Inspection on 02/07/07 for Farway Grange

This inspection was carried out on 2nd July 2007.

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 07/03/07

Farway Grange 14/08/06

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 Jo Pasker Key Unannounced Inspection 2nd July 2007 09:30 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 Farway Grange DS0000020462.V342445.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. Farway Grange DS0000020462.V342445.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) Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2007 Brief Description of the Service: 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. The home 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 fee prices in July 2007, range from £500-£850 per week for nursing care. The manager said that rates are negotiable. The fee does not include hairdressing, chiropody, aromatherapy and transport. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk and the following website offers further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx The home holds a copy of the most recent inspection report which is available, on request. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 2 July 2007 and was conducted by 2 inspectors, Jo Pasker and Christine Gould, who spent a total of 8 hours at the home. The purpose of the inspection was to assess all of the key standards and review the requirements and recommendations made in the last report. The Registered Manager, Mrs Freda Bonnard was on hand to aid the inspection process and was very helpful throughout. Information for this report was obtained from discussion with the Registered Manager, discussions with 4 service users and 2 members of staff on duty, a review of a variety of documentation including records provided to the Commission, care records, staff records, maintenance records, policies and procedures and a guided tour of the home. The annual quality assurance assessment (AQAA) sent before the inspection had been completed and returned and a total of 9 comment cards from residents and GP’s were also received. What the service does well: The home continues to ensure that 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. The general health needs of residents are well met with several different external healthcare professionals involved in delivering care. Activities and links with the local community are good and the home continues to have a varied calendar of events organised throughout the year. Residents are offered a good variety of meals and individual choices and requirements are well met. The home has a welcoming and warm atmosphere and visitors are actively encouraged to participate in the home’s events. The home has an effective complaints policy and procedure in place, which ensures that residents and relatives concerns are well managed. Staff are well trained and considerate and caring, with a good knowledge of residents’ needs. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 6 The home manages its quality assurance system well and provides resident centred care. Comments received reflected that residents and relatives were very happy with the overall care provided, including: • • “Wonderful” “The staff are lovely”. What has improved since the last inspection? The home now consults residents and their representatives about care plans and signed plans evidence this. There have been some improvements in addressing specific nursing needs in care plans, such as diabetes and catheter management. There have been some improvements in areas of medicine handling and administration since requirements were made following the last inspection. Specifically these are: • Residents who rely on staff for the administration of prescribed medicines are now properly supervised to ensure they receive the correct medicines. All handwritten instructions for medicine administration are now signed and dated by the author and countersigned by another member of staff who has checked the entry for accuracy. When a variable dose of a medicine is prescribed (e.g. “give 1 or 2”) the amount actually administered on each occasion is now recorded. When a prescribed medicine is not administered the reason for omission is now accurately recorded. At all times all medicines are now securely stored. When a medicine is prescribed for ‘as required’ administration the MAR now states the potential reason for administration (e.g. as required for abdominal pain). • • • • • Resident’s were seen to be treated with respect and their right to dignity and privacy maintained. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 7 The social care needs and circumstances of each service user are now being assessed to enable the provision of individual stimulation and recreation. The home has carried out extensive maintenance and refurbishment to make it a more pleasant and safe environment in which to live and storage facilities have been considerably improved. The home is making progress to achieve the target of having at least 50 of staff with a National Vocational Qualification (NVQ) in care. Four staff currently hold a qualification and eight others are commencing training. The home now obtain 2 suitable references for any newly employed staff, prior to them commencing work, one from the most recent employer and interview records are now kept. Only one system of storage is now used for the safekeeping of residents’ money and all receipts are now dated. The home has ensured that processes for the safe use of bed rails, including evidence of regular assessment and safety checks, have been implemented. There is documentary evidence of the investigation and periodic audit of all accidents and untoward incidents to minimise risks of recurrence to protect residents from harm and injury. The Health & Safety assessment of the premises has been extended to include the use of multiple electric socket bars seen in residents’ rooms. What they could do better: The home have worked hard to improve care plans and they were generally well set out with some detailed information so that care staff generally knew what care was needed. However, important information about specific care needs was missing on some of the care plans. Further improvement is needed with care plans so that care staff are informed of what action they must take to ensure the health, personal and social care needs of residents are fully met. Many improvements have also been made with regard to medication handling and administration but some areas still need to improve. There must be clear audit trails for all medication in the home and amounts must correspond to documentation held; all opened packets of medication must be dated and any medication publications used, must be current in date. The home should make available patient information leaflets for all medicines administered within the home, to provide residents and their relatives with details of the effects of the medications they are prescribed. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 8 The list of abbreviated signatures of nurses involved in medicine handling should be complete i.e. should include all nurses engaged in this work in the home, including agency staff. The home must ensure there are sufficient recreational activities to offer the residents at weekends. The majority of staff have now had training in adult protection however the Registered Provider must make arrangements to ensure that all staff are adequately trained to prevent residents being harmed or being placed at risk of harm or abuse. The laundry floor and walls must be regularly cleaned to prevent a build up of dust and fluff, which may present a hazard with regard to infection control or fire safety. The registered provider must ensure that qualified nurse staffing levels are continuously reviewed to ensure that at all times there are sufficient nurses to meet the complex nursing needs of residents’ accommodated. 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. Two written references must be obtained for all newly employed staff prior to starting work and reliance on documented verbal references, as substitutes must be avoided. The Registered Provider must put forward a suitable candidate for the Registered Managers position and be able to demonstrate that they possess, or are working towards, a management qualification, which is equivalent to the Registered Manager’s Award. Residents’ finances must be carefully managed and all monies and records must tally, to ensure that resident’s finances are adequately protected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Farway Grange DS0000020462.V342445.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 Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so Standard 6 does not apply). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents (or their representatives) are provided with information about Farway Grange and are encouraged to visit, in advance of admission, to establish their impressions of life at the home and the standard of available accommodation. EVIDENCE: This requirement was met at the last inspection and no new residents had been admitted to the home since. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Detailed care plans are available for individual residents but do not always accurately reflect the practice that is carried out, in meeting people’s needs and preferences. The health needs of the residents are well met with evidence of good support from community health professionals. Improvements must continue to be made to standards for medicine handling and recording to ensure that there is a reliable audit trail for all medicines in the home and to safeguard residents from risk. Residents are treated with dignity ensuring that that their rights and privacy are upheld. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care records of 2 residents were reviewed and were seen to contain a good level of detail about individual’s personal care requirements. Each contained a variety of assessments including: • Nutrition • Falls • Continence • Pressure areas. There was evidence that some care plans had been discussed with the resident or their representative as the relevant person had signed them. The Registered Manager has worked hard to meet the previous requirement made and there has been an improvement in the content and quality of care plans since the last inspection. Evidence was seen of specific nursing interventions needed to manage individual’s specific needs, such as diabetes management and urinary catheter management. However, some of the information in the care plans/assessments was not specific and had no clear goals to give accurate information to staff as to how care needs were to be met, for example: • 1 fibre score sheet scored 10, stating ‘increase your fibre’ but it was not clear how this was to be achieved. • 1 falls risk assessment with a high score, stated an intervention was to “arrange for advice and exercises from physiotherapist and OT”. • 1 monthly weight chart was not completed as the resident refuses, but this was not reflected on the care plan. One care file identified the resident as having a particular type of dressing applied to a pressure area yet this was not clearly documented in the care plan and was also not prescribed on the Medicine Administration Record (MAR). There was limited information in the daily entries relating to dressing changes and no clear assessment, care plan or evaluation of wounds. Another file contained a bedrail risk assessment but when the inspector visited the resident in their room, found the bedrail to be very shaky on one side and with a gap between the mattress and the bed. This was drawn to the attention of the Registered Manager who stated that the resident only uses the bed rails for support when standing yet the assessment seen did not relate to the actual use i.e. support when standing. It was clear from speaking to the Registered Manager and other staff members, that they were aware of residents’ individual care needs and how they met these. Residents confirmed that care takes place and this was seen during a tour of the premises. However, care plans and assessments need to continue to improve to accurately reflect the practice that is carried out. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 13 GP’s returning comment cards said that if advice is given to the home this is incorporated into residents’ plans and one GP commented: • “The home offers a high standard of care which is tailored to each residents particular needs” The Annual Quality Assurance Assessment (AQAA) returned by the Registered Manager details the involvement of many external healthcare professionals who visit the home, including optical, dental and chiropody services. Other professionals are involved according to the needs of the individual resident, as documented in the care files and included: • GP’s • Dietician • OT • Physiotherapist • Psychologist • Continence advisor • Community mental health nurse • Clinical nurse specialists • Specialist consultants. All of the 7 respondents to the service user survey indicated that they ‘always’ receive the medical support they need and all GP comment cards received, stated that staff demonstrated a clear understanding of the care needs of residents. Since the last inspection, great effort has been made by the Registered Manager and registered nurses in meeting the previous requirements and recommendations made with regard to medicine handling and administration. • • • • • • All hand written entries seen were double signed No blank spaces were seen on the MAR sheets The MAR sheets seen, all stated the potential reason for administration of ‘as required’ medication Records of regular audits undertaken were seen with any issues identified and rectified A clear and up to date list of abbreviated signatures of nurses involved in medicine handling was seen-except it did not include agency staff On the day of inspection the medicine trolley was secured to the wall of the office and the AQAA received stated that the trolley is now taken to individuals’ rooms during medicine rounds. However, there was no clear audit trail for 4 medicines sampled-amounts held did not correspond with those recorded and 1 medicine had no date of opening recorded on the box or amount carried forward. Patient information leaflets were not readily available and the British National Formulary (BNF) book in use was not a current one. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 14 Improvements must continue to be made to standards for medicine handling and recording to ensure that there is a reliable audit trail for all medicines in the home. The pharmacy inspector has been asked to assess these standards again at an unannounced later date, to ensure that the home continues to address the serious shortfalls in the safe handling of medication and that residents are not put at risk of harm. The residents spoken with generally said they were well cared for. Observation of staff working in the home showed they were polite, kind and attentive and residents’ dignity was maintained during personal care, such as assisted washes or being taken to the toilet. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a wide range of activities and events for residents and satisfies their social, religious and recreational needs. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Both relatives and staff members assist residents to make choices, enabling them to achieve control over their lives. The meals in this home offer choice and variety ensuring that residents receive a wholesome diet. EVIDENCE: The home continues to employ 3 part time activity organisers and provide a range of activities and events based on the assessed needs of the residents. Several residents are unable to participate in group activities so they are visited individually either in their room or in a communal area by an activity organiser. During a tour of the premises several people were seen being Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 16 supported in making some paper craft flowers, which they said gave them a sense of achievement in being able to make something. Many residents’ rooms were decorated with items and pictures they had made themselves. Another resident said they enjoyed reading and watching television so the home ensured a variety of books were supplied and they were enabled to have a television in their room. There is no rolling activities programme but one of the activity organisers spoken with confirmed that all activities are person centred and based upon each residents’ abilities and preferences, which are then documented in individuals’ files. A list of planned summer outing was seen on the board in the hallway and this had been planned by listening to residents’ suggestions. It was confirmed that there are occasionally trips at weekends but generally there are few activities planned at weekends. The home is currently planning to provide a wooden building in the garden to be used as an activity centre and sensory room. It was evident through observation and comments received that residents were given some opportunities to exercise choice and control over their lives. The AQAA submitted by the home confirmed this and detailed how the needs of residents with varying faiths are met. Observation confirmed that residents maintained contact with friends and family, as they wished. Visiting is open and flexible and visitors are welcomed into the home and to participate in the homes’ events. A variety of meals are offered on the menus seen and the chef confirmed that he caters for individuals’ needs and requests. The Registered Manager said that they were going to introduce an optional themed menu on certain nights based on the traditional food from the diverse range of staff they had from different countries. Residents had been consulted on this and some were willing to try it. Food seen was fresh and appetising and 5 residents returning comment forms said that they always liked the meals at the home and 2 said usually. Comments included: • “Very good meals, I do like it very much” • “They usually inform me what is to eat for the day. I am quite willing to try different foods”. The kitchen was seen and changes made since the last inspection, include a new sink and improved storage facilities based in the refurbished and converted garage. More space has been made in the kitchen area as the freezer was stored in the garage and all dry goods were well stored on appropriate shelving, in a clean, dry, hygienic environment. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a good complaints system, which ensures that complaints are managed properly and residents and relatives can be sure that their concerns will be listened to and acted upon. Adult protection is appropriately addressed in staff training however, not all staff have received training therefore leaving residents at potential risk of harm. Policies and practice, in order to safeguard residents from potential abuse and harm, are in place. EVIDENCE: The home has a clear complaints procedure available to everyone. The home had not received any complaints since the last inspection. Six 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. Six people said that they knew how to make a complaint but one said “I don’t know where or who to make a complaint to”. All GP’s returning comment cards said they had received no complaints about the home. The home has adequate policies and procedures in place for the protection of residents from abuse or neglect. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. The majority of staff have received Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 18 training in adult protection and it is included as part of induction however the manager confirmed that no new training had taken place since the last inspection, as previously planned. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 &26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained and improvements to décor, storage and some furnishings have been made, therefore improving the living environment for residents. The home is generally clean and free from any offensive odours, providing a pleasant and hygienic environment. EVIDENCE: The completed AQAA received back from the home prior to inspection, stated that much work had been carried out in meeting the requirements made at the last inspection. This was confirmed by a tour of the premises which evidenced improvements made, including: • 2 bedrooms have been decorated in the residents preferred style. DS0000020462.V342445.R01.S.doc Version 5.2 Page 20 Farway Grange • • • • • • • • The office, lounge and top floor hall have been repainted. New carpets in some areas New curtains in lounge and redecorated bedrooms New bed linen, towels and pillows in all areas Replaced sink in kitchen Ground floor shower room floor professionally cleaned Top floor bathroom flooring replaced Broken recliner chair condemned and replacement supplied. There are plans to continue redecorating bedrooms, communal areas and replacing soft furnishings. Residents’ bedrooms were no longer being used to store linen or other items. The large triple garage in the garden had been altered and refurbished to provide proper shelving and adequate storage space for equipment, nursing supplies and a separate area for kitchen supplies and fridges/freezers. There is a clear on going programme of maintenance and refurbishment, overseen by the dedicated maintenance manager. On the day of inspection, old windows were seen being replaced by new double-glazing units and more are planned within the home. Other improvements planned include replacing the toilet in the top floor bathroom and metal coverings ordered to protect lower doors and walls from wheelchair use. Laundry is well managed within the home, with all residents clothing labelled and named individual boxes used for washing. However, the floor and walls of the laundry room, particularly behind the washing and tumble drier machines were not clean, with large amounts of dust and fluff collected there. This may present a hazard to infection control and fire safety. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is concern that Registered nurse staffing levels are not presently adequate to meet the complex administration needs of residents accommodated. Staff are generally well trained and experienced and residents can be confident they will be well looked after. However, residents would also benefit from more staff having an NVQ 2 in care. Recruitment practices ensure the protection of residents from potentially unsuitable staff however improvements could be made in documentation records. EVIDENCE: The duty rota was seen for the week commencing and showed adequate levels of care staff on duty yet the Registered Manager was the only registered nurse in the home that morning and was responsible for the medication round and all management duties. Following a requirement made during the last 2 inspections, the manager had advised the Commission that she had increased her supernumerary hours to 18 each week to try and adequately supervise, lead and direct care staff and that there were now 2 registered nurses Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 22 allocated on duty. The manager informed the inspector that she had been the only Registered nurse on duty at times over the previous 3 weeks as another RGN had left and agency staff were not recruited to fill the position. However, shortfalls in the home’s system for the administration of medicines reflect the pressure on Registered nurses’ time to get work done. It will therefore be a requirement in this report, again, that the home 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. Of the resident comment cards returned 5 said that staff acted and listened on what they said, 2 said sometimes; 3 said that staff were always available when they were needed, 2 said usually, 2 said sometimes and comments included: • “It usually depends on who is working the day you have an enquiry” • “…they are quite willing to assist”. The home has an ongoing training programme, which includes NVQ level 2 in care. The registered manager confirmed that at the time of inspection less than 50 of care staff held this award but since the last inspection several health care assistants had started work on this award. The files of 4 staff members were viewed during the inspection. The files that were found to contain only one reference at the last inspection were seen to now have two but several references were verbal ones that had been documented by the Registered Manager. She confirmed that frequently, referees did not return written references and so she documented telephone conversations instead. It was discussed that this should not be routinely acceptable and that the home must ensure that two written references are provided before employing staff. Training files demonstrated that healthcare assistants were receiving some induction training following the Skills for Care Common Induction Standards and evidence was seen of first day induction training with staff. Further information on available training can be accessed through the following websites: www.picbdp.co.uk http:/www.pic/ www.skillsforcare.org.uk http:/www.skillsforcare.org.uk/ Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this 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. However shortfalls in nursing responsibility and practice potentially 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. The home has a good system in place for protecting residents’ finances, however records show that this is not always well managed. The welfare of residents and staff are well promoted and protected, ensuring that risks to health and safety are minimised. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Manager, Mrs Freda Bonnard, has demonstrated a strong commitment to addressing the requirements and recommendations made from the previous report and it is clear that many improvements have been made. She continues to demonstrate good organisational skills in managing care, the daily routine and ensuring good standards of record keeping. It is evident that she has a sound knowledge of the home’s residents and their needs and works constantly to ensure that they are at the centre of what the home does. She has developed strong links with healthcare professionals in the community and is well respected by staff, residents and visitors alike. However, she continues to be the only Registered nurse in the home at times whilst also having the sole responsibility of all management tasks and is only allocated 18 supernumerary hours a week to carry out this management role. During the course of the inspection, she was seen to answer the phone several times and had to interrupt the medication round to do so on one occasion. This pressure on Registered nurses’ time, including Mrs Bonnard’s, to get work done is reflected in the continuing shortfalls in the home’s system for the administration of medicines. Since the last report, the Registered Manager has made the decision to resign and at the time of inspection, the Registered Provider was seeking a new manager. It will be essential that the home have a suitably experienced and qualified manager in place to ensure that improvements continue to be met and residents are adequately protected and safely cared for. It will therefore be a requirement in this report, again, that the Registered Provider ensures that a new manager must demonstrate they possess, or are working towards, a management qualification, which is equivalent to the Registered Manager’s Award and also be suitable to apply for the position of Registered Manager. The home submitted a completed AQAA prior to the inspection detailing how they currently meet Care Standards and how they plan to improve. Residents’, relatives’ and healthcare professionals’ opinions are sought by the home through the use of their annual questionnaires, with results displayed in the home and actions taken as necessary. There is an annual development plan in place and the home plan to implement the use of more clinical audit tools. The system for managing residents’ finances has improved and all monies are now stored in a single lockable unit, together with the record book and receipts. All hairdressing receipts seen were also dated. The financial accounts of 3 residents were viewed- 2 were accurate but 1 contained £20 more than was documented. The Registered Manager explained that a relative would have brought the money into the home over the weekend but the member of staff who had accepted it had not documented it. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 25 The accident book was seen and evidence of monthly audits, identifying any trends and possible action needed. All maintenance records seen were up to date, including the annual maintenance inspection report, hot water and Legionella testing and boiler and tumble drier servicing. Records demonstrated that regular safety and maintenance checks were being carried out on bedrails and some rails and bumpers had been replaced, following a previous requirement made. Fire records showed that fire equipment was well maintained and staff were trained in fire safety and that safety assessments had been extended to include the use of multiple electric socket bars, seen in residents’ rooms at the last inspection. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 26 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement The registered person must, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. • This must include all aspects of physical requirements and nursing needs give accurate information regarding specific interventions to staff, as to how needs are to be met. This requirement was first made on the 07/03/07. 2. OP9 13 (2) The registered person must make arrangements for the safe recording, handling, safekeeping and administration of medicines within the home. • There must be a clear audit trail for all medicines held, for example by recording the date a new pack is started or a carry forward balance on the DS0000020462.V342445.R01.S.doc Timescale for action 30/09/07 15/08/07 Farway Grange Version 5.2 Page 28 • MAR chart. The amount of an individual medication held must correspond to the amounts recorded as received, administered and disposed of. Medication requirements have now been made in the last 5 reports. 3. OP18 13 (6) The registered person shall make 30/09/07 arrangements by training staff or other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. • All staff should receive adult protection training. The registered person shall make 15/08/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. • The laundry floor and surfaces must be regularly cleaned and kept free from substances, which may present a risk to the health and safety of staff and residents. The registered person shall, with 15/08/07 regard to the size of the care home, the statement of purpose and the number and needs of service usersensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. • Registered nurse staffing levels must be continuously reviewed to ensure that at all times DS0000020462.V342445.R01.S.doc Version 5.2 Page 29 4. OP26 13 (3) 5. OP27 18 Farway Grange there are sufficient nurses to meet the complex nursing needs of residents’ accommodated. This requirement was first made on the 14/08/06. 6. OP29 19 Schedule 2 The registered provider must 30/09/07 ensure that, prior to a member of staff commencing employment all the information outlined in Schedule 2 of the Care Homes Regulations 2001 is obtained. • Two written references relating to the person must be obtained and reliance on documented verbal references, as substitutes must be avoided. This requirement was first made on the 07/03/07. 7. OP31 9 (2) A person is not fit to manage a care home unlesshe/she has the qualifications, skills and experience necessary for managing the care home. • The Registered Provider must put forward a suitable candidate for the Registered Managers position. • The Registered Manager must demonstrate that they possess, or are working towards, a management qualification, which is equivalent to the Registered Manager’s Award. Part of this requirement was first made on the 14/08/06. 8. OP35 17 The registered person shall DS0000020462.V342445.R01.S.doc 30/09/07 15/08/07 Version 5.2 Page 30 Farway Grange maintain in the care home the records specified in Schedule 4 and that are(a) kept up to date. • The home must keep accurate records of all service users’ money held and ensure that amounts kept, tally with documentation. This requirement was first made on the 07/03/07. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP9 OP9 Good Practice Recommendations It is recommended that the home make patient information leaflets available so that residents can have information about the medication they are taking. It is recommended that a current copy of the BNF should be used so that staff have up to date information about medicines to refer to. The list of abbreviated signatures of nurses involved in medicine handling should be complete i.e. should include all nurses engaged in this work in the home including agency staff. This recommendation was first made on the 07/03/07. 4. 5. OP12 OP28 The home should make provision for weekend activities and recreation for the residents to provide stimulation. 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. Farway Grange DS0000020462.V342445.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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