CARE HOMES FOR OLDER PEOPLE
Farrant House 44 Farrant Road Longsight Manchester M12 4PF Lead Inspector
Gary Largent Unannounced 26 May 2005 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 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 F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Farrant House Address 44 Farrant Road Longsight Manchester M12 4PF 0161 257 3323 0161 225 9920 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Services Limited Maxine Hanson Care home with nursing (N) 44 Category(ies) of Old age, not falling within any other category registration, with number (OP) (40) of places Physical disability (PD) (4) Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 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. 2 Three named service users require nursing care by reason of physical disability and one named service user requires personal care only, out of category by reason of age. If these service users no longer reside at the home or their primary reason for requiring care changes, the service user category will revert to OP (old age). 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. 3 4 The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 1 December 2004 Brief Description of the Service: The Home provided accommodation with nursing care for up to 44 older people. 40 residents lived at the home although 5 of them were hospitalised at the time of the inspection. 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 areas and amenities. The home is a large design and build two-storey home set in its own small and well-maintained 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 home’s entrances and grounds. The home provided smoking and non-smoking areas for the residents. The home’s hairdressing salon and the administrators office was situated in the reception area.
Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 26th May 2005 between 8am and 6:30pm. 23 residents were spoken with during the inspection in addition to nine staff members and the home’s management team. One visitor to the home at the time of the inspection was spoken with. The visitor was very positive in his comments regarding the home and the standards of care and accommodation provided. The inspection included a tour of the home where the living conditions were inspected. Care, medicine, accident, duty, fire, complaint and other records were inspected in addition to staff personnel files. During the inspection only a selection of key 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 residents said that they usually enjoyed the food provided by the home. The visitor spoken with was complimentary about the home, the food and the care provided. The home had revised the menu choices available to the residents. This appeared to have met with the approval of the residents. The staff members were seen by the inspector to be responsive to the residents’ needs. The staff appeared to have an awareness of the residents’ assessed needs, their choices and preferences. The majority of the residents who spoke with the inspector appeared to know of how to make a complaint and they were aware that the complaint procedure was contained within the Service Users’ Guide. The residents said that the staff members were friendly, generally cheerful and helpful. The home manager had completed the Registered Manager’s Award and the deputy manager had begun a course leading to the same qualification. The staffing levels at the home appeared to be adequate to assist and support the residents. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
A number of requirements have been made within this inspection report. The home’s decoration was beginning to look tired. Wallpaper was scuffed in places. Some walls were stained and the condition of several of the carpets was poor. Some of the carpets needed to be thoroughly deep cleaned or replaced. Risk assessments were not fully included in the plans of care and there was little evidence to show that the residents or their family members had contributed to the plans development. The daily statements of health could better reflect the residents’ assessed and known needs. Some recording gaps had been left between night entries in the daily statements of health. This was discussed with the manager during the inspection, who crossed and signed the spaces. It appeared as though the gaps could have been left to enable the day duty staff to make a later entry between the night entries. Pressure care prevention and management measures could be better recorded to ensure consistency and awareness. There was limited evidence indicating the activities planned and undertaken at the home. There was no indication that the residents had been involved in
Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 7 planning any activities or that there personal preferences had informed the staff regarding the type of activity to be undertaken. Staff supervision records needed to be improved. Two requirements made at the home’s previous inspection had not been fully met within the agreed timescale i.e., by 1st February 2005. The requirements related to the residents’ involvement in developing the plan of care whilst ensuring that the daily records made by staff referred to the residents’ needs. The second unmet requirement related to making sure that the residents are able to fully discuss and contribute to the social activities planned at the home in addition to the home’s need to employ a named person to develop activity programmes. No enforcement action has been considered or taken in the period since the last inspection. 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 F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3 and 6 A thorough assessment of needs is carried out before residents move into the home, which ensures that care needs will be met. Accurate and up to date information to enable prospective residents to determine whether the home can meet their needs in full was available. EVIDENCE: The home’s Statement of Purpose and the Service User Guides appeared to contain up to date and accurate information, which enable prospective residents to determine if the home would be able to meet their needs. All of the residents had undergone a pre-admission assessment of needs. The standard of the assessment was varied, some containing more information than others. The assessments included sections relating to the residents’ dietary needs, including likes and dislikes. The pre-admission assessment of needs included the residents’ foot care and oral hygiene needs in addition to a falls history. The manager, a Registered General Nurse (RGN) carried out the pre-admission assessments. The home benefited from a clear policy relating to pre-admission assessment. The residents’ plan of care was developed from the pre-admission assessment and the needs identified by the care manager (social worker) and the assessment of needs conducted by any National Health Service (NHS) nurse. The home did not offer intermediate care facilities.
Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 Overall residents’ health, personal and social care needs were being met although some assessed needs had not been addressed. These shortfalls had the potential to place residents at risk. EVIDENCE: Plans of care were developed from the assessments conducted by the care manager, the NHS nurse and the home’s own assessments. Plans of care were reviewed monthly and contained the residents’ falls history. The involvement of the resident or their representatives in care planning was not routinely recorded. The daily statements of health did not always refer to the residents’ assessed needs. The resident or their representative did not routinely agree risk assessments nor had they been consistently integrated into the plans of care. All residents were registered with identified local General Practitioners. Pressure sore risk assessments were in place and reviewed monthly. Body maps identified the site of any pressure sores. Nutritional screening was routinely conducted. The home operated a safe system of ordering, storage, administration and disposal of medication. Details should be recorded to advise staff members of when and why to administer “as required” medication.
Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 11 Medical consultations and physical examinations were conducted within the service users’ own bedrooms. Those ground floor bedrooms facing onto Elgar Street (i.e., rooms 12 – 19, inclusive) could be easily seen into by local residents and passers by. This reduced the residents’ expectation of privacy. The service users received their mail unopened. Where service users lacked the capacity to manage their mail it was passed unopened to their relatives or representatives. The issue of the service users’ mail delivery was supported by a corporate policy. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 Social activities were arranged although the residents’ involvement in shaping these was limited. Meals appeared to be varied, nutritious, healthy and balanced. EVIDENCE: All residents had a social history assessment undertaken at the pre-admission stage. There was no evidence that the residents were consulted in the development of an activity programme or that such consultations were recorded and taken into account when devising any programme of activities. No restrictions had been placed upon visitors to the home and one visitor regularly arrived at the home late at night to continue the pattern of visiting before his relative’s admission to the home. None of the residents were represented by financial appointees from the home. All residents were in receipt of direct payments. Residents were supported by independent advocacy services, court of protection solicitors, social services and family appointees. Three residents were able to manage their own financial affairs. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 13 The residents were able to place their meal orders the day before they were prepared and served. Alternative meals were available at each mealtime. Records of meal orders were retained. Meal times were flexible. The care staff assisted residents to eat their meals where such a need had been assessed. The assistance offered was relaxed and sociable in nature. The residents and staff members confirmed that light snacks were available throughout day and night upon request. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 and 18 Complaints appeared to be well managed. The procedures in place were able to ensure that allegations of suspected abuse were acted upon and safeguarded residents from the risk of abuse. EVIDENCE: The home maintained a complaint file containing details of the complaints received and the actions taken. The file failed to consistently record the outcomes of the complaints. 17 Complaints had been received in the preceding year; 5 had been upheld, 1 was upheld in part, 9 were not upheld and 2 had no recorded outcomes. Three of the 17 complaints had been referred by the home using the Adult Protection procedures. Those residents and the visitor who spoke with the inspector were aware of the complaint procedure but had had no cause to use it. The complaint procedure was displayed and contained a 28-day time frame. The complaint procedure was available within the Statement of Purpose and the Service User Guide. Written information was available to advise complainants that they were able to refer their complaint to the Commission at any stage. The home had an Adult Protection procedure (including Whistle Blowing), which complied with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19, 24 and 26 In general, the home was well maintained, comfortable and safe for those residents living there. Some limited areas of the home were malodorous. EVIDENCE: The home was accessible a passenger lift offered access to all levels of the home. Communal areas were available on both floors of the home and included both non-smoking and smoking areas. The home’s laundry was situated on the ground floor “service” corridor. 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. Many bedrooms had been personalised and were homely in appearance. They contained the residents’ own personal items and furnishings. Privacy locks were fitted to bedroom doors and a lockable space was available to safely store small personal items and medication. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 16 Several bedrooms were malodorous, in particular room 34. The decoration in many areas of the home was tired in appearance and required a measure of remedial attention. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 The number and deployment of staff available was sufficient to meet the residents’ assessed needs. The procedures for recruiting staff were robust and provided adequate safeguards to protect residents. EVIDENCE: The home’s duty records were inspected and were able to demonstrate that the home was compliant with the condition of registration specific to staffing levels. Domestic and ancillary staff members were employed in numbers sufficient to meet the residents’ assessed needs and those of the home, other than in those areas indicated elsewhere within the report. Two of the home’s care assistant staff had completed the NVQ level II i.e., 14 . One care staff member had achieved the NVQ level III. The home manager stated her belief that the home would meet the National Minimum Standard of a minimum of 50 of the care assistant staff having achieved the NVQ level II qualification by the end of 2005. The home did not employ any trainee staff. A significant effort had been made to improve the staff members’ personnel files, which had been indexed. All staff files inspected contained two appropriate references and evidence of clear Criminal Records Bureau (CRB) declarations. Volunteers were not involved with the home. Staff supervision records were inconsistent and individual training and development records were not available. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 and 38 The home appeared to be well managed, which ensured that the health, safety and welfare of the residents is promoted and protected. EVIDENCE: The manager was an experienced Registered General Nurse (RGN) and she had achieved the Registered Managers Award. The home benefited from a system of formal staff appraisal, which established the staff members’ baseline training and development needs. Individual records were not available to show how such needs were being addressed. Evidence was available to show that care staff supervision had been ongoing at the home. The supervision records did not show that the frequency was in keeping with that stated within the National Minimum Standards. The manager stated that other staff members were supervised on a continuous basis. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 19 The manager said that all of the home’s maintenance certificates and records were up to date. The residents’ care files on the home’s ground floor were not secure. The records were maintained at the nurses’ station, which was frequently unmanned and accessible to all persons visiting the home. This presented the potential risk of the residents’ personal information being accessed by unauthorised people. Accident records were not filed into individual residents’ care files until after the monthly audit had been completed. This resulted in personal information regarding numerous residents being maintained together and potentially permitting unauthorised access to information regarding all residents who had had an accident reported. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 x x N/A 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 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x 2 x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 x x x x 2 2 3 Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? 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(1), 15(1) (2) Requirement The manager must ensure that evidence is retained of the residents 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. The manager must ensure that all of the residents identified needs have an associated plan of care. The manager must ensure that the residents are consulted in the development of the activity programme and that such consultations are recorded and taken into account when devising such a programme of activities. This requirement had been made at the previous inspection and had not been met by the timescale of 1st February 2005. The provider must ensure that complete and accurate records are retained of all complaints received by the home. Timescale for action 13 July 2005 2. OP8 12(1) (a) 13 July 2005 13 July 2005 3. OP12 12, 16(2) (m) (n) 4. OP16 17(2) Schedule 4 (11) 13 July 2005 Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 22 5. OP19 23(2) 6. 7. 8. OP19 OP24 & OP26 OP37 23(2) 16(2) 17 The provider must ensure that the carpeting to the ground floor corridor is thoroughly cleaned or replaced. The provider must put in place a programme of redecoration. The carpet in bedroom 34 must be effectively deep cleaned or replaced. The manager must ensure that the care and other records maintained in relation to the homes residents are kept securely within the home and in accordance with the Data Protection Act 1998. 31 August 2005 13 July 2005 13 July 2005 13 July 2005 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. 3. 4. 5. Refer to Standard OP9 OP10 OP12 OP28 OP36 Good Practice Recommendations Plans of care should describe why and when as required medications should be administered. The ground floor bedrooms facing onto Elgar Street (i.e., rooms 12 – 19, inclusive) are fitted with appropriate curtaining to protect the residents privacy. An activity organiser should be employed to meet the residents’ assessed social, recreational and occupational needs. The provider should take the appropriate action to ensure that 50 of the homes care assistant staff have achieved the NVQ level II by the end of 2005. The care staff should be supervised at least six times per year and evidence is retained to support the supervision. Farrant House F55 F05 s21642 Farrant House V229457 D260505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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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