Inspection on 12/11/07 for Farthings Nursing Home

This inspection was carried out on 12th November 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 10/01/07

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 12th November 2007 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 Farthings Nursing Home DS0000006042.V350239.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.V350239.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.V350239.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. 10th January 2007 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 £600 per week, with added expenses for hairdressing, chiropody, toiletries, transport and newspapers. Farthings Nursing Home DS0000006042.V350239.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 eight hours. Prior to the visit the Manager completed an annual quality assurance assessment. This is a document that provides CSCI with written information and an assessment about the quality of the service the home provides. The registered person is asked to provide us with this each year. This information, in part, has been used to focus our inspection activity and is included in this report. There was an expert by experience on this key inspection. This is someone who is or has been a user of care services or a carer. The expert by experience visits the home mainly to talk to residents about their view of the home including the routines of daily life and activities available, meals on offer and the care and support they receive in the home. They also spend time looking around the building to consider the suitability of the environment. The expert by experience’s comments are incorporated into this report. Comments cards were received from fifteen residents, four relatives, ten staff and one GP. The owner, administrator, deputy Manager and three staff were spoken with. The inspection involved case tracking five residents as a means of assessing some of the National Minimum Standards. This process allows the inspector to focus on a small group of people living at the home. All records relating to this group of 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 other people living at the home are not excluded and are also invited to chat. The inspector spoke to four residents individually and several residents who were sitting in the communal areas were also spoken with. 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 and the report produced from this. 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 Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 6 who understand the needs of the people living there. A resident remarked, “The staff are the best, really good. I really wanted to come here, I love it, everything about it”. A relative said “They do their best to make everyone’s life happy and comfortable”. There is a detailed admission process with an informative assessment. Where possible, prospective residents and their relatives visit the home so they can learn about the home and meet some residents and staff before moving in. One resident said, “My family came to look around as I was in hospital and they were very impressed with the home.” Another resident said that she was in hospital adding, “My family visited several homes before choosing The Farthings.” Each resident has a plan of care and detailed records that guide staff in their care of residents. It is regularly checked to make sure that it still meets their needs. Residents’ health needs are met and residents’ get the services and care they need. Residents’ relatives and friends are welcomed into the home enabling residents’ to maintain relationships. They are encouraged to give their views on the home so that the needs of the residents are met. Residents’ religious beliefs and observances are taken into account ensuring that their spiritual needs are met. Mealtimes are flexible and relaxed. The main meal is at lunchtime. Several residents said they enjoyed the meals. One resident said, “The quality of food has improved”. Another resident commented, “The food is excellent”, and another remarked, “I enjoy the meals, we have a choice.” Medication procedures and administration are well managed ensuring that residents receive their medication as prescribed. Most areas of staff recruitment are good protecting residents from people who should not work with them. Staff training is good. Over half of the care staff have qualifications in care and there are frequent opportunities for other training to help staff to support residents. Staff feel that the training helps them to give good care to residents. The manager and owners regularly check that the quality of care is satisfactory meeting with, or writing to residents, relatives and staff and to ask their views of the service. 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 that senior staff are helpful and caring Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The Farthings prohibits smoking except in exceptional circumstances. It would be helpful to prospective residents and their families if this was made clear in the service user guide, as this is given to them when they express an interest in the home. This allows them to make an early nformed choice about choosing a non smoking or smoking home. Residents and/or relatives are not generally involved in care plan reviews and should be. This enables them to state their preferences in the way they are supported. There needs to be detailed information about managing challenging behaviour in one of the care plans so that all staff know how to deal with this effectively and consistently. There has already been some improvement in leisure activities but some residents would like more frequent and varied activities. In particular activities that take little physical effort but allow frailer residents to be involved. A resident said, “Sometimes we have some activities but it varies”. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 8 It would be helpful if residents were given an option of Breakfast times to allow residents the choice of getting up early or later in the morning. The manager should look at ways of reducing the waiting time before meals and at ways of ensuring a small number of people do not sometimes receive part of their meal cold in order to improve the experience at mealtimes. The record of complaints information should always be available for inspection to allow the inspector to look at how complaints are managed. It would be helpful if the manager put discussions and agreements with complainants in writing to ensure that everyone is clear about the outcome of concerns. The manager needs to have a detailed work history for all job applicants. This reduces the risk of employing anyone who should not work with vulnerable adults. 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.V350239.R01.S.doc Version 5.2 Page 9 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.V350239.R01.S.doc Version 5.2 Page 10 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 of the information needed to choose a home, which will meet their needs. EVIDENCE: The home has a detailed admission policy covering all the necessary information. The manager and owner and manager told us before and during the visit that the home provides prospective residents and their relatives with a copy of the Service User Guide, which gives them the information they need to make a choice of home. The Guide contains the terms and conditions of living in the home and includes information on the latest inspection report and where inspection reports are kept in the home. This gives residents information about the routines and practices and other necessary information about the home. The guide needs some minor updating. The Farthings prohibits smoking except in exceptional circumstances. This is recorded on the contract but not in the Service User guide. It would be helpful Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 11 to prospective residents and their families if this was made clear in the service user guide, as this is given to them when they express an interest in the home and the contract not given until later. This allows them to make an early nformed choice about choosing a non smoking or smoking home. Prospective residents are encouraged to visit the home before admission. This can be in the form of a short visit or a stay of several hours. Residents spoken to said they or their relative if they were too ill to visit, were told all about the home to help them to decide if they wanted to move there. One resident said, “My family came to look around as I was in hospital and they were very impressed with the home.” Another resident said that she was in hospital adding, “My family visited several homes before choosing The Farthings.” The records of five residents were examined. All the records contained an assessment of needs which had been carried out one by the senior staff in the home and where funded by health or social services prior to admission. All residents have a written contract so that they have information about their terms and conditions of residency. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. 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 are met. EVIDENCE: The records of five residents were looked at and these clearly described their healthcare needs. Each resident has a plan of care (care plan), risk assessments and a brief personal history which includes likes and dislikes. This sets out the care needed to ensure all aspects of health, personal and care needs are met. 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. The care plans are generally quite clinical and health orientated. However most residents’ health is poor and a priority in their care. Care plans are reviewed regularly. However residents and/or relatives are not generally involved in care plan reviews and should be. This enables them to state their preferences in the way they are supported. Residents or their relatives should sign the review to say they have been involved in the care plan review or that Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 13 they choose not to be involved in care planning. Daily records are kept to provide a current and detailed picture of residents care and support needs. Of the care plans sampled, most were satisfactory. However one resident had challenging behaviour but there was only brief mention of this in the resident’s care plan and there was no management strategy to support staff. There needs to be a detailed strategy so that all staff know how to deal with this behaviour effectively and consistently. Residents dietary, cultural and religious needs are met and residents have the aids and appliances that they need as part of their care. A member of staff advised that, “A full report is given at handover and any changes in care or new medication that has been prescribed.” Another commented, “We are able to discuss the care of the service users during reports and with nursing staff.” Staff members are aware of the healthcare and personal needs of residents and to a lesser extent their social and leisure needs and their likes and dislikes. This ensures that their health care needs are met. Social and leisure activities have started to improve since the last key inspection. The GP who returned the comment cards said that staff demonstrated a clear understanding of the care needs of service users. Residents said through the comment cards that the health care services they use meet their needs. One relative remarked, “ They will ring me if there is any change in my mother’s health. All the staff are very caring and monitor everything well.” A small number of residents felt that staff can be very busy and they may have to wait some time for assistance. Residents and relatives feel that the home looks after the residents health well. A resident said through the comment cards, “The staff have been very good to me and I feel at home here.” Another added “ I mainly like to do things for myself but help is always at hand if I need it. A relative said, “Everyone seems to be very well looked after.” Whilst another relative commented, “I am happy with the existing level of care.” Most residents and relatives say staff listen and act on what they say but one resident commented, “I don’t think some staff listen to what I say or can’t understand me”. The practices in the home ensure that residents are treated with respect and their right to privacy is upheld. Staff were seen to knock on the bedroom door before entering any bedroom”. The GP who returned the comment card said that the staff in the home respect residents’ dignity well. One relative said “They do their best to make everyone’s life happy and comfortable”. Another relative remarked, “Staff do their best to care for the residents as individuals, not just as a number. Emotional welfare is important and the staff/resident relationships are very good.” Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 14 The home serves special diets as required. Including vegetarian, diabetic diets and blended food to make sure all residents have a good diet. Medication administration was checked. This was safely stored, administered, recorded and disposed of. The manager and deputy carry out detailed audits regularly. No residents administer their own prescribed medication. However several residents administer herbal medication and vitamins themselves once staff have checked with their GP that they do not interact with their prescribed medicine and a risk assessment for self administering has been carried out. The GP who returned the comment card is satisfied with the medication administration and 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,“I am happy with the existing level of care”. Another relative said, “Very good care has been given to my mother.” Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a healthy varied diet and spiritual, cultural, social and leisure activities meet resident’s expectations, needs and choices. EVIDENCE: Staff were observed throughout the visit. Staff interactions with residents were, caring and supportive and residents said that they were well looked after. One resident commented, “It’s like home from home.” Another said, “I am very happy here. They will have to carry me out of here, that is the only way I will leave.” Residents cultural and religious needs are met. Current residents are all nominally Christian, or have no religious beliefs and there are frequent visits to the home from local vicar’s, priests and ministers. 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. Staff at the home have demonstrated over time that they can meet the religious practices of residents from different faiths. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 16 Staff said that they are encouraged to discuss appropriate ways of meeting residents diverse needs as well as dignity and privacy issues. During the visit the staff were very attentive with the residents and treated them with dignity. There are now more activities than at the previous key inspection. A care staff now takes the lead on organising activities and they have become more frequent. However they would still benefit from further developing as some residents would like more regular activities. There are some indoor leisure activities in place such as arts and crafts, bingo sessions, card and board games and watching videos. Some residents listen to talking books. Entertainers come to the home every few weeks. Staff sometimes dress up for themed evenings, including a recent Halloween night talked about by many residents. There is a hairdresser, who visits the home four times each week, Recently some residents have been making Christmas cards, which they said they enjoyed. There are also occasional trips out for meals; several residents mentioned how much they enjoyed a recent meal out. Residents said that they could do with more outings. One resident said, “Sometimes we have some activities but it varies”. Some residents choose not to get involved in activities. One resident said, “There are activities on offer but I don’t like to take part.” Another resident explained, “Health reasons prevent any greater participation in activities”. The member of staff now taking the lead in activities could maybe look for activities that take little physical effort but allow frailer residents to be involved. Residents spend their time in their rooms or the lounges as they wish. A number of client do not come out of their rooms either for meals or to socialise with the other residents in the home. Staff encourage them to meet with others but respect their right to remain alone if they wish. The service user guide states that all resident’s alcohol is stored in the medical room by staff but senior staff said that this is not the case in practice. Residents can hold their own alcoholic drinks in their room 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 or not as they wish. 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. There are always female staff on duty. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 17 There is one full time and one part time chef in post to prepare and cook the meals. They serve special diets as required including vegetarian, diabetic diets and blended food. 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. Most residents said meals were always or usually good. A resident said through the comment cards, “Every effort is made by chef to provide suitably blended meals. Personal requests are acted upon where possible. One resident said, “The quality of food has improved”. Another resident commented, “The food is excellent”, and another remarked, “I enjoy the meals, we have a choice.” Although another resident said that she did not like the food. I usually enjoy the meals the food is usually good though it is corn beef hash tonight. I don’t like it. I can have something else if I want. Breakfast includes a cooked meal. All residents have breakfast in their bedroom. This is a cooked breakfast. The times of breakfast are not generally flexible but this is now recorded in the Service users Guide and residents and relatives may be able to negotiate times if they ask. Residents or their relatives are also told of breakfast times when they visit the home. Breakfast is between 8am – 8:30am, and residents spoken to said they could have what they wanted including a cooked meal. Breakfast at this time may be very early for some people and means that all residents have to be awake each day very early. The residents have their main meal at lunch time. The evening meal is a lighter meal. The expert by experience had lunch with the residents in the dining room. Staff were starting to be put into the dining room at 11.35am and had then to wait for their lunch, which was after 12.00. This is a long time to wait to receive their meal. The manager should look at ways of reducing the waiting time before meals. The tables were pleasantly decorated with tablecloths and serviettes with matching crockery and cutlery. Lunch was soup, chicken pie (both home made) and fresh vegetables and a choice of sweets. The meal was generally well received although some residents said that the potatoes were cold when they got their meal. Senior staff agreed to look at how meals are distributed. During the meal the staff were very attentive to the clients needs and assisted those who could not feed themselves. One resident takes a long time over her meal. The manager should look at ways of keeping this warm; as it is often cold by the time she has finished it. The Radio in the dining room was initially on quite loud and was playing inappropriate music for the age group of the clients. It was turned down and a more age appropriate CD was then put on. Staff were generally attentive but attention to the issues highlighted above would improve mealtimes. Lunch appeared unhurried and relaxed and most residents spoken to said that they Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 18 had enjoyed it. Residents can have meals in their bedrooms or the dining room as they wish and drinks are provided to all residents several times a day. Relatives/friends said through the comment cards that the home helps their friend or relative keep in touch with them. Relatives are encouraged to visit regularly and always receive a warm welcome. 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 does not get involved in this. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 the service. The arrangements in place for handling complaints and safeguarding adults ensure that people feel confident that their complaints will be listened to and acted upon and they are adequately protected . EVIDENCE: There had been one minor complaint received by the home since the last visit but the complaints book was locked away and unavailable on the visit. Complaints information should always be available on inspection and should be accesible to staff to use if needed. There has been one complaint sent to CSCI regarding care practices. This was sent to provider to investigate. The complaint was discussed with complainant and the way forward agreed. There were some typed notes available but the home had not sent a letter confirming discussion and agreements to the complainant and this would have been helpful. This then enables both parties to be clear about the issues and resolutions to the problem. Senior staff have reminded all residents and relatives of the complaints procedure and who to contact if they are not happy about something in the home. There is also a copy of the procedure in the hall. All residents and relatives spoken to or who returned the comment cards said they were very satisfied that they knew how to complain and were comfortable approaching senior staff if they had any concerns. There were many positive comments Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 20 from residents and their relatives about feeling free to express any concerns. These included a relative who said, “ No cause for complaint” and a resident who commented, “I would talk to the trained staff or Matron if I had a problem but I have never had to make a complaint.” 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 on Induction training also in house training and many staff on National Vocational Qualifications (NVQ) training. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 & 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: There are several lounges and some small lounge diners as well as a large bright dining room. There was a smell of urine in the entrance hall. This needs attention, as it is unpleasant for service users living in the home and is the visitors’ first impression of the home. 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. Aids and adaptations are in place to help the residents’ mobility, personal toilet and bathing needs. These include grabrails and mobility aids and an upright lift Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 22 transports residents from one floor to the other. A member of staff remarked, “We have all the right equipment to make life easier on the residents and staff.” There is an ongoing refurbishment programme to ensure the building is maintained to a good standard. 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. The owners have bought some new electronically adjustable beds to assist with mobility. New wardrobes and bedroom equipment are being purchased; the owners will gradually work around all bedrooms. There is a large open plan garden area around the house, which allows residents to stroll around the grounds or enjoy the garden with staff support in the warm weather. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures, sufficient staff numbers and training ensure the wellbeing and safety of residents. EVIDENCE: Most residents spoken to said staff were very caring. One resident remarked, “The staff are the best, really good. I really wanted to come here, I love it, everything about it”. Another resident said, “The staff are very good, some are better than others but they are all kind”. 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. Extra staff are put on a shift if someone needs additional care, particularly when someone is at the end of life so that they have someone with them. Some residents and relatives said more staff are needed. One resident said through the comment card, “ I would like more staff.” Another resident remarked, “ I have to wait sometimes when I ring for help, I would like staff to come more quickly when we ring as we can’t always wait for help.” Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 24 Staff turnover has reduced and there is a more regular staff teaming working closely together. There allows more chance of staff and residents developing a rapport. The home now rarely uses agency staff but attempts to use the same people if cover is needed. This assists residents to feel secure with familiar staff. The records of three recently employed members of staff were checked. All staff had application forms and interviews notes were in place. POVA certificates and CRB certificates were in place and staff had not commenced work before the POVA confirmation was received. . However one member of staff did not have a full working history and needed one. Only the year of any change of employment was recorded. Gaps in employment cannot be checked adequately without the month of any employment changes. This reduces the effectiveness of the recruitment and selection process and the safeguards that protect people living in the home. There is an induction checklist in place to ensure staff have a basic knowledge of the residents, the home and their role in the home. One member of staff said, “I was given a full induction before commencing the job.” Another added, “My first shifts were supernumerary, working with another registered nurse to cover all aspects of the role.” Staff are encouraged to complete NVQ training. This is a national, practical and theoretical qualification in care. The home has achieved 58 of care staff with a level 2 or above National Vocational Training (NVQ). This is above the 50 of staff required to have NVQ training. NVQ training assists staff in providing good quality care to residents. Staff spoken said that the manager provided a lot of training to improve their skills and the care of residents. Staff receive other training such as moving and handling, safeguarding adults and food handling. Staff who completed the comment cards were complimentary about the frequency and choice of training made available to them. One member of staff said 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. Another member of staff commented, “Staff are encouraged to take new courses when available, or are shown by staff who have such training.” With another adding, “We are encouraged to go on courses to help us improve and learn new ways of working.” The home is working with the ‘Overseas Nurses Programme’ and two overseas nurses have been working as care staff while working through the programme. Four nurses have already completed the programme and have now gained employment as nurses elsewhere. Other overseas nurses who are not on the programme are working as care staff in the home and these staff bring their previous skills and experience to their care role. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 25 Residents, relatives and friends said through the comment cards that care staff have the right skills and experience to look after people properly. A resident commented, “The staff are super, they really look after you.” Another added, “They are good staff – very kind”. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is effectively managed, with quality assurance systems that support and protect residents and staff and enable residents, relatives and staff have a voice. 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. She has not completed the Registered Managers Award (RMA). However her deputy has completed this. The manager is providing clear leadership and focus in the home. She is enthusiastic and knowledgeable about nursing older people and this interest and knowledge of current practice is transmitted to others working in the Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 27 home. The home is well managed and residents, relatives and staff say they feel well supported. One relative said, “The home is well run and we are impressed with the staff.” The registered manager and deputy manager ensure that they chat every day to every resident. This enables them to monitor their health and care needs and to check that they are satisfied with the service. They also chat regularly to relatives. Residents, relatives and staff spoken to said senior staff are willing to listen if they have any concerns. One member of staff said, ”We always have the right support from Matron and she makes herself available for any concern the service users or staff may have.” Systems are in place for quality assurance. The home has received the Investors in People award which is valid until 2009. There are regular staff meetings and the views of residents and their relatives are regularly sought informally and through written surveys. She also carries out regular unannounced monitoring visits to observe care practice. The residents themselves or relatives of most residents at the home handle their financial affairs. The home rarely gets involved in this. Supervision is provided on a regular basis. Regular formal supervision allows the manager and member of staff to look in detail at their work practice, skills, areas for development and future training. This enables them to look at aspects of their and the homes care practice and improves residents care. The home sends out questionnaires, and has meetings with residents and relatives to find out their views and discusses staff views through supervision. This improves the understanding between residents and their family, staff and the home. Staff training and good care practice were observed in the home and these protect the health and welfare of residents, relatives and staff. The home has a written fire risk assessment agreed with the fire service. The chef has recently attended training on health and safety in the kitchen from the Food Standards Agency. He will be using this in the home very soon. There is a rolling maintenance programme in place and repairs and redecoration are carried out as needed. Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 29 No 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 OP29 Regulation 19 Requirement The manager needs to have a record of the month and year of any changes of employment of prospective members of staff so that there is a complete working history reducing the risk of employing anyone who should not work with vulnerable adults. Timescale for action 17/12/07 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 2 3 Refer to Standard OP1 OP7 OP7 Good Practice Recommendations The manager should include in the service users guide that the home is a no smoking home so that people have the information to make an informed choice about the home. Residents and/or relatives should be involved in care plan reviews. This enables them to state their preferences in the way they are supported. There should be detailed information on how to manage a resident’s challenging behaviour so that all staff know how to deal with this effectively and consistently. DS0000006042.V350239.R01.S.doc Version 5.2 Page 30 Farthings Nursing Home 4. 5 OP12 OP12 The manager should continue to extend the leisure activities. In particular activities that take little physical effort but allow frailer residents to be involved The manager should look at a more flexible timing for breakfast, reducing the waiting time before meals and improving the speed of service in order to improve the experience at mealtimes. The record of complaints information should always be available for inspection to allow the inspector to look at how complaints are managed. The manager should put discussions and agreements with complainants in writing to ensure that everyone is clear about the outcome. The unpleasant smell of urine in the entrance hall needs attention as it is unpleasant for service users living in the home and is the visitors’ first impression of the home. 6 OP16 7 OP16 8 OP26 Farthings Nursing Home DS0000006042.V350239.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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. 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