Inspection on 10/01/07 for Farthings Nursing Home

This inspection was carried out on 10th January 2007.

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

Farthings Nursing Home 12/11/07

Farthings Nursing Home 14/02/06

Farthings Nursing Home 02/08/05

Farthings Nursing Home 24/02/05

Farthings Nursing Home 07/07/04

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 Farthings Nursing Home Farthings Nursing Home Wilson Square Little Bispham Blackpool Lancashire FY5 1RF Lead Inspector Pauline Caulfield Unannounced Inspection 10:00 10 & 17 January 2007 th th 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 Farthings Nursing Home DS0000006042.V320305.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. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farthings Nursing Home Address Farthings Nursing Home Wilson Square Little Bispham Blackpool Lancashire FY5 1RF 01253 864309 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) Westlive Limited - T/A The Farthings Nursing Home Mrs Sheena Cook Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (3), Terminally ill (3) of places Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may accommodate up to a maximum of 64 older persons when not utilising those placed designated for persons with a physical disability and/or terminal illness. The total number of persons accommodated in the home at any one time shall not exceed 64. 14th February 2006 Date of last inspection Brief Description of the Service: The Farthings Nursing Home is registered to accommodate 64 older people for nursing and personal care. It is a large purpose built building that provides passenger lift access to both floors. There are a number of lounge areas on each floor and a dining room on the ground floor. There are 54 single bedrooms and five doubles, the majority of which have en-suite facilities. There is a large parking area at the front of the property. It is located in a residential area of Bispham. There is a Statement of Purpose/Service User Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are, and what the resident can expect if he or she decides to live at the home. Information received prior to this visit (30/11) showed that the fees for care at the home are from £340.34 to £470 per week, with added expenses for hairdressing, chiropody, toiletries, transport and newspapers. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit, which commenced at 10am for seven hours on one day and five hours on another. Prior to the visit the manager completed a pre-inspection questionnaire and comments cards were received from nineteen residents, with support from relatives, four relatives and six General Practitioners. The Registered Manager, Deputy manager, administrator, two nurses, four care staff and two support staff were spoken to. The inspection involved case tracking five residents as a means of assessing some of the National Minimum Standards. This process allows the inspectors to focus on a small group of people living at the home. All records relating to these people are inspected along with the rooms they occupy in the home. They are invited to discuss their experience of the home with the inspector, however this is not to the exclusion of other people living at the home. Six residents were spoken to individually. Conversation with residents was very much dependent on their ability or wishes to speak to the Inspector. A tour of the home was carried out and a selection of staff, residents and administrative records were examined. From the observations made, comments received and written documentation seen, the information has been put together to form this report. What the service does well: The residents in this home are well cared for. Staff were seen to be caring and supportive, looking after the residents well. There is a competent staff team who understand the needs of the people living there. One resident said “All staff members are very nice and meet all my needs”. A relative said, “Mum says that she finds the staff to be very caring”. There is a good admission process with detailed assessment and a visit to the home where possible so the resident and relatives can get learn about the home and meet some residents and staff before moving in. Each resident has a plan of care and detailed records that guide staff in their care of residents. Residents are supported in their religious beliefs and observances ensuring that their spiritual needs are met. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 6 Residents’ relatives and friends are welcomed into the home ensuring that residents’ relationships are maintained. One relative said, I am always made welcome when I visit Mum”. Another resident said, “The owners, staff, matron and sisters are all very thoughtful and always make me welcome”. Mealtimes are pleasant and unhurried. Most residents said meals were good. Several families said their relatives were very satisfied with the food Medication procedures and administration are well managed ensuring that residents receive their medication as prescribed. Most residents and relatives feel that the home is clean and fresh smelling so that residents live in pleasant surroundings. The domestic staff have qualifications in housekeeping which they feel has improved their cleaning skills. Staff training is good. Many of the care staff have qualifications in care and there are frequent opportunities for other training. This knowledge and training helps meet residents care needs and protect the health and welfare of residents, relatives and staff. The manager and owners regularly check that the quality of care is satisfactory by looking around the home, sending out surveys and asking residents, relatives and staff their views. The manager has a good approach to managing the home. She is enthusiastic and knowledgeable about supporting older people and this is passed onto the staff. Residents and staff say they feel well supported. What has improved since the last inspection? What they could do better: The statement of purpose/service user guide that gives information about the home needs updating, so that residents have up to date information about the home. Each resident should be given a contract of terms and conditions by the time they are admitted to the home so they know about charges and conditions of residence in the home. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 7 Breakfast times should be more flexible to allow residents the choice of getting up early or later in the morning. Some residents and relatives said that they were satisfied with the activities in the home but more said that they would like more frequent activities and for staff to spend more time chatting to residents. One relative said, “Nobody seems to have much time to spend with residents just chatting and passing the time of day”. Residents and relatives all need to know about the complaints procedure so that they can tell the home about any concerns they may have. Staff need all the necessary checks before they commence employment in the home. This will make sure that people who should not work with vulnerable adults do not work in the home. 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. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 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 Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5. Standard 6 not applicable as the home does not provide intermediate care. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have most information needed to choose a home, which will meet their needs. EVIDENCE: The home has a detailed admission policy which tells staff the correct information to give and the correct procedures to follow during the admission process. When prospective residents, relatives or social workers contact the home considering admission, the manager shows them around the home and visits them at their home or in hospital to see if the home is able to meet their needs. They also agree an admission date and on any items of furniture the resident wants to bring with them. One relative said, “Mum was too ill to visit the home”. Another relative said “A full and very good tour of the home. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 10 Matron was very informative.” A resident said, “My family had a look around homes and chose here for me”. All new residents are given a copy of the Service User Guide. This gives residents information about the routines and practices in the home. Residents keep this information in their rooms. The Service User Guide whilst informative needs updating and information about mealtimes and rising/retiring times and whether these are flexible or not needs recording. One relative said, “As carers we had a tour of the home and Mum received a brochure on the home”. Another relative said “My Mother had enough information about the Farthings before she went there. Five residents were case tracked. Two residents had a written contract, three did not. Those that didn’t were residents who had been admitted in the three weeks before the inspection around the Christmas period. Most residents said via comment cards that they had written contracts and copies of contracts were seen in some residents files. Residents must have contracts by the time they are admitted to the home so they are aware of the charges and their conditions of residence. The records of five residents were examined. All of the records contained an assessment of needs that had been carried out one by the manager of the home and where funded by social services, one by health or social services prior to admission. The inspector spoke to most residents case tracked and some other residents. Several said that their relatives looked at homes for them, although some visited with their relatives before moving in. All residents spoken to said they had been given information about the home. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s health and welfare is monitored to ensure health and personal needs, respect and privacy are met. EVIDENCE: The records of five residents were looked at. Each resident has a plan of care and a brief personal history which includes likes and dislikes. There were detailed risk assessments including moving and handling, nutrition and pressure area care. This information shows all staff the correct way of caring for each individual. Care plans are regularly reviewed. Detailed daily records are kept to provide a more informative picture of residents. Most residents feel they have access to health care services that meet their needs. Although a small number of residents feel that care can be rushed and staff ‘do for’ rather than assist. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 12 Most residents and relatives feel that the residents health issues are dealt with well. Some residents are very frail. Health needs of residents include diabetes, epilepsy, aftercare of strokes, mobility difficulties and the general effects of ageing. Staff spoken to were knowledgeable about residents’ healthcare and personal needs and their likes and dislikes. All GP’s who returned the comment cards said that staff demonstrate a clear understanding of the care needs of service users. Some of the residents have bedrails to prevent them falling out of bed. Risk assessments have been carried out and agreed with residents and families. Staff look at a range of preventative strategies to ensure the residents safety and dignity were preserved. Records showed that efficient systems are in place to enable residents to receive appropriate healthcare support. Specific health issues are picked up on and acted upon quickly. Ways of managing specific difficulties or behaviours and multi disciplinary meetings are put into place quickly and effectively where needed. Some relatives and residents feel that staff take too long to answer nurse call bells. One resident suggested that requests for assistance to use the toilet, take too long resulting in deterioration of continence. Other residents said staff answered their calls quickly. During the visits the inspector observed the time taken to answer call bells. Staff were quite quick responding to calls. Occasionally the home finds it is unable to meet the needs of a resident because his or her needs have changed and are more intensive than previously. If this occurs staff liase with the appropriate professions and support the resident, relatives and other residents in the home until a more suitable placement is found. Medication administration was checked. This was safely stored, administered, recorded and disposed of using appropriate disposal methods and there are detailed audits carried out regularly. This ensures that residents have their medication as prescribed, safely and effectively. No residents administer their own prescribed medication. Several residents administer herbal medication and vitamins themselves once staff have checked that they do not interact with their prescribed medicine and a risk assessment for self administering has been carried out. Most GP’s said that they are satisfied with the overall care provided to service users in the home. Most residents and relatives were satisfied with the care and the information provided. One relative said,“My Mother receives all the care and support she needs, no complaints at all.” Another relative said,” I am always contacted if there are any problems and if new medication is given.” However a few residents were less satisfied. One resident said, “I have to search for staff”. Some families would like staff to spend more time with Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 13 mobilising their relatives. One relative felt that it would be useful for residents to be supported to walk with their walking aids more frequently. Another relative said, “We feel that if staff had a little more time [residents] would have the opportunity to be more mobile”. Senior staff may want to look at whether it is possible to support residents to mobilise a little more. The manager said that some relatives have not realised the residents mobility is deteriorating. Discussions to explain this would be beneficial. There are clear practices in place for the care of residents who are dying and their relatives. There is always at least one member of staff with any residents who are known to be very unwell, unless they do not want a member of staff with them or residents and their relatives want to be together without staff. There is clear information about care during the last stages of life including clear plans of care for any resident that has specific wishes relating to this. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Cultural, religious, social and recreational activities meet some resident’s expectations, needs and choices and residents receive a healthy varied diet. EVIDENCE: Staff were observed throughout the visit. Staff interactions with residents were, caring and supportive. But while some residents and relatives said that they were satisfied with the activities in the home more said that they would like staff to spend more time chatting to residents. One relative said, “Nobody seems to have much time to spend with residents just chatting and passing the time of day”. Some residents choose not to get involved in activities but for some residents the day is long and they want more frequent activities or staff to chat to them more frequently. Residents’ views made via comment cards. Included: “More activities would be appreciated” “I get up in the morning and stay in my room until bedtime.” “Activities are infrequent and not very varied”. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 15 There are some indoor leisure activities in place such as arts and crafts, bingo sessions, card and board games, dominoes and reminiscence sessions and watching videos. Some residents listen to talking books. Entertainers come to the home every few weeks, staff sometimes dress up for themed evenings and there are occasional trips out for meals. There is a hairdresser who visits the home four times each week. Senior staff spoken to said that they have activities whenever there is time but other tasks must take priority. The manager should look at ways of ensuring activities have a higher profile in the home as many residents want to spend time conversing and enjoying social activities with staff and other residents and need support to do this. Residents cultural and religious needs are met. Although current residents are all nominally Christian, or have no religious beliefs, staff at the home have demonstrated over time that they can meet the religious practices of residents from different faiths. There are frequent visits to the home from local vicar’s, priests and ministers and some residents have attended a place of worship with relative or friends taking them or if there is no-one else to take them, staff will take them. One resident said, “It is very important to me to still be part of the parish”. Senior staff are not aware that any past or present residents were gay, lesbian, bisexual or transgender. Staff should be aware of the diverse range of lifestyles residents may have lived and be sensitive to this. The manager should encourage staff to look at appropriate ways of supporting residents and meeting their diverse needs. The practices in the home ensure that residents are treated with respect and their right to privacy is upheld. One resident said, “The staff always knock before entering my bedroom”. Residents spend their time in their rooms or the lounges as they wish. One relative said, “ The staff treat mum with dignity and respect, giving me peace of mind”. There are a smaller number of men than women currently living in the home, but the needs of both sexes are catered for. Male residents are given the choice of the same sex staff, with a male carer on duty wherever possible. Female residents always have several female staff on duty. The service user guide states that staff hold resident’s alcohol in the medical room but senior staff said that this is not the case in practice. Residents can hold their own alcoholic drinks in their bedroom providing a risk assessment advises that this is safe. The Service user guide needs updating to reflect this. Most routines in the home are generally flexible and residents spoken to said that they are free to go to bed when they choose and join activities, when available as they wish. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 16 There are two cooks in post to prepare and cook the meals. They serve special diets as required including diabetic diets and blended food. Most residents said meals were always or usually good, while some were less happy. One resident said, “the quality of food has improved”, whilst another said that quality had worsened. Another resident said, “The food is usually good”, yet another said that food is not good. A relative said, “I never thought my relative would accept the food but she is very satisfied.” Another relative said, “My mother seems to enjoy her food when she is up to it”. Menus and records of food served appeared nutritious and varied. The manager goes around the home and sees every resident each morning to ask them what they would like to eat that day and to check that everything is alright with them. Breakfast includes a cooked meal. All residents have breakfast in their bedroom. The times of breakfast are not flexible. Breakfast must be eaten between 7:30am – 8:30am, which may be very early for some people and means that all residents have to be awake each day very early and do not have the option of a lie in unless they choose to miss breakfast. Senior staff felt that it would cause problems to extend the times for breakfast and added that residents can go back to sleep for a while after breakfast. Senior staff said that residents’ or their relatives are told of breakfast times when they visit the home. However there is a lot of information to be taken in during a visit and sometimes the resident is not on the visit to the home. Important information like this should be provided in writing before admission so that if senior staff feel it is not possible to have a more flexible breakfast time, residents are aware of this before admission. The residents have their main meal at lunch time. The evening meal is a lighter meal. Residents can have meals in their bedrooms if they wish. Drinks are provided to all residents several times a day. The inspector was close to the dining room at lunchtime. Lunch appeared unhurried and relaxed and residents spoken to said that they had enjoyed it. Family and friends are encouraged and welcomed in the home. One relative said in the homes survey, “I am always made welcome when I visit Mum”. Another resident said, “The owners, staff, matron and sisters are all very thoughtful and make me as welcome as [my relative] – very comfortable. I never thought I would be so lucky.” The use of the lounges as well as residents’ own bedrooms enables residents to have visitors in privacy as they wish. Residents’ birthdays and other special events are celebrated. The residents themselves or relatives of most residents at the home handle their financial affairs. The home rarely gets involved in this. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. The arrangements in place for handling complaints and safeguarding adults ensure that most people feel confident that their complaints will be listened to and taken seriously and they are adequately protected. EVIDENCE: Most residents or relatives spoken to or who returned the comment cards knew who to complain to if they had any concerns and most were confident that any concerns that they had would be taken seriously and acted upon. Several residents and relatives said they have not needed to complain, as they are pleased with the care they or their relative receives. One family said, “We have never had any reason to complain. Any concerns we have had have been dealt with quickly.” Residents spoken to said problems were listened to and dealt with. There have been no complaints received by the home since the last visit and most people said they were comfortable approaching senior staff if they had any concerns. However a small number of residents and relatives said through the comment cards that they are not aware of how to complain and feel that staff do not always listen and act on what they say. One resident said, “ Issues are usually raised with family members who take up the problems. Complaint is not openly encouraged”. A relative said, “We have never been advised who or how to do this [complain] but would assume we go through Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 18 Matron then the manager”. Senior staff said they send the complaints procedure out with the contract and it is also in the service user guide. There is also usually a copy in the hall. As there are people unaware or unsure of how to express concerns senior staff should consider looking at alternative ways that residents and relatives are encouraged to express any worries or concerns and are aware of the complaints procedure and who to contact if they are not happy about something in the home. The home has a procedure in place for dealing with safeguarding adults. Staff spoken to had a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. Staff had covered safeguarding adults training either on Induction training or on National Vocational Qualifications (NVQ) training. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 19 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, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good, providing residents with a comfortable and homely place to live. EVIDENCE: A tour of the home showed that the general environment was good. Communal areas were homely and comfortable. There are several lounges and some small lounge diners as well as a large bright dining room. Resident surveys showed that most residents felt that the home was clean and fresh and pleasantly furnished. Although a small number of residents and relatives said that the home is always clean but sometimes not fresh. The home smelt fresh and clean during the visit. One relative said, “There are a good number of cleaning staff and they are very pleasant in manner and have a good laugh with Mum.” The domestic staff have National Vocational Qualifications (NVQ) in housekeeping. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 20 Aids and adaptations were in place to help the residents’ mobility, personal toilet and bathing needs. There is an ongoing refurbishment programme to ensure the building is maintained to a good standard. One section of the home was being repainted at the start of the visit, the corridor and bedrooms were being redecorated and refurbished where needed. Bedrooms were well personalised and those residents spoken to said that they were happy with their bedroom. Residents are encouraged to bring in their own items of furniture and or pictures and ornaments to make their bedroom more homelike. One resident said how nice it was still to have some of her own things about her. There is a large open plan garden area around the house, which allows residents to stroll around the grounds or sit with staff supervision in the warm weather. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are well trained, skilled and in sufficient numbers to meet the changing needs of the residents but the procedures for the recruitment and selection of staff do not provide safeguards in all areas to protect people living in the home. EVIDENCE: Most residents who returned the comment cards and those spoken to said staff were very good. One resident said “All staff members are very nice and meet all my needs”. A relative said, “Mum says that she finds the staff to be very caring”. Other comments were “Staff could not do any more” and “No-one could ask for more. A small number of residents commented that a few staff do not always listen and act on what they say. One resident said that some staff are inclined to ignore the residents preferences and sometimes do things for speed. Most residents said that staff answered promptly when they called but a small number said that it can take some time for staff to answer calls. Some residents and relatives said more staff were needed. This was usually in order to support residents in independence and mobility and to increase leisure activities and time for staff to chat to residents. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 22 There were sufficient numbers of nursing, care and ancillary staff on duty during this unannounced inspection. Staff rotas were studied. The rota showed satisfactory numbers of staff on duty and sufficient staff were on duty during the visits. Staff spoken to felt that there were enough staff to support residents. Several residents expressed concerns over the high turnover of staff and said that this could cause problems with communication and relationships, as there is little time to form any rapport. Although there have been over thirty staff leave the homes employment since the last inspection, staff turnover may seem higher to residents and relatives as there are fifty nine staff in total– a large staff team. As staff work throughout the home some staff, particularly part time staff may seem unfamiliar to some residents and families. Senior staff should look at how to reduce this concern. The home regularly uses agency staff but attempts to use the same people if this is possible. The records of five recently employed members of staff were checked. All staff had application forms and interviews notes including checks on any gaps in employment were in place. Pova certificates were in place and CRB certificates had been sent for or received for all staff as per the care home regulations. However three of the five staff had only one reference in place and although the two other staff had two references, they had started working in the home before both references were received. This is unsafe practice and reduces the effectiveness of the recruitment and selection process and the safeguards that protect people living in the home. The religious beliefs and lifestyles of staff are respected and supported, staff feel that this makes the home a pleasant and effective workplace. The home is working with the ‘Overseas Nurses Programme’ and two overseas nurses have been working as care staff while working through the programme. They have recently completed the programme and are awaiting registration with the Nursing and Midwifery Council (NMC). 54 of care staff have completed National Vocational Qualifications (NVQ) The home also employs seven care staff who were nurses in other countries. Good training improves staff skills and knowledge and enables staff to provide up to date care practices in the home. Staff also receive other training such as moving and handling, safeguarding adults and food handling on a regular basis. One resident said, “Staff are mostly good and seem to be well trained and managed”. Staff spoken to commented how refreshing it was to be offered so many opportunities to increase their knowledge and skills. They said that it was good that even if they had completed training such as moving and handling elsewhere, they were not able to move residents until they had received a refresher course in the home, and senior staff were sure that they had the skills to move residents safely. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is providing clear direction and effective management in the home. Good quality assurance systems and most areas of health and safety support and protect residents and staff. EVIDENCE: The manager, Mrs Sheena Cook who is a registered nurse, has many years experience as a manager caring for older people and has worked in the home since it opened in 1989. Mrs Cook has not completed the Registered Managers Award (RMA). However her deputy has completed this. Mrs Cook frequently updates her skills and knowledge through training courses. She then passes on this knowledge to improve and update care practices in the home. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 24 The manager is providing clear leadership and focus in the home. She is enthusiastic and knowledgeable about supporting older people and this is passed onto the staff. Discussions with the manager indicated a positive approach to the management of the home. The home is well managed and residents, relatives and staff say they feel well supported. One resident said, “She [the manager] comes to see all of us every day just to see how we are”. A relative said, “Senior staff are very helpful and supportive to the family.” Another relative said, “They are always available to speak to”. All staff spoken to said how supportive senior staff were and in particular how approachable and caring the manager was. One member of staff said “You can go and see her anytime about anything and she will help if she can”. Another said. “If you have a problem or need some advice she will always give you time to talk.” Systems are in place for quality assurance. The home has received the Investors in People award which is valid until 2009. This is an external award which recognises the owners commitment to staff training and development. There are regular staff meetings and the views of residents and their relatives are regularly sought informally and through written surveys Staff training and good care practice were observed in the home and these protect the health and welfare of residents, relatives and staff. One member of staff said “Information is always put on the notice board and you can ask to go on a course or the manager will suggest courses”. Another member of staff added, “There are some courses you have to go on, everybody has to.” These include Moving and Handling, Food Hygiene and Health and Safety courses designed to keep residents safe. The home did not have a written fire risk assessment on the first visit and this omission reduced the protection of residents, relatives and staff. By the second day of the visit a fire risk assessment had been compiled. Senior staff should liaise with the Lancashire Fire and Rescue Service regarding the adequacy of the assessment to ensure the safety of residents. There are regular fire safety checks; regular training for residents and staff, and all staff are knowledgeable about what to do in the event of a fire. There is a flexible rolling programme of maintenance to ensure repairs and redecoration are carried out as needed. To ensure residents live in a pleasant and safe environment. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5A Requirement The Responsible Person must ensure that all residents receive a contract before or on the day of admission to the home in order for them to have full details of their terms of occupancy in the home. The Responsible Person must ensure that all staff have two references before they commence employment. This will ensure the safety and protection of residents from people who should not work with vulnerable adults. Timescale for action 05/02/07 2 OP29 19 05/02/07 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 Refer to Standard OP1 Good Practice Recommendations The Responsible Person should update the information in the service user guide, to provide the information needed for residents and their relatives to choose a home. DS0000006042.V320305.R01.S.doc Version 5.2 Page 27 Farthings Nursing Home 2 3 4 5 OP12 OP12 OP16 OP38 The Responsible Person should improve the choice of and frequency of social and leisure activities to give residents options of how to spend their time in the home. The Responsible Person should consider a more flexible timing for breakfast to enable residents to rise later in the morning if they wish. The Responsible Person should contact residents and relatives regarding the complaints procedure so that everyone knows how to complain if they need to. The Responsible Person should liaise with the Lancashire Fire and Rescue Service regarding the adequacy of the fire assessment. Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Farthings Nursing Home DS0000006042.V320305.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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