Inspection on 28/11/06 for Farnworth Care Home

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 28/04/06

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 & 29th November 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.V297997.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 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 01204 578444 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 (82) of places Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 120 service users, to include: Up to 82 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. 28th April 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 dementia. 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 and separate toilets. 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 £344.74 to £385.01per week for residents funded by social services (plus the free nursing care contribution where nursing is being provided). For those residents paying privately the fees were from £425.00 to £525 per week. This information was received on the 6th October 2006. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 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 although the home was aware that an inspection was due. This was because several weeks before the inspection questionnaires were sent out to the residents, their relatives and to the home itself. The questionnaires that were sent out to the residents were called Have Your Say and they asked what people thought of the quality of the service and the facilities provided. 29 questionnaires were returned from residents and 3 from relatives. 2 Inspectors visited the home over 2 days and spent a total of 34 inspection hours at the home. During this time the Inspectors looked at care and medicine records to ensure that the health and care needs of the residents were being met. The Inspectors then looked around the building at the bedrooms, bathrooms toilets and sitting areas on each unit to check if they were clean and well decorated. They then visited residents in their own bedrooms and lounge areas. This was to check out the care that was being provided for them. The Inspectors also looked at what the residents had for their lunch and evening meal. 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 train their staff. How the home manages the residents’ spending money was also looked into. To make sure that the home and the equipment in it were safe some of the maintenance and service records were looked at. In order to get further information about the home the Inspectors also spent time talking to 8 residents, 5 relatives, 7 care assistants, 2 Nurses, the activities organiser and the homes manager. What the service does well: Before residents went into the home one of the senior members of staff visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. The qualified nurses and care staff were very good at caring for the residents who were very ill and needed lots of specialised care. The nurses and senior care staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the residents care plan when they have done this, and what action they have taken to reduce the risk. People visiting the home are made welcome and can visit at any time. Some of the comments made to the Inspectors were : Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 6 “We are delighted and pleased with the care shown to our mother” “Can’t fault them” “The manager is very good”. “No anxieties or concerns”. “They are a good set of girls” Activities were considered to be a very important part of the residents’ day. The activities person who worked at the home was aware of what each resident liked, and was able, to do. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 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.V297997.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. The system for ensuring that all prospective residents had a detailed assessment undertaken before their 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 judgement has been made using available evidence including a visit to this service. EVIDENCE: Residential, Nursing and Dementia Units. Before any resident was admitted to the home an assessment of their needs was undertaken either by the manager or a senior member of the nursing staff from the home, or from the professional i.e. care manager, requesting their admission Inspection of resident care files, 3 from each unit, showed that the staff at the home had undertaken assessments before the residents were admitted. The assessments gave a very clear overall picture of the resident’s needs. Assessments undertaken by other professionals requesting a residents’ admission i.e. care manager/social worker were also in place. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 9 The home is to be commended for the recent development and introduction of an upgraded pre-admission assessment tool that assesses a wider range of needs including safe moving and handling, nutritional condition, care needs and provides a ‘pen picture’ of the resident. This document is called A Start Up Care Plan pack. It is from the above information the home is then able to assess whether they can meet their needs and then a care plan and a range of other care delivery information is put together. New residents and their families are welcome to visit the home where they can spend some time, meet the residents and the staff, and have a meal before deciding to live there. Standard 6 does not apply. The home does not provide Intermediate Care. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 &10 Quality in this outcome area is good. The health and social care needs of the residents were met in a safe, caring and dignified way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residential Unit. The care files of three case tracked residents were looked at. These contained care plans that had been kept up to date monthly as is required. These care plans are well laid out on a need by need basis and they are easy to read and follow. Each plan described the resident’s health, personal and social care needs. Those staff that the inspector spoke with said that they knew each residents needs by reading the care plans, which are readily available to them. Requirements made previously about the development of care plans for residents with diabetes, the noting of resident religious preferences and the signing of care plan agreements had all been addressed. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 11 Regular day and night reports describing the residents’ care and progress were in place and records were also regularly completed of when the residents had been bathed or showered. Talking to residents, the unit manager and the staff and looking at records showed that the resident’s health care needs are taken care of and that when necessary health workers such as doctors, nurses and opticians are called. Risk assessments were found to be in place for safe moving and handling, nutrition, falls and pressure sore risk. These had been reviewed at monthly intervals and where increased risk had been identified this had been addressed in the care plans. None of the residents had pressure sores at the time of this inspection. Records also showed that the weight of the residents’ is also regularly checked monthly. The medications were securely stored in a locked room in a locked and tethered medication trolley. The residents’ medicines are provided in pre-filled blister packs with preprinted prescription/recording sheets also provided. These records were found to be properly completed and to be up to date with the amounts recorded as being given corresponding with the quantities remaining in the blister packs. The medications supplied are checked in to the unit , and medicines returned to the pharmacy are also recorded. Identification photographs of each resident are kept with the medication administration records. The home has a satisfactory medicines policy and procedure that includes guidance for the self-administration of medicines and the use of homely remedies. Medicines are given out either by qualified nurses or by senior care assistants that have been trained in this task with their safe practice having been observed and verified. The unit had safe storage for Controlled Drugs with a random check of two of these found to balance correctly with the amount recorded in the register. Records looked at, emphasised the need for the residents privacy and dignity to be respected at all times. Residents spoken with were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity was respected at all times. This was also observed during the inspection. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines, for example knocking on bedroom doors before entering. The residents said that the staff had a “kind and considerate” manner and that the staff spoke to them in a “civil and polite” way. The staff were seen to have a good relationship with the residents, speaking to them in a natural, caring and friendly manner. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 12 Nursing Unit The care plans of 3 of the residents were inspected. The care plans gave a lot of good information and clear instruction and guidance on how the care needs of the residents were to be met when problems had been identified. The staff also looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails and looked at any other general safety risks. Risk assessments were in place for whether a resident was at risk of falling. They also looked at and they wrote down, how any 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. Two of the residents had been admitted to the home with pressure sores. A good plan of care was in place for the treatment of the wounds. The home had also sought advice and guidance from a wound care nurse specialist to ensure that the residents were receiving the correct care and treatment. The staff were taking photographs of the pressure sores so that they could keep a visual record of progress or deterioration. This is good practice. The residents were being cared for properly on pressure relieving mattresses and this was documented in their care plans along with a pressure sore prevention plan. From the care plans inspected it was evident that the residents were weighed at least on a monthly basis and action taken if any weight loss had occurred. A discussion with the residents and relatives identified that the residents had access to other health care services including hearing, sight tests and a visiting chiropodist. Evidence of these visits was kept in the residents’ individual files. Overall a safe system of medicine management was in place. The medicine rooms were kept locked, the medication keys were held securely and the trolley was secured to the wall when not in use. Medicines were securely stored and accurately recorded. It was identified on the first day of inspection however that the controlled drug cupboard that was inside another locked cupboard was not secured to the back of the cupboard and the wall. Management corrected this the same day. The following areas needed addressing: • • One prescription stated that one or two tablets were to be given, staff were not documenting just how many tablets had been administered. Handwritten instructions for medicines (Transcriptions) were not signed, checked and countersigned. Signing and checking transcriptions reduces the risk of drug errors. Personal support to residents was offered is such a way so as to promote and protect their privacy, dignity and independence. Staff were seen knocking on doors and waiting for an answer before entering the bedrooms or toilets. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 13 Those residents spoken with said that the staff spoke to them respectfully and used their preferred name. How a resident would like to be called was also written in their care plan. Dementia Unit The care plans of 2 of the residents were inspected. The care plans gave a lot of good information and clear instruction and guidance on how the care needs of the residents were to be met when problems had been identified. The staff also looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails and looked at any other general safety risks. Risk assessments were in place for whether a resident was at risk of falling. They also looked at and they wrote down, how any 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. Following a discussion with a family member who had some concerns about his relative in relation to the number of falls and weight loss, the Inspector spent a long time examining the care plan. This resident had a risk assessment in relation to falls but it had not been recently updated despite the resident falling several times in a short period of time since her transfer from the residential unit. She had been referred however to the falls coordinator at the local hospital. This resident was being weighed on a regular basis and the weight was being recorded. Staff had acted appropriately and passed their concerns to her GP who had prescribed food supplements. Staff had also started a food diary, where they were recording what she was eating and when the food supplements were being given. There was however, no evidence in her care plan that she had been prescribed food supplements and that a food diary was in place. She had actually gained a small amount of weight since her transfer to the dementia unit. The unit manager updated the eating and drinking care plan and risk assessment whilst the Inspector was on the unit. The care plans on all the units include a Carer Gender Choice Agreement form. This takes into consideration the residents’ choice about whether they want a male or female to care for them. A safe system of medicine management was in place. The medicine rooms were kept locked, the medication keys were held securely and the trolley was secured to the wall when not in use. Medicines, including controlled drugs, were securely stored and accurately recorded. The care staff interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. The Inspector saw that the staff spoke to the residents in a calm and dignified way. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 14 In answer to the questions on the Have Your Say Questionnaire – 1.Do you receive the care and support you need? The following comments were made: • As my mother has only been in the care home for one week we have seen a significant improvement in her since going there. She is now very calm and settled and can now hold a conversation with us. • • All the carers are very helpful. I like living here 2.Do you receive the medical support you need? • All of the 29 residents commented: Yes always. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 Quality in this outcome area is good. The home enabled residents to have as much personal freedom and choice as possible although they could be more involved in the choice of meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a full time well experienced activities organiser who organises and implements a programme of social and recreational activities for the residents. A wide range of both individual and group activities are offered at the home including table and floor games, reminiscence, aerobics, sensory experiences, relaxation and memory quizzes In addition, entertainers visit the home, outings are arranged to various venues and a mobile cinema visits the home regularly. The activities programme is displayed on all floors of the home, which those residents spoken with were well aware of and they chose to join in as they pleased. A record is kept of each session and of who participated in them. The activities organiser also offers individual activities to residents and in discussion it was apparent that this worker knows the residents well. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 16 At the time of this inspection preparations were being made for the Christmas celebrations with a Christmas party and fair arranged. From talking with residents, relatives and staff the inspector confirmed that the visiting arrangements are flexible with these being described in the resident’s information guide. Those residents spoken with said that they “were free to see their visitors wherever they wanted to”. They described taking visitors to their bedrooms for privacy or seeing them in the lounges. The relatives said that they are made welcome and they said that they are offered refreshments. Issues regarding residents choice are described in a variety of documentation including the home’s Service User Guide and Statement of Purpose. Residents said that they had choice about such things as going to bed and getting up times, which clothes to wear, which lounge they sat in, how they spent their day and whether or not to participate in activities. For those residents who may have a limited ability to make decisions and choices about their day-today living arrangements the staff said that they try to assist the them with this by offering choices about such things as what clothing to wear, when to rise and retire and helping to choose from the menu. The residents are able to, and do bring personal items in to the home such as televisions, radios, photographs, pictures and ornaments. In answer to the question on the Have Your Say Questionnaire the following comments were made: Are there activities arranged by the home that you can take part in? • 25 residents replied always, 2 usually & 2 sometimes. • I take part in activities most of the time. • I join in groups and go on trips out. Also I have one-to-ones’. • I enjoyed the day trips. • The inspectors need to concentrate on activities and stimulation for the residents. • The residential unit is restricted in activity and I think would benefit from more qualified input. Residential Unit The inspector had a meal at lunchtime. The choice was either roast beef or pork chops with potatoes and vegetables. The inspector had the roast beef with this being well presented, with good portions offered and to be hot, good and appetising. Comments made by the residents about this meal varied with some people saying that they had enjoyed the food whilst others were less satisfied. Some residents said that the pork chops were tough and difficult to eat and that some of the food was not very warm. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 17 Meals are served in an attractive and comfortable dining room with tables that can seat four people that are provided with tablecloths, place mats, condiments and a small vase of flowers. Nursing Unit The Inspector did not dine with the residents but observed lunch being served. There was a choice of main course that also included a choice of 3 vegetables plus 2 types of potatoes, new and mashed. The food was sent up to the unit in a dumb waiter and then placed in a heated serving unit. This was not big enough to house the cheese and onion pie so therefore this was left out and became cold. The manager told the Inspector that the owner had agreed to buy heated food trolleys for each unit and they were on order. The tables were nicely set with napkins and condiments. Hot and cold drinks were available. Dementia Unit The Inspector did not dine with the residents but observed lunch being served. Several of the residents needed assistance with eating and needed a soft or pureed diet. Staff were assisting them discreetly and did not hurry them along. In answer to the question on the Have Your Say Questionnaire the following comments were made: Do you like the meals at the home? • 3 replied always, 9 usually, under the new management a14 sometimes , 1 never, 1 not able to comment yet and 1did not answer. • The meals vary. Sometimes okay they are good and sometimes they are not. • The chef is not very imaginative. • Food is okay most of the time. • Food is served on cold plates. • Could be more choice and differently cooked. • The puddings could be better at teatime. A relative commented that: I have made several complaints regarding the food but there has been no response. As my relative is self- funding we should not have to provide extra food on a daily basis. The home has been seeking the views of residents and their families by the use of survey questionnaires in relation to the food and the Inspectors were told that the home is aware that there are some concerns from some residents but they are hoping to sort this out. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The home has a clear complaints system that ensures that concerns are speedily dealt. Good protection of vulnerable adults guidance and the continued provision of staff training in this topic makes sure that residents are protected from abuse. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home has a satisfactory complaints procedure that states how a complaint is to be made, who to and that an initial response will be provided within 24 hours with a final outcome forwarded within 28 days. The facility of making concerns known directly to the CSCI is also included in this paperwork. The complaints procedure is displayed on the corridor on each unit and attached to the Service User Guide that is available in each resident’s bedroom. The home has a proper record for writing down complaints. Four complaints have been made to the home since the last inspection in August 2006. All of these complaints are currently in the process of being looked into by the acting manager. No complaints have been made to the CSCI during the above period. Discussion with residents and relatives showed that they were aware of the home’s complaints process and they said that they would have no hesitation in making their concerns known to the staff or the manager. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 19 Talking with staff showed that they would know what to do if a resident made a complaint. A number of staff said that if “they couldn’t sort things out at the time” then they would inform the manager about the problem. There are written procedures and policies covering adult protection, whistle blowing, the non acceptance of gifts, borrowing money and legacies and the home has a full copy of the Bolton inter-agency Safeguarding Policy. Information obtained from staff training records showed that 26 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. In answer to the questions on the Have Your Say Questionnaire the following comments were made Do you know who to speak to if you are not happy? • 6 replied always and 23 replied usually. Do you know how to make a complaint? • 7 replied always and 22 replied usually. • Very happy here, no need to complain. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 24 25 & 26. Quality in this outcome area is good. The residents live in suitably adapted, clean, comfortable and very pleasant surroundings This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is relatively newly built and is well maintained and is in good order both to the inside and the outside. Decoration, furnishings, lighting and equipment are of good quality and they are presented to a high standard. There is are well kept lawns and a patio area to the back of the home that has level access from a ground floor lounge. In the period since the last inspection the smoking lounge on the ground floor of the home has been fitted with a new laminate floor, magnetic release catches (fire system connected) have been fitted to bedroom doors and staff hand washing facilities and clinical waste bins have been provided in bedrooms. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 21 Bedrooms are spacious, well equipped and all are provided with suitable ensuite facilities. Toilets are close to the lounges and dining rooms and bathrooms are available on each floor of the home. Bedroom, toilet and bathroom doors are lockable and every bedroom is provided with a lockable unit for the safekeeping of residents’ personal items. The case-tracked resident’s bedrooms were checked. They were nicely decorated and suitably furnished and equipped. The residents spoken to were satisfied with the standard of the accommodation provided. There is good accessibility around the building with ramps, assisted baths and other equpment provided. Aids and adaptation are provided in bedrooms, bathroom, corridors and toilets. Good control of infection information was available on all the units and staff hand-washing facilities, such as liquid soap and paper towels were available in the bedrooms toilets and bathrooms. 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. In answer to the questions on the Have Your Say Questionnaire the following comments were made Is the home fresh and clean? • 28 replied always and 1 replied usually. • Hang on to Ann the cleaner. • Bed linen is changed frequently Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is good. The residents’ needs were being met and they were being cared for by caring and conscientious staff that were safely recruited and trained and therefore had the knowledge and skills to meet the residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Looking at staff rotas showed that as well as employing care staff, the home also employs domestic, catering and maintenance staff. Residential Unit The unit manager and the staff described a largely stable staff group some of whom have worked at the home since it first opened in February 2005, which ensures that residents are cared for by people they know and are familiar with. Staff morale was good with staff saying that “there is a good atmosphere” and that “we work together well as a group”. The residents said that the staff are “kind”, “happy to help” and that they were “patient and considerate”. The staff were seen to have a natural and comfortable understanding with the residents and they had time to sit and talk with them. On the day of this inspection enough staff were on duty to meet the residents care needs. Examination of staff duty rotas for the period 27th November to 31st December 2006 showed that four staff are provided between 8am and 2pm, three or four staff from 2pm to 8pm and three staff available overnight. These figures are increased if 21 or more residents are accommodated. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 23 The staff and the unit manager were clear in stating that in their opinion there was enough staff to meet the needs and dependency levels of the people presently living on this floor of the home. Nursing Unit Inspection of the staffing rotas and a discussion with the nursing and care staff identified that there was just sufficient staff on duty to meet the needs of the 16 residents. Staff did say that the dependency levels of the residents were high but if they felt that their needs could not be met they felt confident that the manager would ensure that more staff would be provided. Dementia unit Inspection of the staffing rotas, observation of practice and a discussion with the nursing and care staff identified that there was sufficient staff on duty to meet the needs of the 23 residents. The unit worked on 2 qualified nurses and 4 care assistants between the hours of 8am to 8pm and 1 qualified nurse and 2 care assistants during the night hours of 8pm to 8am. The unit manager is a Registered Mental Nurse and other Registered Mental Nurses and Registered General Nurses support her. In answer to the questions on the Have Your Say Questionnaire the following comments were made Are the staff available when you need them? • 16 replied yes and 13 replied usually. • They come straightaway usually depends on how busy they are. The home is required to have 50 of the care staff with NVQ level 2 qualifications or above by the end of 2005. Of the 35 care staff employed at the home 15 have got a National Vocational Qualification at Level 2 or above with 11 other staff presently undertaking assessment at Level 2, one person doing Level 3 and one other person undertaking Level 4. The 11 staff presently undertaking Level 2 assessment are expected to complete this training by December of this year and three other staff are due to enrol for this training soon. 43 of the staff are therefore trained to the required level and the continued operation of the above training programme will ensure that the required figure is achieved shortly. The files of five recently recruited staff members were checked for the required safe recruitment information. All of these showed that the home’s recruitment systems were safe and sound. Appropriate job application forms had been completed, two written references obtained, identification had been confirmed and contracts of employment and job descriptions provided. Criminal convictions and health declarations were in place and in all instances POVA First clearances and full CRB checks had been obtained. Discussions with the staff also confirmed that they had been properly and safely recruited. Looking at paperwork showed that the home keeps a check on the nursing staff’s registration status to make sure that as required such registrations are Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 24 up to date with the Nursing and Midwifery Council. This information was found to be up to date and accurate. The home’s deputy manager has recently assumed responsibility for staff development and training. The training programme for 2006 has now been completed with a further programme now being in the process of being devised for 2007. The home uses a mixture of internal and external staff training resources with such training being recorded on both individual staff records and collectively on a chart. For the training topics of infection control, confidentiality, fire safety, food hygiene and health and safety the staff are provided with training booklets that are used to reinforce the instruction that they have received in these subjects. The home has an in-house induction checklist for new staff and the required Skills for care Common Induction Standards are also used for the introduction of new staff to their caring tasks and duties. A requirement of a previous inspection (April 2006) was that the home must ensure that the training of staff in health and safety, safe moving and handling, fire safety, first aid, food hygiene, infection control and Protection of Vulnerable Adults continues. Examination of the above-mentioned training chart showed that although good progress has been made with this training this needs to be continued. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38. Quality in this outcome area is good. The managers’ experience and qualifications should ensure that there continues to be effective leadership and guidance to the staff, thereby ensuring that the residents receive safe, consistent quality care. The home consults the residents and their families about the way that the service is run so that both improvements can be made and problems can be dealt with. Procedures and practices within the home promote and safeguard the health, safety and welfare of the people living and working in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager in post is in the process of being registered with the CSCI. This person has considerable experience of working within the NHS and the care home sector and is in the process of undertaking the required Registered Managers Award. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 26 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. The home has been seeking the views of residents and their families by the use of survey questionnaires that are distributed at monthly intervals. A large number of survey forms have been returned with most of them scoring positively for the questions that asked about how well the home is meeting the residents’ needs. These results were then analysed with action being taken to deal with any issues raised. The manager also undertakes regular internal quality audits of the home’s systems for items such as residents care plans, the medication arrangements, cleanliness and standards of care. These audits are also analysed with necessary action taken. The home holds money for a number of residents for safekeeping. This system was checked with the details and was being properly recorded. The money is held in a “pooled” bank account with the total and individual balances being recorded in such a way that these can be readily checked and verified. The manager was told to ensure that this bank account is only used for the holding and transactions of residents’ funds and that it is clearly identified with the bank as a residents’ fund account. The Inspectors have received written confirmation from the home that this is now identified as the residents’ account. Secure storage is available for the safekeeping of money and of any valuable items. 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 with the details being evaluated in terms of how many accidents are happening and on whom they are happening to. Regular weekly checking and testing of the fire detection system, fire exits, emergency lights, and fire door closers is undertaken and documented. Safe hot water temperatures are checked and recorded at weekly intervals with water mixing valves being adjusted as required by the maintenance worker. Information obtained from the pre-inspection questionnaire and from random checking of servicing records showed that the homes fixtures, fitting and equipment is properly maintained and regularly serviced apart from that for the home’s gas services, which required checking. Arrangements were made for this work to be carried out during the second day of the inspection. Confirmation that this had been done was sent in writing to the Inspectors. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 27 The examination of paperwork and conversations with staff also confirmed that a number of staff had been provided with the required training in safe moving and handling,fire safety,first aid, food hygiene and infection control but that as mentioned previously in this report, this training needs to be continued for those staff that have not yet received such guidance. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 28 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 3 8 3 9 3 10 3 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 3 3 3 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 28/11/06 arrangements for the recording,handling,safekeeping, safe administation and disposal of medicines received into the care home. Staff must document the actual amount/number of tablets being given. Requirement 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 OP9 OP15 Good Practice Recommendations To ensure the accuracy of a transcription, handwritten transcriptions should be checked with another member of staff, signed and countersigned It is strongly recommended that residents have even more involvement in the drawing up of the menus. Farnworth Care Home DS0000060318.V297997.R01.S.doc Version 5.2 Page 30 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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