager. There is currently no quality assurance system being operated at the home. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 27 The home’s acting manager has recently undertaken “spot checks” of some residents care plans but this has not been recorded. The acting manager intends to start internal quality audits of the home’s medication arrangements; care plans etc starting from the 1st May 2006 and to record these checks. Survey leaflets for residents and families are on display in the home’s foyer, but they have not been used and they are not really suitable. The home does have a better and more comprehensive format, which must now be brought in to use. The home holds money for a number of residents for safekeeping. The system in place for the management of residents’ money was good. Secure storage was available for the safekeeping of money and of any valuable items. The care staff have not yet been be given the opportunity to meet with their line manager at regular intervals to discuss their work, development and possible training needs. Any accidents that happen are properly recorded and monitored. The home uses a standard accident form for each floor. They are then transferred to the main office and kept in a file—these are assembled on a month-by-month basis. Regular weekly checking and testing of fire detection system, fire exits, emergency lights, and fire door closers is undertaken and documented. An experienced, competent person undertakes the fire training. Two fire training sessions have been undertaken recently, one on the 12th and one on the 20th April 2006. 12 staff attended. The equipment and services within the home were serviced on a regular basis in accordance with the individual requirements. The home had a detailed Health & Safety Policy. Shortfalls in relation to health and safety matters were identified however in relation to the following: Staff hand washing facilities were not available in the majority of the bedrooms on the nursing unit. There were no staff hand washing facilities in the bedrooms on the residential and dementia units. To prevent cross infection staff hand washing facilities must be in place wherever personal care is being delivered. Individual clinical waste bins were not in place in every bedroom where clinical waste was being generated. To prevent cross infection these must be provided. Several bedroom doors were wedged open. Staff informed the Inspector that this was at the request of the resident or their family. Fire doors must be kept closed or magnetic catches that are connected to the fire alarm system must be fitted to the doors. During the night visit of the 16th May 2006 following a discussion with the staff on the residential unit. it became obvious that they were not really sure about what to do in the event of a fire within the home. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 28 An Immediate Requirement form was issued that required management to provide urgent fire training and a fire drill before either each carers next shift, but at least before Friday 19th May 2006. This has been complied with. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x 3 x x 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 1 x 2 Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 30 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 Standard OP7 Regulation 15 Requirement The Registered Person must ensure that care plans are up to date and give a clear picture of the residents’ condition. The Registered Person must ensure that when a previously identified problem/care need, no longer exists then this must be documented in the care plan/evaluation. The Registered Person must ensure that a care plan is in place that details how the resident with diabetes is to be cared for. This must include the care of the skin and feet, the monitoring of blood sugar and what to do in the event of an emergency situation, such as hypoglycaemia. The Registered Person must ensure that any care plan in relation to the covert administration of medicines is detailed and relevant. The Registered Person must ensure that there is evidence of resident/representative involvement in drawing up the DS0000060318.V289580.R01.S.doc Timescale for action 31/05/06 2 OP7 15 31/05/06 3 OP7 15 31/05/06 4 OP7 15 31/05/06 5 OP7 15 31/08/06 Farnworth Care Home Version 5.1 Page 31 6 OP7 12 &15 7 OP8 12 8 OP8 7 9 OP9 13 10 OP15 16 11. OP18 18 12 OP19 16 13 OP26 13 care plan. The Registered Person must ensure that staff document in a care plan the details of a residents’ religion and whether or not they are practicing their religion. The Registered Person must ensure that washing bowls are provided for the residents who are not able to attend to their personal care needs in their ensuite room, and have to receive personal care in bed The Registered Person must ensure that the personal care records of every resident are kept up to date.. The Registered Person must ensure that the residents who self medicate keep their medications locked away. The Registered Person must ensure that the residents receive a varied and well balanced diet. Residents should be involved in the drawing up of the menus. The system of the serving of meals must be reviewed to ensure that the meals are not served cold. The Registered Person must ensure that training in adult protection continues. A copy of the proposed training plan must be forwarded to the CSCI by the documented date: The Registered Person must ensure that the carpet in the designated smoking lounge on the residential unit is replaced The Registered Person must ensure that, to reduce the risk of cross infection, staff hand washing facilities must be provided in the residents’ ensuite toilets and clinical waste bins provided in rooms where DS0000060318.V289580.R01.S.doc 31/05/06 31/05/06 31/05/06 28/04/06 30/06/06 31/08/06 31/08/06 31/08/06 Farnworth Care Home Version 5.1 Page 32 14 OP28 18 15. OP30 18 16 OP30 18 17. OP33 24 18. OP36 18 19. OP38 18 clinical waste is generated 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. A copy of the proposed training plan must be forwarded to the CSCI by the documented date: The Registered Person must ensure that care staff are given training in needs assessment, care of diabetes and also in the writing and reviewing of residents care plans. A copy of the proposed training plan must be forwarded to the CSCI by the documented date: The Registered Person must ensure that specific training is provided for those staff caring for those residents with dementia care needs A copy of the proposed training plan must be forwarded to the CSCI by the documented date: 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 timescales of 31/10/05 & 17/03/06 not met) The Registered Person must ensure that all of the care staff are provided with formal and recorded individual supervision at regular intervals as required under Standard 36. (Previous timescale of 17/03/06 not met). The Registered Person must ensure that the training of staff in health and safety training as specified under Standard 38.2 (safe moving and handling, fire DS0000060318.V289580.R01.S.doc 31/08/06 31/08/06 31/08/06 31/08/06 31/08/06 31/08/06 Farnworth Care Home Version 5.1 Page 33 20 OP38 23 safety, first aid, food hygiene and infection control) continues. A copy of the proposed training plan must be forwarded to the CSCI by the documented date: The Registered Person must ensure that fire doors are kept closed or fitted with magnetic detantes. An action plan in relation to the fitting of the detantes must be forwarded to the CSCI by the documented date. 31/08/06 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 OP3 OP7 Good Practice Recommendations The care manager assessments should be kept with the care plans so that they can be referred to at all times. Serious thought should be given to including in the care plans the positive aspects of the residents’ activities of daily living. Staff should include in the care plan what the resident can do as well as what they cannot. Farnworth Care Home DS0000060318.V289580.R01.S.doc Version 5.1 Page 34 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.V289580.R01.S.doc Version 5.1 Page 35 - 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. 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