CARE HOMES FOR OLDER PEOPLE
Farrant House Nursing Home 44 Farrant Road Longsight Manchester M12 4PF Lead Inspector
Geraldine Blow Unannounced Inspection 10th November 2005 10:00 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 Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 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. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Farrant House Nursing Home Address 44 Farrant Road Longsight Manchester M12 4PF 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) 0161 257 3323 0161 225 9920 Southern Cross Healthcare Services Limited Mrs Maxine J Hanson Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (4) of places Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 44 service users will be accommodated. The home can accommodate up to 24 service users requiring nursing care on the ground floor and up to 20 service users requiring personal care only on the first floor. All service users will be aged over 60 years of age except where a variation has been granted in respect of age for a named individual. One named service user requires personal care only, out of category by reason of age. If this service user no longer resides at the home or their primary reason for requiring care changes, the service user category will revert to OP (old age). The service should, at all times, employ a suitably qualified and experienced manager. Minimum nursing staffing levels indicated in the Notice originally issued in accordance with Section 13 of the Care Standards Act on 20 August 2002 and here re-issued must be maintained in relation to those service users accommodated for nursing care; please see attached matrix. 26th May 2005 2. 3. 4. Date of last inspection Brief Description of the Service: The Home provided accommodation with nursing care for up to 44 older people. The home is situated in the Longsight area of Manchester close to a main public transport route, a local market, shops and a supermarket; public houses and other social facilities and amenities. The home is a purpose built, two-storey home set in its own small, wellmaintained and accessible grounds. The home offered accommodation in 40 single and 2 double bedrooms. 18 bedrooms, including both double bedrooms, have en-suite facilities. Access to the home was at ground level. A passenger lift was provided. The front door was digitally locked for security reasons and exit could be achieved by pressing a switch at the side of the door. CCTV covered the homes entrances and grounds. The home provided smoking and non-smoking areas for the residents. The homes hairdressing salon and the administrators office was situated in the reception area. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second unannounced inspection this year and took place on the 10th November 2005. During the inspection time was spent talking to the registered manager, the deputy manager, residents, visitors and staff to find out their views of the home. Also time was spent watching how staff worked with the residents. In addition a tour of the building was conducted and time was spent examining residents files, records and other relevant documentation. Since the last inspection, in May 2005, the CSCI has not received any complaints. The home kept a record of any complaints made directly to them, which included details of the investigation and any action taken. Since the last inspection the home had received 1 complaint relating to some missing items of clothing. During this inspection only a selection of the key National Minimum Standards were assessed. Therefore in order to gain a full picture of how the home meets the needs of residents, this report should be read with the previous and any future reports. What the service does well:
The home appeared to treat the residents with respect and dignity. Staff were seen to have a good relationship with the residents and were seen to be kind and patient when dealing with residents individual needs. The visitors spoken to said that the staff looked after their relatives very well. One visitor said, “this home is excellent and you can’t fault the staff at all”. Another visitor said “this is a much better home than the last one my mum was in, the staff look after her very well”. She also said that her mum was at times quite confused but staff always took the time to explain to her mum what they were going to do before they did it. All the visitors spoken to confirmed that the home had an open visiting policy. One visitor said he came twice a day every day and the staff always make him feel very welcome. Another visitor said that when she visited the staff always offered her a cup of tea and she was made to feel welcome. The visitors and residents spoken to all said that the home was kept clean and tidy. One visitor stated that the home had never smelt ‘particularly unpleasant’. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 6 Where the need arises the home provides equipment for the prevention or treatment of pressure sores. If bedrails were used they had protective bumpers in place to help prevent injury. The home has a relative and residents notice board in the main reception area advertising relevant information. This includes forthcoming activates and details of how to contact external agents i.e. Age Concern. What has improved since the last inspection? What they could do better:
Although, as stated above, the majority of the care plans were detailed there were some that needed improvement. For example, in one resident’s file the risk assessment sheets had not been signed or dated by the member of staff completing them, one plan of care had vague statements and some of the daily statements of health did not include a detailed account of the nursing care provided. Not all of the files examined had evidence that residents or their relatives had been involved in the drawing up of the care plan. However, all visitors spoken to said that the staff kept them fully informed of any changes and they had been invited to be involved in the care planning process.
Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 7 The home has had a recent outbreak of scabies. The situation had been appropriately dealt with. Some infection control recommendations have been made. As stated at the last inspection the home’s decoration was beginning to look a bit tired. Some of the wallpaper was scuffed in places. Some walls were stained and the condition of several of the carpets was poor even after being deep cleaned. The home must not wedge open fire doors within the home. The manager stated that she would liaise with the Fire Service to gain further advice. The hoist and the hoist slings must not be stored on the ground floor corridor. The home must obtain the correct Accident Reporting book in accordance with the Data Protection Act 1998. Some prescribed creams and high calorie drinks had not been signed for. All prescribed medication must be signed for. 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. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 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 Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 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): EVIDENCE: These standards were inspected at the previous inspection. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Overall the health and personal care needs of the residents appeared to be met at the home. However, the standard of documentation was variable and inconsistent. The system for recording all prescribed medicines needed some improvement to provide an accurate audit trail of medication. EVIDENCE: A random sample of care plans were examined. Some the plans of care were detailed and they had been reviewed on a monthly basis. However one file had not been reviewed the previous month and in one file the care plan was found to be vague and did not set out in detail the action needed to be taken by care staff. For example it stated, ‘assist with washing and dressing’. The daily statements of health did not always refer to the residents’ assessed needs. For example one care plan stated the resident required 2 hourly supervision while in bed, there was no recorded evidence that this had been implemented. In addition some entries were vague, for example “had a settled
Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 11 day”. The daily statements must accurately reflect the nursing care given over a 24-hour period. Appropriate risk assessments were seen within resident’s files. However 1 file inspected evidenced that the resident had bed rails in situ, with protective bumpers, but a risk assessment for the use of bed rails had not been completed. Also a number of the risk assessments had not been signed or dated by the member of staff completing them. In one file examined it clearly identified that the resident was peg fed. The manager confirmed that the resident was nil by mouth, however it was of some concern that this had not been documented anywhere within the residents file. As already stated in this report visitors spoken to confirmed that they were invited to be involved in the drawing up of the care plans and were kept informed of any changes. However in 2 of the files inspected there was no documented evidence of this. On examination of the Medicine Administration Record (MAR) sheets it was noted that some prescribed medication e.g. creams and high calorie drinks had not been signed for. All prescribed medication must be signed for by the person administrating them to facilitate audits and to ensure that the records are clear and accurate. The medication file contained residents’ photographs, which acted as an aid to identification at the time of medication administration. In addition there was a list of current staff signatures. Inline with new legislation, from the 1st Aril 2005, the home had employed the services of an independent company to dispose of pharmaceutical waste. It was recommended that 2 staff witness and sign for the disposal of waste medication. The home receives the prescriptions prior them being sent to the dispensing pharmacist and retains a copy o f the original prescription. In accordance with the Royal Pharmaceutical Guidelines the manager/desingnated person must sign the exemption declaration on the back of the prescription form on behalf of the resident if the resident is uanble to do this themselves, prior to the prescription being submitted to the pharmacy for dispensing. From observations made during the inspection and discussions with members of staff, visitors and residents it appeared that the nurses and care staff treated the residents with respect and dignity. Privacy screens were available in the double rooms, although at the time of the inspection both double rooms were singly occupied. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 12 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 Activities were available to residents. Residents are encouraged to maintain contact with family and friends. EVIDENCE: Since the last inspection the home has employed a part time activity organiser. A questionnaire had been sent out to ensure residents are consulted in the development of an activity programme, as required at the last inspection. The home must continue to evidence the involvement of residents in this process. Evidence was seen of recent activities and future planned activities. It was recommended that the organiser keep a record of all activities and the residents who were involved and those who declined to take part. Residents and visitors spoken to confirmed that the home operated an open visiting policy and visitors could be received in the privacy of the residents’ own room or in any of the communal areas of the home. It was evident that residents were able to bring personal possessions into the home and a list of belongings was completed on admission. The home had details on display regarding contact details of external agents who could act in a resident’s best interest.
Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 13 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 The home had a complaint procedure and complaints appeared to be well managed. EVIDENCE: The home maintained a complaint file containing details of the complaints received, investigations and the actions taken. The home had received 1 complaint since the last inspection, regarding some items of missing clothing. The complainant had been reimbursed. The visitors who spoke with the inspector were aware of how to make a complaint. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 14 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, 24 & 26 In general, the home was clean, well maintained, comfortable and safe for those residents living there. EVIDENCE: The home was accessible to residents in a wheelchair and a passenger lift offered access to all levels of the home. A variety of communal areas were available on both floors of the home and included both non-smoking and smoking areas. The carpet on the ground floor and first floor corridor were found to be dirty in appearance and heavily stained. The manager stated that both carpets had been deep cleaned and a quote had gone to head office for a new carpet for the ground floor. Many bedrooms had been personalised and were homely in appearance. Some contained the residents’ own personal items and furnishings. A list of residents’ property had been recorded on admission. Privacy locks were fitted to bedroom doors and a lockable space was available to safely store small personal items and medication.
Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 15 The home’s laundry was situated on the ground floor corridor and contained appropriate washing and drying facilities. Soiled linen did not come into contact with food storage, preparation, cooking, serving or dining areas. Literature was available in respect of the Control of Substances Hazardous to Health (COSHH). The home had extensive policies relevant to infection control. The home has had a recent outbreak of scabies and a number of concerns relating to infection control were identified during the inspection. It was noted that the hoist slings were stored on hooks on the ground floor corridor, all on top of each other, which poses a risk of cross infection. Alternative and appropriate storage must be found The manager and deputy manager told the inspector that Personal Protective Equipment (PPE) was available in resident’s bedrooms where personal care was delivered. However they were not available in bathrooms and toilets. It has been recommended, in accordance with Infection Control guidance that: 1. PPE, which includes gloves, aprons and wipes should be made available in toilets and bathrooms to facilitate the management of personal care. 2. The home should consider purchasing individual hand held alcohol gel for staff. 3. The home should ensure equipment is cleaned in between resident use. 4. The home should make equipment wipes available in the nurses’ office, sluices and next to hoists to facilitate cleaning. 5. To prevent the risk of cross infection an individual sling should be provided for each resident requiring the use of the hoist. 6.The home should develop and implement a policy on the use of wipes. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 16 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): 28 Appropriate NVQ training has been provided EVIDENCE: The manager told the inspector that the home employed 23 carers. Three cares had achieved NVQ level 3 and 1 carer had achieved NVQ level 2. Eleven carers were due to complete NVQ level 2 in the near future. Once completed the home will have met the National Minimum Standard of having 50 of care assistant staff trained at NVQ level 2 before the end of 2005. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 17 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, 36, 37 & 38 The home appeared to be well managed. However to protect the safety of residents fire doors must not be wedged open. EVIDENCE: The registered manager and the deputy manager were both experienced Registered General Nurse’s (RGN’s). They appeared both competent and committed to improving the service delivered to the residents. The home benefited from a system of formal staff appraisal, which established the staff members’ baseline training and development needs. The inspector was told that supervision was conducted on a minimum basis of at least 6 times a year. Written records were kept and held on individual staff files. As required at the last inspection residents’ care files were now kept secure and out of public view in a filing cabinets.
Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 18 The home did not have an accident recording book in accordance with the Data Protection Act 1998. Several of the resident’s bedroom doors were found to be propped open. It was acknowledged that this was done as direct wishes of the resident or their relative / representative. Fire doors must not be wedged open and it was recommended that the home liaise with the Fire Service for further advice. The hoist must not be stored on the main ground floor corridor as this causes a potential health and safety risk. Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X 3 X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 2 Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 20 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 14 & 15 Requirement The manager must ensure that evidence is retained of the residents/families involvement in the care planning process. This requirement had been made at the previous inspection and had not been met by the timescale of 1st February 2005. 1. The plan of care must include detailed risk assessments for the use of bed rails. 2. The residents plan of care must set out in detail the actions which need to be taken by staff to ensure that all aspects of health, personal and social care needs are met. 3. An accurate record must be kept of the nursing care provided including a record of the residents condition and any treatment given. 4. The plan of care must be reivewed at least once a month. Timescale for action 31/12/05 2 OP7 13,15,17 Sch 3 31/12/05 Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 21 5. The member of staff completing any documentation must sign and date it. 3 4 OP8 OP9 14,17 Sch 3 13 The individual plan of care must accuratley reflect the residents nurtitional needs i.e Nil by Mouth 1. All prescribed medication must be signed for by the person administrating them. 2. In accordance with the Royal Pharmaceutical Guidelines the manager/desingnated person must sign the exemption declaration on the back of the prescription form on behalf of the resident if the resident is uanble to do this themselves, prior to the prescription being submitted to the pharmacy for dispensing. 5 OP19 23 The provider must ensure that the carpeting to the ground and first floor corridor is thoroughly cleaned or, if this proves ineffective, replaced. To reduce the risk of cross infection the hoist slings must be stored in an appropriate manner 1. Fire doors must not be wedged open 2. The hoist must not be stored on the main ground floor corridor. 17/11/05 31/12/05 31/12/05 6 7 OP26 OP38 13 23 17/11/05 17/11/05 Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 22 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 OP12 Good Practice Recommendations It is recommended that 2 staff witness and sign for the disposal of waste medication. It is recommended that the activity organiser keep a record of all activities and the residents who attend. It is recommended, in accordance with Infection Control Guidelines that: 1. Personal Protective Equipment (PPE), which includes gloves, aprons and wipes should be made available in toilets and bathrooms to facilitate the management of personal care. 2. The home should ensure equipment such as the hoist is cleaned in between each use either by the use of equipment wipes or soap and water. 3. To prevent the risk of cross infection an individual sling should be provided for each resident requiring the use of the hoist. 4. The home should consider purchasing individual hand held alcohol gel for staff or wall mounting alcohol gel. 5. The home should develop and implement a policy to include the above. It is recommended that the home liaise with the Fire Service for further advice regarding risk assessments and self-closing door devices. 3 OP26 4 OP38 Farrant House Nursing Home DS0000021642.V262375.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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