CARE HOMES FOR OLDER PEOPLE
Farway Grange 31-33 Howard Road Queens Park Bournemouth Dorset BH8 9EA Lead Inspector
Gill Kennedy Unannounced 18 and 23 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Farway Grange Address 31-33 Howard Road Queens Park Bournemouth Dorset BH8 9EA 01202 511399 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) Mr S Nathoo Mrs Freda Isabel Bonard CRH N - Care Home With Nursing 26 Category(ies) of PD(E) Physical disability - over 65 (26) registration, with number PD Physical disability - (8) of places OP Old age - (26) Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13 December 2004 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 amenities. Farway Grange consists of two converted older type houses numbered 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. The four bedrooms on the first floor of number 31 are only reached by stairs. There are twenty-three bedrooms in total providing twentysix places. The communal space consists of a lounge situated on the ground floor of number 33. The home does not have a seperate dining room for residents. Farway Grange is registered as a care home providing nursing and personal care for up to twenty-six people which includes a maximum of up to eight younger adults under the age of 65 years. Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. This was the first time the inspector had visited the home. On the first day of the inspection The Deputy Manager, Claire Coombs, was the senior person on duty. During this visit a follow up date was arranged to see the registered manager, Mrs Bonard. Both were helpful and co-operative and were available to answer questions and provide documentation as needed. The files of three residents were read during this inspection. Five residents were spoken to in their rooms, but only three were able to express their views about life in the home and the services provided. Three visitors were interviewed, two in the company of residents. Four staff files were inspected and three staff spoken to. A selection of bedrooms and the communal areas were seen during this inspection. The time taken on this inspection was 9 hours, and 11 standards were inspected. The terms resident and service user used in this report are interchangeable. What the service does well:
The home has a very experienced registered manager and deputy who have worked at the home for several years and have a good understanding of the residents needs and the type of people they are able to accommodate. The visitors seen commented positively about the manager of the home, feeling she was caring and approachable. As well as catering for older people Farway Grange accommodates younger disabled people and maintains links with specialist consultants and health professionals with the aim of addressing any particular needs they may have. There are a variety of activities on offer for residents and two staff are employed specifically to facilitate this. Social activities can be tailored to suit individual needs and interests. One resident had recently enjoyed a night out at the dog track and said staff often take him/her out on an individual basis, shopping and so on.
Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 6 Visitors reported that they always felt welcome and two said that they had recently been involved in organising a social event at the home. Farway Grange was found to be clean with no odours and one visitor said this had been a deciding factor when she was looking for a home for her relative. What has improved since the last inspection? What they could do better: 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.
Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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 Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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) None of these standards were inspected. EVIDENCE: Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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 and 8 There is a consistent care planning system in place to provide staff with the information they need to meet service users needs, but this is not always updated in accordance with this standard. Service users health care needs are promoted and maintained in line with their care plan. EVIDENCE: Three residents files were seen. A variety of nursing risk assessment tools were used to highlight the needs of service users and this was followed with details of how these would be met and organised in separate sections. The qualified nursing staff take responsibility for maintaining these records. Daily notes were kept which provided an ongoing record of the care delivered. Care staff confirmed they refer to care plans and demonstrated an understanding of residents needs. There were details recorded on social activities provided for individuals and evidence of service user and relatives involvement in care plans. However, one resident over 65 years of age had not been reviewed monthly.
Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 10 The home relates to five GP practices and if practical residents can retain their own GP. Mrs Bonard said the home also had developed links with Consultants who provide specialist services for younger disabled residents. At the time of the inspection the registered manager reported that there were no residents with pressure sores. Where there was cause for concern special equipment would be provided, this was noted on care plans and evidenced going round the home. Nutritional screening is undertaken on admission and there was evidence of weights being recorded, although in the case of one service user where girth could only be recorded this had not been updated, however, this resident was on a PEG feed and the dietician had been involved in his/her care. The chiropodist visits every six weeks and other specialist health related services are arranged according to need. At present one resident is awaiting specialist equipment, which is seating for his/her wheelchair. This has resulted in a currently restricted lifestyle and Mrs Bonard is liaising with the wheel chair clinic on the resident’s behalf, as there is a great demand for this specialist service. Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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 14 There are a variety of activities available and these can be tailored to individual needs. The home is welcoming to visitors and also involves them in social activities in the home. Residents are encouraged to exercise as much choice and control over their lives as possible. EVIDENCE: The home employs two activities organisers. The Service User’s Guide indicates that the home has a large bus available that is able to carry up to fourteen passengers, including a wheelchair and there is also a single wheelchair friendly vehicle for individual outings and healthcare appointments. There are various group outings arranged, as well as the chance for one to one social outings. One resident talked of a recent visit to the local dog track, which everyone who went had enjoyed. The home had also recently had a social event where cream teas were served and two visitors said they had been involved in arranging this afternoon.
Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 12 All three visitors who were seen said they always felt welcome in the home and two of them visited daily. Residents’ independence is encouraged and they are able to deal with their own finances if they wish and have the capacity to do so. It was noted that bedrooms were personalised and residents are able to bring their possessions into the home, bearing in mind the restraint of space. Mrs Bonard has information available for residents if they wish to seek advice from local advocacy services. Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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) None of these standards were assessed. EVIDENCE: Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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 A homely and clean environment is achieved and the home is decorated and maintained to a satisfactory standard. EVIDENCE: Since the last inspection a programme of work has been undertaken which includes the installation of a new porch, which has provided easier wheelchair access for residents. Three ceiling hoists have been fitted and the registered manager said four more would be installed in June 2005. A bathroom has also been extended and a Parker bath has been installed which further improves the facilities for residents. Via the front entrance residents are able to access the garden at the rear of the property, which is well stocked and kept in good order. Evidence was seen of a maintenance book where staff record work that needs doing by the building manager. Mrs Bonard was advised to ask this manager to sign for when he has completed each item of maintenance work and she said she would do this. There is also a record kept detailing the decoration history of each bedroom and the communal areas.
Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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 and 29 The home is not able to demonstrate that a suitable system is in place to ensure the skill mix of staff meets the needs of residents at all times of the day. The recruitment practices are poor and do not protect residents. EVIDENCE: Staffing rosters indicate that one registered nurse is on duty at all times of the day and night, and on two days a week Mrs Bonard and her Deputy work jointly together from 8.00 – 14.00, though she is planning to arrange for her deputy to work on with her until 16.00 hours on these days. Five care assistants are on duty during the hours of 8.00 – 20.00 and the proprietor states that the skill mix includes three senior carers during the hours of 8.0014.00, although it is not possible to confirm this from the staffing rota as the full names and designations for care staff are not listed. In addition to care duties, staff are also responsible for the laundry and heating up and serving the meals at teatime which have been prepared earlier by the chef before he goes off duty. There is also a housekeeper who works from 8.00-14.30 six days a week plus the maintenance man. The staffing arrangements during the hours of 8.00-20.00 ensure that the staff levels exceed the previous regulators total of five for each shift, but the two nurses previously required by the health authority are not available from 8:00 – 14:00 and care staff also have to fulfil other duties.
Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 16 Mrs Bonard stated that there is no specific job description for senior care staff and currently only one of them has NVQ 2, although records of some of the senior care staff indicate that they have considerable experience and have attended a wide variety of courses. The home employs nineteen care assistants and currently two have NVQ2. The four other senior care assistants are now studying for NVQ2 and one person is doing a modern apprenticeship course, the equivalent value of NVQ2. Four staff files were examined during this inspection. Whilst the home had employment policies and procedures in place these had not been adhered to and the requirement made at the last inspection had not been addressed. For example, on three files were was no evidence of references being sought and on only one file seen was there an indication that a CRB check had been applied for, but as a minimum there was no indication on any of the files that a ‘POVA first’ check had been obtained before these staff were employed. One file indicated that a care assistant had been employed who is under the required age of 18 years. In view of these concerns an immediate requirement was issued. Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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 38 Whilst the registered manager is experienced and committed to providing a good service she needs to obtain NVQ4 in management to fully meet Standard 31. Generally systems are in place which ensure the health and welfare of service users and staff, although some action needs to be taken to encompass all areas of safety and maintenance. EVIDENCE: Mrs Bonard, the registered manager, is a very experienced qualified nurse on Part one of the register, having worked for many years with elderly and younger chronically sick service users. Several years ago Mrs Bonard undertook a course that contained elements of management, but the qualification she received is not equivalent to NVQ 4. A recommendation was made at the last inspection that this qualification was sought. During this inspection a further discussion took place concerning this
Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 18 recommendation and subsequently Mr Nathoo, the proprietor, wrote confirming he is firmly behind Mrs Bonard undertaking the NVQ4 in management and will assist and support her. The manager plans to start this training as soon as possible. The home was able to demonstrate that all staff had undertaken fire training and this was confirmed in discussion with them. Fire checks and servicing also take place at the required intervals. An annual fire evacuation had taken place in August 2004, but Mrs Bonard agreed that a partial evacuation was now due and agreed to expedite this. Records were seen to indicate that equipment was regularly serviced, although one staff member did highlight that one hoist was not working and the hydraulics on one bed were not operating correctly. This was drawn to the attention of the registered manager who said these issues would be addressed. There was evidence that water temperatures had recently been checked and were at safe levels. The electrical certificate for the building was granted on 27.02.03 and is current for three years. Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 1 28 1 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x x x x x 2 Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement The service users plan must be kept under review and he/she must be consulted about any changes and evidence of this clearly documentated. Staffing levels set by the former Health Authority should be adhered to or a clear, robust and written case must be made in order for a lower ratio of qualified nursing staff to healthcare assistants can be used. Such a case must have been made following discussion and agreement with the Primary Care Trust responsible for funding free nursing care. The home must be able to demonstrate that 50 of staff have NVQ2 or equivalent. Evidence must be provided to demonstrate that this training is underway. It is required that staff records are to be kept for all staff according to the Care Home Regulations– Regulation 19 and schedule 2 (as amended through statutory instrument 2004 no 1770 – which came into force on 26th July 2004) (Timescale
D55 S20462 Farway Grange V215066 180505 Stage 4.doc Timescale for action 23.08.05 2. 27 18 31.12.05 3. 28 18 23.08.05 4. 29 19 30.06.05 Farway Grange Version 1.30 Page 21 31.01.05 not met.) 5. 29 19 All staff must have a new CRB check prior to employment, and if this is impractical due to operational requirements, as a minimum must have obtained a POVA first check before starting work and evidence of this must be available. CRB checks are no longer transferable. All equipment must be in good working order to prevent any unecessary risk to service users. Immediate 6. 38 13 30.06.05 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. Refer to Standard 27 31 Good Practice Recommendations Staff under 18 years of age should not be providing personal care. The registered manager should be able to demosntrate that they have a relevant management qualification. Farway Grange D55 S20462 Farway Grange V215066 180505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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