CARE HOMES FOR OLDER PEOPLE
The Farthings Nursing Home Wilson Square Little Bispham Blackpool FY5 1RF Lead Inspector
Janet Spink Announced 1 and 2 August 2005 9:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Farthings Nursing Home Address Wilson Square Little Bispham Blackpool FY5 1RF 01253 864309 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Westlive Limited Mrs Sheena Cook CRHN Care Home with Nursing 64 Category(ies) of OP Old Age 58 registration, with number PD Physical Disability 3 of places TI Terminally Ill 3 The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 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 and/or terminal illness. The total number of persons accommodated in the hme at any one time shall not exceed 64. Date of last inspection 24 February 2005 Brief Description of the Service: The Farthings Nursing Home is registered to accommodate 64 older pople for nursing and personal care. It is a large purpose built building that provides a 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. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and was conducted over a period of eight and a half hours over two days. The inspection involved case tracking four patients, discussions with nine patients, a domestic, a relative, the manager and deputy manager. Care staff were not spoken to on this occasion as this will be done on the unannounced visit. Comment cards were received from twelve relatives and ten patients. One relative remarked, “I am always kept up to date with every aspect of my mother’s care. I find it very reassuring.” What the service does well: What has improved since the last inspection? What they could do better:
Some comment cards from patients remarked that activities are offered “sometimes”. The manager explained that organised activities have declined recently due to the high number of frail patients in the home. It was agreed to review this. An additional cook should be employed to ensure that patients are receiving freshly prepared food in the evening.
The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 6 The home has benefited from some decoration and re-carpeting in some areas. This could be further enhanced for patients by upgrading the bedroom furniture including wardrobes, drawers and adjustable beds. The complaints procedure should be more accessible as some patients and relatives were not of aware of this. NVQ (National Vocational Qualification) level II in care should be achieved by 50 of all care staff. This is a recognised course for carers and will ensure that staff are aware of good care practices. The registered manager should consider how she is to achieve a relevant management qualification. This will ensure she then meets the minimum standards and keeps up to date with training. 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 Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All new patients have a full care needs assessment carried out before moving into the establishment ensuring that the home can meet their needs. EVIDENCE: Four patient files were examined and all provided evidence that an assessment is carried out prior to admission. This is carried out by a qualified nurse who visits the patient at their own home or in hospital. This complements the assessment undertaken by a social worker which was also seen to be on files. Assessments were seen to include details such as dietary need, mobility, personal care needs and medication. This forms the basis of the care plan. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The home ensures that patient’s health and personal care is closely monitored and reviewed so that individual needs are met by the staff team. EVIDENCE: The inspector viewed care plans for four people who had different dependency needs and one of these people was receiving treatment for pressure care. All four care plans were informative giving clear directions for staff in relation to bathing, moving and handling and level of personal assistance required. Observation confirmed that patients are assisted with personal care in a sensitive and dignified manner. The care plans, daily notes and treatment charts for the patient who had pressure sores were examined by the inspector. The patient herself was not able to provide information due to her frailty. All records confirmed that the appropriate treatment is given in relation to the care of the pressure areas. The inspector also observed that pressure relief mattresses are provided. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 10 The home was able to provide evidence that there is good communication between themselves and the incontinence advisor. One patient explained to the inspector that, “I was a wreck when I came in here. I used to have to use pads, but now I get myself to the toilet.” They also confirmed that a barber and chiropodist visit the home regularly. The home was found to be meeting the health needs of the service users. The pharmacist inspector was present during the inspection and has submitted a separate letter to the home about his findings. It was confirmed during the inspection however, that there were no concerns regarding medication practices in the home. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Relatives are welcome in the home at any time and are treated respectfully. Residents are encouraged to make some choices about living in the home. EVIDENCE: Routines in the home are generally flexible and patients informed the inspector that they are free to go to bed when they choose and can have meals in their bedrooms if they wish. This was observed during the inspection. One lady commented that she was taken down to the dining room very early before a meal and has a long wait before the meal is served. This was discussed with the manager and deputy who agreed to review the system for the patient’s convenience. Comment cards from patients had remarked that activities were offered “sometimes.” This has declined recently due to the high number of frail patients in the home. The manager agreed to review this. There is a trip arranged for a day in the near future for a pub lunch, and the home provides books, videos, talking books and some games for patients use. All patients spoken to felt that meals are of good quality and quantity. One patient referred to meals as “lavish”. A choice is offered, and the menu showed that a varied and nutritious diet is offered.
The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 12 The inspector spoke to the cook who confirmed that he is not restricted to a small budget but can order food at his discretion from local, fresh providers. He had sound knowledge of the people who have special diets or allergies. It was noted, however that the cook only works up until dinner time on most days so that a light tea is prepared prior to him leaving. It was confirmed that the cook’s hours are approximately forty each week, which is below the previous guidance of fifty six for a home of this size. From discussions with the manager and the cook the inspector was of the opinion that another person should be employed to ensure that the evening meal is freshly prepared by an appropriately trained cook. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The complaints procedure is in place, however this needs to be brought to the attention of patients and relatives more pro actively. EVIDENCE: The inspector received twelve comment cards from relatives. The majority of the remarks were positive about the home, however a number made comment that they were not aware of the complaints procedure. The registered provider and manager agreed to review this so that patients’ views and opinions are encouraged. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is clean and provides a comfortable environment for the patients accommodated. The maintenance plan should address upgrading of bedroom furniture as this will enhance the home for service users. EVIDENCE: A formal assessment of the building was not undertaken, however it was noted that some bedroom furniture is starting to look worn and in need of replacement. The home has started to replace the beds with adjustable ones that are more fit for nursing purposes. This should continue to be addressed to ensure that staff and service users have suitable equipment to ensure their safety. The home was found to clean and airy. There were no unpleasant odours despite a high number of people being incontinent. The inspector spoke to a member of the domestic staff who explained her daily, weekly and monthly duties. The inspector was informed that the domestic duties are carried out in a manner that does not disrupt the routine of the patients. National Vocational Qualification (NVQ) training has been completed by all the domestic staff.
The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Staffing levels are appropriate to the needs of the people accommodated, and training is provided to ensure staff are assisting patients in a safe manner. EVIDENCE: The staff rota was examined, and this provided evidence that sufficient staff are deployed in the home. Patients spoken to confirmed that staff have time to talk to them although they are busy, and one said “I don’t often ring the bell, but when I do there’s always someone willing to help me.” Another patient who requires two people to assist them to transfer from his wheel chair to his bed confirmed that this was never carried out by less than the required two staff, and with the use of a hoist. Recruitment and selection documentation was viewed for two new members of care staff. This confirmed that the manager carries this out in a professional manner ensuring that all necessary checks are undertaken prior to appointing someone. Induction and training records were viewed for two members of staff. These showed that regular training is provided in numerous relevant areas including fire safety, abuse of the elderly, moving and handling, infection control and promoting continence. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 16 The home has accessed local training facilities to provide NVQ training to care staff. At the time of the inspection seven care staff had completed NVQ level II in care, five are currently undertaking this award and ten are enrolling in August to commence this. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 32 The home is well managed and run in the best interests of the patients. There is good leadership, guidance and direction to ensure that patients receive consistent care. EVIDENCE: The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 18 The registered manager is a State Registered Nurse who has managed the home for sixteen years. She was able to demonstrate to the inspector that she has a good knowledge of age related disorders and attended courses to update her skills. The manager is aware that a qualification in management to NVQ level 4 is required for registered managers. The inspector was informed that the deputy manager has recently successfully completed the required qualification of the registered manager’s award. All patients spoken to commented that the manager is competent and were confident in her abilities to manage the home. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 2 3 x x x x x x The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 20 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 12 15 16 19 28 31 Good Practice Recommendations A programme of activities should be developed to ensure that activities are offered on a more regular basis. An additional person should be employed to ensure that patients are receiving freshly prepared meals at all times. Consideration should be given to ensure that all patients are aware of the complaints procedure. The maintenance plan should address the refurbishment of bedroom furniture including adjustable beds. 50 of care staff should achieve NVQ level II in care. The registered manager should consider options in relation to obtaining the relevant mangers qualification. The Farthings Nursing Home F57 F09 S6042 Farthings V184555 010805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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