Inspection on 14/08/06 for Farway Grange

This inspection was carried out on 14th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Farway Grange 30/04/08

Farway Grange 02/07/07

Farway Grange 07/03/07

Farway Grange 23/02/06

Farway Grange 18/05/05

Farway Grange 13/12/04

Farway Grange 05/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Farway Grange 31-33 Howard Road Queens Park Bournemouth Dorset BH8 9EA Lead Inspector Carole Payne Key Unannounced Inspection 14th August 2006 09:00 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 DS0000020462.V301074.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. DS0000020462.V301074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farway Grange Address 31-33 Howard Road Queens Park Bournemouth Dorset BH8 9EA 01202 511399 NONE 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) Mr S Nathoo Mrs Freda Isabel Bonard Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (8), Physical disability of places over 65 years of age (26) DS0000020462.V301074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: Farway Grange is situated in the residential area of Queens Park within a short distance of the shopping centre, the seaside and other local amenities. There are bus routes nearby into Bournemouth centre, where there are good local and national transport links. Farway Grange consists of two converted older type houses numbers 31 and 33 Howard Road. Number 31 has two floors and number 33 has three floors. The two houses are linked at ground level. A passenger lift services number 33 but not number 31. Stairs reach the four bedrooms on the first floor of number 31. There are twenty-three bedrooms in total providing twenty-six places. The communal space consists of a lounge situated on the ground floor of number 33. Car parking is available to the front of the home or in the surrounding roads. Mr Nathoo, who is the Registered Provider, owns the home and there is a Registered Manager, Mrs Freda Bonnard, who deals with the daily running of the home. The home’s current fee range is £500 to £850. The manager said that rates are negotiable. The fee does not include hairdressing, chiropody, aromatherapy and transport. Farway Grange is registered as a care home providing nursing and personal care for up to twenty-six older people and also nursing and personal care for a maximum of eight younger adults within the twenty-six places. DS0000020462.V301074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 14th August 2006 and took a total of 10.5 hours, including time spent in planning the visit. The inspector, Carole Payne, was made to feel welcome in the home during the visit. The manager, Mrs Freda Bonard, was present throughout the inspection. This was a statutory inspection and was carried out to ensure that the residents who are living at Farway Grange are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were reviewed. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with eight people living at the home, four visitors and five staff members on duty. Eight resident survey forms, four General Practitioner (GP) comment cards and seven comment cards from relatives / visitors to the home were received prior to the inspection. Friends or family members had completed some resident survey forms on behalf of residents. Throughout the visit and following the inspection, the registered manager has demonstrated a commitment to address issues raised. What the service does well: Comments received from residents returning resident survey forms included: ‘The home is run very well and the staff are caring and attentive.’ A relative visiting the service said that they were ‘very happy’ with the care provided. A General Practitioner commented that Farway Grange is a ‘well run home.’ A thorough assessment of needs is carried out prior to residents moving into the home and people are assured that their needs will be met. Residents’ personal, social and healthcare needs are set out in detailed and personalised plans of care, which support staff members to provide care. Residents are treated with sensitive respect, protecting their privacy and dignity. The home takes steps to seek specialist healthcare support in order to ensure that residents’ specific and complex needs are met. Residents experience a varied quality of life, which reflects their interests and preferences. They are supported to maintain good contact and links with DS0000020462.V301074.R01.S.doc Version 5.2 Page 6 families, friends and the local community. Relatives and staff members, where appropriate, support residents to express choices, enabling them to enjoy control over their lives. A varied and nutritious diet is served to suit the needs and preferences of residents. Farway Grange has a complaint’s procedure in place, which enables people to feel confident that their complaints will be listened and responded to. People living at Farway Grange benefit from living in an environment, which is well maintained and at the time of the visit, kept them safe. The home is maintained to a good standard of cleanliness; residents live in pleasant and hygienic surroundings. Residents are supported and protected by the thorough recruitment policies and practices in the home. What has improved since the last inspection? Improvements have been made to some aspects of safely handling medicines. On each resident’s file seen there was a risk assessment regarding the person taking care of his, or her, own medication. The home has started to routinely audit medicines. The manager has also put in place a system for recording medicines received into the home. During this visit the trolley was safely secured. The home’s policy for the disposal of medications has been updated in accordance with guidance from the Royal Pharmaceutical Society. During this visit no medicines were found which were passed their expiry date. The manager has also taken into account guidance provided by the pharmacist inspector regarding what to include in care plans for residents with diabetes and in the event of an epileptic fit. From medicines seen staff members now ensure that medication is suitably labelled. However, there still remain serious shortfalls, which put residents at risk of harm. (See What the Home Could Do Better.) The home’s complaint’s procedure has been updated to include details of the Commission for Social Care Inspection. Since the last visit to the home a number of improvements have been made to the environment, enabling people to enjoy comfortable and supportive surroundings. For example twenty-one rooms of the twenty-five individual rooms are now fitted with a ceiling track hoist. The home has started using the Skills for Care (the National Training Organisation’s) common induction standards for new staff members starting work in the home. The home also has a planned programme of training ensuring that staff members are updated in key areas of working practice, placing residents in safe hands. DS0000020462.V301074.R01.S.doc Version 5.2 Page 7 The registered person has organised for an external trainer to come in and deliver updates in key areas of working practice. Good quality assurance systems are being developed, supporting the running of the home in the best interests of residents. What they could do better: It must be ensured that staff members have the specific skills to meet all the needs of residents who move into the home. This must include training in caring for residents who have a learning disability, who have entered the home due to their nursing needs. Training must also be provided in communication skills, focusing specifically on the needs of the residents currently accommodated. Although there have been some improvements regarding the safe handling of medications there remains some serious concerns putting residents at risk of harm. It must be ensured that staff members follow safe procedures administering medicines to one service user at a time; efficient records must be maintained including signing of the giving of medication at the time of administration; countersigning handwritten entries to the Medication Administration Records; clear audit trails for medicines and reviews of medicines with the General Practitioner as required. It is recommended in this report that the social care plans in place include individual interests as evidenced from the social histories, that the home has started to develop in consultation with people and their families. Effective recording of the course of complaints received will support the home’s open ethos to the receipt of complaints. The shortfalls in the adequacy of adult protection training do not promote the protection of residents from abuse. Risk assessments must be carried out regarding individual radiators and those, which, when switched on, present a high risk, must be fitted with a cover or suitable low surface device. Trained nurse staffing levels must be reviewed to ensure that at all times there are sufficient trained nurses to meet the complex nursing needs of residents’ accommodated. Six staff members are undertaking a National Vocational Qualification in Care at level 2 in addition to four of the twenty-three care staff members who currently have a National Vocational Qualification in Care (NVQ). The home is DS0000020462.V301074.R01.S.doc Version 5.2 Page 8 making progress to achieve the target of having at least 50 of staff with this qualification. Key areas of responsibility must be addressed to ensure that the home is safely managed. The registered manager must demonstrate that she possesses, or is working towards, a management qualification, which is equivalent to the Registered Manager’s Award. The registered manager must, at all times, carry out safe nursing practice with regard to the safe administration of medicines to people living in the home, setting an exemplary standard of safe conduct to other Registered nurses. Residents’ financial interests must be safeguarded. Residents’ monies must be kept in individual accounts in residents’ own names. The registered person must not use the account in connection with running the home. Two people must check and sign that they have verified money being paid into, and out of, residents’ monies held at the service. Care must be taken to ensure that, where appropriate, a medical practitioner, appropriately checks any resident sustaining an injury to the head, to ensure that any medical need is promptly identified and addressed. 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. DS0000020462.V301074.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 DS0000020462.V301074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A thorough assessment of needs is carried out prior to residents moving into the home. However, the home does not always ensure that staff members have all the specific skills to meet the needs of residents who do move into the home. EVIDENCE: Two pre-admission assessments were viewed for residents who had recently moved into the home. One resident had been admitted as an emergency and had previously lived at the service. The manager had completed an assessment on the day of admission, which was thorough, including all activities of daily living, needs and preferences, so that care provided was planned to meet individual needs. The other resident had moved from another county and the manager had been unable to visit the resident prior to moving in. Comprehensive details had been provided by the relevant county council, DS0000020462.V301074.R01.S.doc Version 5.2 Page 11 enabling the manager to make a decision as to whether the home was able to meet the person’s needs. Prompt assessments and care plans were drawn up following admission. All residents responding in survey forms said that they had received enough information about the home to decide that it was the right place for them and all had received contracts, which set out the terms and conditions of their residency. The manager confirmed that in normal circumstances she would visit the prospective resident prior to them moving into the home. During the inspection she liaised on the phone regarding inviting people to come and look around the home and assess the facilities and services that the home is able to offer. Recently the home admitted a resident with nursing needs. Care documentation viewed showed that these needs are not now the primary reason for residency. The home is, therefore, applying for a variation, as the category of care is not within the home’s current registration categories of people for whom care may be provided. The home is currently accommodating a number of residents with a learning disability. It is advised that staff members receive training in caring for people with a learning disability and communication, as a high number of residents have specific problems in relation to interacting and expressing what they would like to say. Another resident, who had recently moved into the home, had specific care needs. Staff members had not received training in this area of practice. The manager was keen to ensure that the training required is provided. DS0000020462.V301074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. This outcome relates specifically to unsafe practices in the handling of medication. Other aspects of this section had good outcomes for people living in the home. Residents’ personal, social and healthcare needs are set out in detailed, plans of care, which support the meeting of people’s needs and preferences. Residents’ healthcare needs are satisfactorily met. However, a continued failure to safely administer medications puts people at risk of harm. People living at Farway Grange are treated with care and respect, protecting their privacy and dignity. EVIDENCE: Care plans were viewed for four people living in the home. Detailed assessments, including the assessment of risk, inform care planning, supporting the delivery of care to meet people’s needs. This includes people’s personal, social and healthcare needs. Care plans set out when and how care DS0000020462.V301074.R01.S.doc Version 5.2 Page 13 is to be delivered. Plans seen included reference to involvement of the resident, or their representative, and all plans had been reviewed regularly, on a monthly basis, or according to changing needs. Relatives or visitors returning comment cards said that they were consulted about their family members’ / friends’ care if they are unable to make decisions for themselves. Clinical assessment tools are used to assess risk, for example in relation to pressure sores. Where a risk is identified a clear plan is drawn up, detailing how the risk is to be minimised, including the use of pressure relieving equipment, good skin care, nutrition and monitoring. From plans sampled residents have the appropriate equipment in place in their own rooms, to provide comfort and promote good skin integrity. People’s needs in relation to continence care are clearly assessed and recorded and good care practice is supported by clear care plans, which include the management of catheters. General Practitioners (GPs) returning comment cards said that if advice is given to the home this is incorporated into residents’ plans. The pre-inspection questionnaire submitted by the registered manager details external healthcare professionals involved with and visiting the home, including optical, dental and chiropody services. Records include references to the involvement of a physiotherapist, speech and language therapist, diabetic and multiple sclerosis specialist nurses, according to the specific needs of the person. Consultation with external professionals informs care planning, for example in relation to the management of diabetes and the care of a person who suffers seizures. Six people living in the home returning resident survey forms say that they always receive the medical support that they need; two people say that this is usually the case. GPs returning comment cards say that the home communicates clearly and works in partnership with them. The pharmacist inspector visited the home on 7th March 2006 and looked at measures in place for the safe handling of medication in the home. A requirement and recommendation made as a result of the visit were reviewed. On arrival at the home the manager was in the process of giving medicines to residents. It was noted that medication had been placed in more than one pot to give to more than one resident. The medications given were not signed for at the time of administration, in accordance with Nursing and Midwifery Council guidelines. Potting up of medicines in this way is an unacceptable and unsafe practice. There were no signatures for handwritten entries onto the Medication Administration Records (MAR) charts for two residents; it was therefore not DS0000020462.V301074.R01.S.doc Version 5.2 Page 14 possible to verify that the entries made were correct. Abbreviations are being used to write down the frequency of medication administration and are open to misinterpretation. From the care plans it was noted that one resident might receive medication covertly in a drink. There was no policy or safe procedure in place regarding this practice and written consideration of consent at the time of the inspection. However the home has taken prompt action and put an appropriate policy in place. There was no clear audit trail for three medicines sampled; amounts held did not correspond with those recorded and the Monitored Dosage System set days were not being followed for one resident. Medicines to be given regularly to one resident had not been given for two weeks, as the manager said that the person was experiencing some side effects, this had not been reviewed by the GP. The temperature of the drugs fridge had not been routinely monitored daily to ensure that medicines are stored at required temperatures. There were no signatures of staff members checking medicines leaving the home and being returned to the pharmacy. Although a number of improvements have been made since the last inspection serious shortfalls in the safe handling of medicines in the home put residents at risk of harm. On each resident’s file seen there was a risk assessment regarding the person taking care of his, or her, own medication. No residents were looking after their own medication at the time of the inspection. The home has started to routinely audit medicines, counting medicines in place and checking this against the MAR chart. The manager has also put in place a system for recording medicines received into the home. During the pharmacist inspector’s visit the drugs trolley had not been secured to the wall. During this visit the trolley was safely secured. The home’s policy for the disposal of medications has been updated in accordance with guidance from the Royal Pharmaceutical Society. During this visit no medicines were found which were passed their expiry date. The manager has also taken into account guidance provided by the pharmacist inspector regarding what to include in care plans for residents with diabetes and in the event of an epileptic fit. Medications, which were administered at lunchtime, were given appropriately and safely, in accordance with good practice guidelines. Eye drops with a limited life on opening had been dated on opening. Medications seen at the time of the visit had the label in place, which had been issued by the pharmacy. Throughout the visit staff members provided sensitive care and support. Staff members knocked on residents’ doors, consulted with residents and spoke to people with respect. From comment cards both GPs and relatives / visitors said that they are able to meet with people living in the home in private. A resident commented on a survey form that staff members are ‘full of care and support.’ During the visit the housekeeper was removing items from a DS0000020462.V301074.R01.S.doc Version 5.2 Page 15 resident’s room for ironing, as she was concerned that residents clothing be in a condition, which ‘you would wish to wear.’ DS0000020462.V301074.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents experience a varied quality of life, which reflects their interests and preferences. Good social histories will support the development of personal social care plans. People living at Farway Grange maintain good contact and links with families, friends and the local community. Both relatives and staff members assist residents to make choices, enabling them to achieve control over their lives. A varied and nutritious diet is served to suit the needs and preferences of residents. EVIDENCE: The home benefits from the contribution of three part time activities coordinators. It is recommended in this report that the social care plans are updated to include individual interests as identified in the social histories, that DS0000020462.V301074.R01.S.doc Version 5.2 Page 17 the home has started to complete in consultation with people and their families. An activities diary is kept up to date, detailing participation in events, outings and other activities arranged by the home. At the time of the visit the home was making plans for a fete. The home has two vehicles and photographs of outings are displayed in the reception area of the home. Some collage and craftwork completed by residents has been framed and brightens the communal areas. Movement to music and themed celebrations take place. The home endeavours to ensure that residents enjoy quality personal time, be it listening to a favourite audio disc, radio station or television channel. One resident said that they were watching their ‘favourite’ television programme. Four visitors to the home during the visit said that they always feel welcome in the home. One relative said that they were made to feel involved with events going on in the home; a fete is planned. Another relative said that they are confident in the care provided to their family member. Some of the home’s residents visit local day centres in the community and representatives of local churches visit the home. Pictures of outings reflect how much some of the home’s residents are able to enjoy the local community and its amenities. During the day residents were supported to make choices about where they would like to be and what they would like to do. One resident said that they did not like the dessert they had been given at lunchtime and was offered alternatives, from which they could make a choice. Although some residents experience communication difficulties, care had been taken to find out what their favourite radio channel is, and one person was listening to the World Service, another had headphones and a disc player to listen to in the lounge, without disturbing other residents. Residents are offered a main menu with a list of alternatives. The chef said that he caters for individual preferences and meets the needs of people requiring a specialist diet. All residents returning a survey form said that they always enjoy the meals at the home. DS0000020462.V301074.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Farway Grange has an effective complaint’s procedure in place, which enables people to feel confident that their complaints will be listened and responded to. Good record keeping does not fully support the open ethos to the receipt of complaints. Although staff awareness has been raised in relation to adult protection, shortfalls in the adequacy of training does not fully promote the protection of residents from abuse. EVIDENCE: The home has a complaints’ procedure, which is displayed in the home. The procedure has been updated to include details of the Commission for Social Care Inspection. A complaints log is used to collate letters and statements taken regarding complaints. It was advised that the home include details of the progress of complaints investigations and outcomes. Since the inspection the manager has submitted a record for documenting complaints received and outcomes. Seven people returning resident survey forms said that they knew who to speak to if they were not happy, one person said that this was usually the case. Five people said that they knew how to make a complaint, one said that DS0000020462.V301074.R01.S.doc Version 5.2 Page 19 this was usually the case, one sometimes. GPs returning comment cards said that they had received no complaints about the home. Reference to adult protection training is now referred to in induction records and is included as part of National Vocational Qualifications undertaken. Mrs Bonard said that she had had informal discussions with staff members to raise awareness of abuse. This was not documented. The deputy manager demonstrated an understanding of action to be taken in the event of an allegation of abuse occurring in the home in her responses to discussion. The manager confirmed in the pre-inspection questionnaire that the home has suitable procedures in place to protect residents from abuse. A requirement for all staff to complete training was included in the last report. The manager is advised to contact local county councils to resource training. An external trainer has also been organised to come into the home from September, to support the service to complete this training as a priority. DS0000020462.V301074.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. People living at Farway Grange benefit from living in an environment, which is generally well maintained. However, uncovered radiators potentially compromise the safety of residents. The home is maintained to a good standard of cleanliness, enabling residents to live in a pleasant and hygienic environment. EVIDENCE: Communal and individual accommodation is maintained to an adequate standard. Efforts have been made to create a sense of homeliness. A mural has been painted on one of the corridor walls with a bus named Farway Grange and paintings of favourite places that the residents like to visit. Another wall has the backdrop to a show that people at the home participated in. DS0000020462.V301074.R01.S.doc Version 5.2 Page 21 Changes made to the environment since the last visit to the home are detailed in the pre-inspection questionnaire submitted by the service. This includes four new carpets, redecoration of some individual rooms; garage space for additional storage; and ceiling hoists to eight individual rooms. The addition of these hoists has created space and supports safe and easy assistance for some residents needing help with moving and transferring. Space has been made for personal items and furnishings. A new call bell system has recently been installed in part of the home. The buildings manager keeps meticulous records of the routine monitoring of the safety and maintenance of equipment and facilities in the home. At present radiators in the home are neither covered, or of a low surface temperature type, which protects residents from the risk of scalding. Some radiators are positioned such that they may come into contact with residents. As the visit was carried out in the summer the radiators were not switched on. General risk assessments are in place regarding the environment. Risk assessments must be carried out regarding individual radiators and those, which present a high risk must be fitted with a cover or suitable low surface temperature device. The manager said that plans were in place to replace an assisted bath on the first floor, which is scratched and worn and presents a risk of cross infection. A relative completing a survey form on behalf of a resident said that standards of cleanliness in the home are ‘excellent.’ The housekeeper said that she very much enjoys her role and takes part in the life of the home, helping with activities and enjoying the opportunities she has to get to know residents. She spoke of how she meets people’s individual needs regarding the schedule of cleaning. All areas of the home visited were maintained to a good standard of cleanliness, providing a pleasant and hygienic environment for people living at the service. Liquid soaps and paper towels are provided and staff members, as appropriate, wear disposable gloves. The home has a laundry, which is accessed, via the office. Care is taken with residents’ clothing; individual baskets are used and care is taken to ensure that clothes are returned to residents ironed and ready to wear. DS0000020462.V301074.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is concern that Registered nurse staffing levels are not presently adequate to meet the complex nursing needs of residents’ accommodated. (See also Management and Administration.) The home’s planned programme of training will ensure that staff members are satisfactorily updated in key areas of working practice, placing residents in safe hands. Residents are supported and protected by the home’s thorough recruitment policies and practices. EVIDENCE: At the time of the visit the home was accommodating twenty-four residents. Twenty residents are wheel chair users and there are a high number of people with complex care needs. Currently one Registered nurse is allocated to work on the floor throughout the twenty-four hour period. The manager has twelve supernumerary hours each week. Shortfalls in the home’s system for the administration of medicines reflect the pressure on Registered nurses’ time to get work done. The home has previously carried out a detailed audit of time needed for nursing tasks. It is required in this report that the home, as it has DS0000020462.V301074.R01.S.doc Version 5.2 Page 23 done previously, reviews Registered nurse time required, ensuring that this is adequate to safely, and thoroughly, carry out nursing care to meet residents’ needs and to supervise, lead and direct care staff. Four of the twenty-three care staff members have a National Vocational Qualification in Care (NVQ) at level 2. In addition to this six staff members are undertaking an NVQ at level 2. Recruitment records were seen for two members of staff who had recently started work in the home. Thorough checks are carried out including Criminal Records Bureau checks, a check of the POVA list (Protection of Vulnerable Adults list), and the completion of an application form, proof of identity, including a photograph on each file. An interview form had been completed detailing key aspects of experience and commitment of the applicant to the post applied for. The home has started using the Skills for Care (the National Training Organisation’s) common induction standards for new staff members starting work in the home. A summary is currently being updated to reflect all mandatory training completed. The manager confirmed that an external trainer has been arranged to come in and deliver updates in key areas of working practice. Useful sources of information and support regarding training were discussed at the time of the visit. Information regarding the Skills for Care website was provided at the time of the visit. This and other useful websites are detailed below: http:/www.picbdp.co.uk/ This is the Partners in Care website and provides information for funding streams for training, including NVQ, Life skills and Leadership & Management. http:/www.skillsforcare.org.uk/ This is the Skills for Care web site and includes information regarding induction standards and there are downloadable knowledge sets and learning logs for areas of practice including: Dementia Infection Control Medication Workers not involved in direct care These knowledge sets are the first 4 of approximately 30 that are currently planned. They are designed to improve consistency in underpinning knowledge for the adult social care work force in England. They identify learning outcomes and are designed for use alongside the Common Induction Standards, which are also available from this web site. They also count as DS0000020462.V301074.R01.S.doc Version 5.2 Page 24 underpinning knowledge towards NVQs and link to the Health & Social Care National Occupational Standards. http:/www.traintogain.gov.uk/ This is a programme and funding stream supported by the Learning and Skills Council and Business Link, who provide a skills brokerage role. This project takes off from 1st August in Dorset and the brokers are currently engaging with care providers to establish what their needs are and how best to access funding and which training provider can best assist to meet the identified needs. http:/www.lsc.gov.uk/bdp/employer/eggt_intro.htm This is the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility. A pilot is being run in the South West to enable employers to give their feedback on the training they have experienced. DS0000020462.V301074.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents live in a home, which is managed by a person who is committed to the service; possessing a good knowledge of residents’ needs and is well respected by members of the team. Shortfalls in nursing responsibility and practice compromise the safe management of the home. Good quality assurance systems are being developed, supporting the running of the home in the best interests of residents. There are currently shortfalls in protecting the financial interests of residents. Although the safety and welfare of residents are upheld in most areas of working practice, key failures compromise the safety of residents. (See Health and Personal Care.) DS0000020462.V301074.R01.S.doc Version 5.2 Page 26 EVIDENCE: Mrs Freda Bonard is the registered manager of the home. Overall she demonstrates good organisational skills in managing care, the daily routine and ensuring good standards of record keeping. For example in terms of care planning, which reflect her input. Four of the staff members on duty on the day of the visit had worked at the home for some years, and a consensus was that it was a happy and ‘cheerful’ home,’ as the housekeeper described it; an environment that staff members feel commitment to and in which people feel well cared for. Unfortunately key shortfalls in the safe administration of medicines have not been addressed since the pharmacist’s last inspection visit to the home. The manager was responsible for safely administering medicines on the morning of the visit and had failed to carry this out according to Nursing and Midwifery Council guidelines. This is unacceptable practice and Mrs Bonard as the registered manager must lead by her own example. Mrs Bonard has expressed a commitment to getting this right and spoke of her recognition of her responsibilities and accountability as a trained nurse and as manager of the home to do this. Following the inspection Mrs Bonard has requested a visit from the pharmacist inspector to support the home in ensuring that safe procedures are implemented. She has also been given contact details for the Primary Care Trust’s pharmacist, who has kindly agreed to provide training to staff members administering medicines. It is essential that, as the manager, Mrs Bonard, leads by the example which she sets in this area of practice, as she does conscientiously in leading other aspects of the management of the home. Although the manager has undertaken a management course, she has not started the Registered Manager’s Award, the qualification required of managers working in a care home. Mrs Bonard is managing a service, which caters for residents within a wide age range, with very different, and complex needs. She has consulted with healthcare specialists to ensure that the service provided to each resident, reflects their needs and current good practice guidelines. She has started to look at clinical audit tools, for reflecting and evidencing good practice, through benchmarking and the setting of action plans against key indicators. The essence of care, as set out by the Department of Health, was discussed. Details can be found on the Department of Health website: http:/www.dh.gov.uk On the rosters submitted by the service prior to the inspection the manager had been taking no more than three hours, or less, per week to carry out her management role, with an additional Registered nurse to carry out nursing duties in the home. During the visit Mrs Bonard confirmed that she was now DS0000020462.V301074.R01.S.doc Version 5.2 Page 27 taking twelve supernumerary hours each week. Given the management tasks required this is very little time to devote exclusively to this work. (See staffing.) The thoroughness of care planning and supportive record keeping, which had been completed by Mrs Bonard, reflect upon her commitment to provide high standards of care. She also expresses a commitment to address the shortfalls identified in this report and has already responded, in writing, to the Commission for Social Care Inspection, regarding some of the action she is taking to ensure that best practice standards are employed within the home. A good response was received to questionnaires distributed by the home on behalf of the Commission for Social Care Inspection, prior to this visit. Since the last inspection visit to the home the manager has produced questionnaires for people living in the home, relatives and visitors and external professionals involved with the life of the service. The opportunity is provided to retain anonymity when responding. From the results of the questionnaires the manager intends to collate results, which will be used to inform the home’s next review of the quality assurance development plan. The home has a current development plan in place, which identifies some areas highlighted within this report, including training planned. The home keeps some personal monies on behalf of residents. Two monies were checked against record of amounts held. One individual purse held 1p more than the written amount, the other had 50p extra. Currently withdrawals and entries are not signed for. It is required that two people check the amounts paid in, or out, and sign to confirm the amounts. The manager was holding monies for residents in a single account in the manager’s name. £2017 was being held on behalf of residents in this account. This account is also used to hold money for activities. It was recognised that the manager had carried this out to support residents who may not have someone to represent them and hold monies on their behalf. However, it was not possible to tell how much interest the person may have acquired, and the manager agreed that money needed to be held in individual named accounts, on behalf of the person, to protect their financial interests. It is advised that where the person does not have anyone to represent them it may be appropriate to access advocacy service on their behalf. The amount held on behalf of residents was deducted from the total amount held in the account to ascertain the amount of activities money being held. This money must be auditable and held separately to residents’ monies. The manager said that she does not act as an appointee for any of the residents. The home has well kept records for the maintenance of equipment and facilities in the home. Routine checks were seen for the monitoring of electrical wiring and fire equipment. The home submitted a pre-inspection questionnaire prior to the visit detailing routine maintenance regularly completed. DS0000020462.V301074.R01.S.doc Version 5.2 Page 28 The home maintains a fire log detailing routine checks of fire equipment, drill practice and training. The manager confirmed that all staff members are satisfactorily updated in fire safety. The maintenance of summary records would support the written records in place, so that training needs can be monitored and identified. During the visit staff members adopted safe standards of manual handling practice. The home benefits from hoists and electric and profiling beds, which promote comfort when assisting residents in safely moving and transferring. The home has COSHH data sheets for individual hazardous substances used in the home and separate risk assessments have been completed in relation to each substance. These are dated April 2006 and were confirmed, by the manager, as reflecting substances in current use. A risk assessment for the environment has been completed and was also dated April 2006. This will need reviewing as aspects of the environment change. Detailed accident records are kept. The manager completes a summary of incidents including details such as time, the nature of the accident and the person affected. It is recommended that the results of the audit be collated to identify trends, action required and outcomes. Two residents had sustained a bump on the head. It is recorded that one resident had a ‘lump’ as a result of the bump. It was advised that care should be taken to ensure that a medical practitioner, checks any resident sustaining an injury to the head. DS0000020462.V301074.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 1 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 1 X X 2 DS0000020462.V301074.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 18 Requirement It must be ensured that staff members have the specific skills to meet all the needs of residents who move into the home. This must include training in caring for residents who have a learning disability, who have entered the home due to their nursing needs. Training must also be provided in communication skills, focusing specifically on the needs of the residents currently accommodated. The registered person must 25/08/06 make arrangements for the recording, safe handling, safekeeping, safe administration and disposal of medicines received including: a) Ensuring that staff follow safe procedures and complete the administration of medicines and sign the record for one resident before starting another. DS0000020462.V301074.R01.S.doc Version 5.2 Page 31 Timescale for action 15/10/06 2. OP9 13(2) b) Recording the administration of medicines accurately on the MAR chart at the time they are given. The timescale of 31/03/06 is not met. Failure to comply with this requirement will result in enforcement action. 3. OP9 13 Medicines that are handwritten 20/08/06 on the MAR chart must be signed by the person making the entry and countersigned by a staff member, once both have checked that the details are correct. A recommendation was issued following the pharmacy inspection on 7/3/06 that medicines that are handwritten on the MAR chart should be countersigned after checking the details are correct. 4. OP9 13 Safe procedures must be adopted by all trained nurses administering medication: a) There must be a clear audit trail for all medicines held. b) The amount of an individual medication held must correspond to the amounts recorded as received, administered and disposed of. c) Two members of staff must sign that they have checked each medicine leaving the home, ensuring that there is a clear auditable record of medicines disposed of. DS0000020462.V301074.R01.S.doc Version 5.2 Page 32 25/08/06 d) Medicines must be given in accordance with prescribed instructions. The home must request a review by the General Practitioner, where changes to the prescription are felt necessary, in the interests of the health and welfare of residents. 5. OP18 13(6) The registered person must make arrangements, by training staff, or by other measures, to prevent residents being harmed, or being placed at risk of harm, or abuse. Previous timescale of 02/06/06 is not met. Progress has been made in meeting this requirement. 6. OP25 13 Risk assessments must be 20/09/06 carried out regarding individual radiators and those, which present a high risk, must be fitted with a cover or suitable low surface device, protecting residents from the risk of scalding. The registered person must review trained nurse staffing levels to ensure that at all times there are sufficient trained nurses to meet the complex nursing needs of residents’ accommodated and it must also be established that there is sufficient supernumerary time for the manager to carry out her role in relation to the management of the home. The registered manager must demonstrate that she possesses, or is working towards, a DS0000020462.V301074.R01.S.doc 20/09/06 7. OP27 18 20/09/06 8. OP31 9 and 18 20/09/06 Version 5.2 Page 33 management qualification, which is equivalent to the Registered Manager’s Award. The registered manager must, at all times, carry out safe nursing practice with regard to the safe administration of medicines to people living in the home, setting an exemplary standard of safe conduct to other trained nurses. 10. OP35 16 and 20 Residents’ financial interests must be safeguarded. Residents’ monies must be kept in individual accounts in residents’ own names. The account must not be used by the registered person in connection with the running of the home. Two people must check and sign that they have verified money being paid into, and out of, residents’ monies held at the service. 11. OP38 12 and 13 Care must be taken to ensure that, where appropriate, a medical practitioner, appropriately checks any resident sustaining an injury to the head, to ensure that any healthcare need is identified. 25/08/06 20/09/06 DS0000020462.V301074.R01.S.doc Version 5.2 Page 34 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 OP9 Good Practice Recommendations The temperature of the home’s drugs fridge should be monitored on a daily basis, to ensure that medicines requiring storing at fridge temperature are safely stored. Abbreviations should not be used when making handwritten entries onto the MAR charts with regard to the frequency of the administration of medication so that clear instructions state when, and how often, medicines are to be administered. Social care plans in place should be updated to include individual interests as evidenced from the social histories, that the home has started to complete in consultation with people and their families, focusing upon the individual interests of people living in the home. A minimum ratio of 50 of care staff should have the NVQ level 2 award in care, or equivalent. The home is making progress towards meeting this recommendation. 5. OP38 It is recommended that evidence in relation to accidents be collated to identify trends, setting down actions required and outcomes as necessary. 2. OP9 3. OP12 4. OP28 DS0000020462.V301074.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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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