CARE HOMES FOR OLDER PEOPLE
Farway Grange 31-33 Howard Road Queens Park Bournemouth Dorset BH8 9EA Lead Inspector
Jo Pasker Unannounced Inspection 23rd February 2006 11:30 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.V253740.R01.S.doc Version 5.0 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.V253740.R01.S.doc Version 5.0 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.V253740.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th May 2005 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. 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. Car parking is available to the front of the home or on the surrounding roads. The home is owned by, Mr Nathoo, who is the Registered Provider and there is a Registered Manager, Mrs Freda Bonnard, who deals with the daily running of the home. 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 overall total of twenty-six places. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was the second of two statutory inspections required in accordance with the Care Standards Act 2000. The lead inspector was Jo Pasker. The inspection took place over 2 days, starting with an unannounced visit on the 23 February at 11.30 hrs and leaving at 16.40 hrs. As agreed with the manager during this visit, the inspector then returned to speak to residents and staff on the 2 March at 11.45 hrs. The total inspection time, including preparation, travelling, inspection and report writing was 12 hours. The inspector spoke to 4 residents, 2 relatives and 2 staff and gathered information from the manager and all documentation requested was made readily available. During the course of the inspection the inspector also observed staff interaction with residents, the carrying out of routine tasks and conducted a tour of the premises. Additional information used to inform the inspection process included any formal notifications of events regularly provided to the Commission by the registered provider. There have been 3 complaints made to the home since the last inspection, 1 of which was also received by the Commission. The inspector is grateful for the time and contributions made throughout the 2 days by service users, staff and management. What the service does well: What has improved since the last inspection?
Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 6 Following the last inspection, 6 requirements and 2 recommendations were made, 6 of which have since been met as follows. Service user’s plans are now regularly reviewed and relatives kept well informed. As many residents are unable to sign for themselves, it is now documented that it has been discussed with them or their representatives. The registered manager has compiled several documents relating to the home’s staffing levels and levels of residents care needs, to demonstrate that adequate consideration is given to this matter. At the time of the inspection this information was considered sufficient to indicate that the home is currently safely run and residents’ needs are met. This may well be reviewed again at a future inspection. Staff records are now all kept according to regulations and contain the required 2 references and CRB checks for all staff. The equipment that was not working properly at the last inspection has now been fixed and is in full working order. The home now ensures that no member of staff under the age of 18 years old provides personal care to residents. What they could do better:
As a result of this inspection a total of 2 requirements and 7 recommendations have been made. This report should be read in conjunction with the additional pharmacy report carried out in March 2006. All medication must be suitably labelled to ensure that directions can be read and residents’ safety ensured. All allegations of abuse or neglect to residents must be dealt with following the home’s adult protection policy and procedure, to prevent residents being harmed or being placed at risk of harm or abuse. Residents’ dietary record sheets should be dated when completed or changed as an indicator of their accuracy. The home’s complaints policy should be updated to accurately reflect the Commission’s current name and details. It is recommended that the home introduce questionnaires and regular training sessions regarding adult protection matters, to improve staff awareness and maintain residents safety.
Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 7 The home should continue to work towards achieving a minimum ratio of 50 of care staff holding the NVQ level 2 award in care or equivalent. Relatives and friends should have the option of completing quality assurance questionnaires privately and anonymously, if wished, to ensure impartiality is maintained. The home should devise a formal documented means of obtaining stakeholders’ opinions on the running of the home to ensure that the home is run in the best interests of residents. The registered provider should provide an annual development plan to improve the home’s quality assurance procedure. 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 DS0000020462.V253740.R01.S.doc Version 5.0 Page 8 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.V253740.R01.S.doc Version 5.0 Page 9 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): Standard 3 Standard 6 – this home does not provide intermediate care. Prior to admission, the needs of each prospective resident are assessed to ensure the home will be properly able to meet them. EVIDENCE: The records of a recently admitted resident were examined and found to include a care management plan and details of the pre-admission assessment, carried out by the registered manager when she visited the person in hospital. The home’s assessment was thorough, with all relevant areas looked at including: • • • • • Personal care and physical well being Diet Continence Mental state and cognition Communication, sight and hearing
DS0000020462.V253740.R01.S.doc Version 5.0 Page 10 Farway Grange • • • • Mobility and falls Foot care and oral health Family/carer involvement Social interests and needs. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 9 & 10 Standards 7 & 8 were assessed at the last inspection. Although the home has suitable policies and procedures in place for the management of medication and is generally well managed, there are some aspects that could be improved upon. Residents are treated with dignity to ensure that their basic rights as individuals are respected. EVIDENCE: There has since been an additional visit looking specifically at medication procedures and policies and this report should be read in conjunction with the additional pharmacy report carried out in March 2006. During the inspection, medicines were properly stored, being locked away and with a refrigerator for cold storage. Staff record fridge temperatures regularly and the records were seen to support this. Records were kept of the receipt, administration and disposal of medication and examination of these showed that all was well recorded.
Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 12 The home uses a monitored dosage system; the dispensing pharmacist provides printed administration charts. The manager said that residents are assessed for their ability to manage their own medicines but at the time of inspection no resident was self-medicating. Records indicated that medicines had been accurately administered but the records must be improved to ensure that residents continue to receive correct medicines and doses, and that the home can properly account for all medicines held. Medicine administration records (MARs) stated the allergy status (to medicines) of each resident, handwritten amendments to the printed MARs were signed and dated but there was not always a summary of all medicines prescribed for each resident, describing purpose and possible side-effects. However, Farway Grange does have medication information leaflets available for residents, families and staff to refer to if needed. It was seen that on some medicines, the resident’s pharmacy label had been stuck over directions originally printed on the box or bottle. It was therefore not possible to read these properly. The registered manager confirmed that the labels were supplied by the pharmacy and then placed there by the home’s staff. Residents were seen to be treated with respect and their privacy and dignity promoted and staff appeared kind and considerate and keen to assist residents. Residents spoken to confirmed that they receive help when needed and comments included: • • “Nothing’s too much trouble” “…always busy, but make sure I get what I need”. Some visitors spoken to also commented: • “We can’t fault the staff here….it’s excellent care”. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 13 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): Standard 15 Standards 12, 13 & 14 were assessed at the last inspection. Meals are appetising and of good quantity and quality, ensuring that residents are offered a varied and healthy diet. EVIDENCE: Most residents eat on the ground floor in the only communal room there is, the lounge, as the home does not have a dedicated dining room. Some residents prefer to receive meals in their bedrooms and this is accommodated by staff. Residents select meals in advance from a planned menu, which is reviewed every 6 months. Residents are offered the choice of a full cooked breakfast in the morning and have a choice of 2 main meals for lunch (alternative choices are also available if a resident does not like either of these). Records are also kept by the kitchen, of what meals service users ate. The chef visits every resident after admission and records their likes/dislikes and any special dietary needs. These are then reviewed every few months. The sheets were seen to evidence this but are not all clearly dated. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 14 A tour of the kitchen was made with the chef during the course of the inspection and plenty of fresh vegetables and fruit were seen for planned meals. All residents spoken to said that the food is of a good standard, for quality, choice and quantity. • • “I enjoy my food here” “If we don’t like what’s on then, there’s always something else available”. On 10 August 2005 the food handling arrangements were assessed and found suitable by an Environmental Health Officer and the inspector saw the relevant report. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 15 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): Standards 16 & 18 There are adequate procedures in place to ensure residents and their relatives can raise concerns and be confident that their concerns will be properly investigated. The home also has policies and procedures for the protection of residents from abuse or neglect. However, the home’s understanding of what constitutes an adult protection issue is poor and as a result, residents’ well-being is not always properly protected. EVIDENCE: The home has a complaints policy and procedure in place and is also on view in the hallway, but needs to be updated with the Commission’s current name and details. There have been 3 complaints received by the home since the last inspection, 1 of which was also received by the Commission. All 3 were investigated by the home and resolved internally and records regarding them were seen to be well documented. However upon inspection, 1 of the complaints should have been referred as an adult protection issue at the time despite the fact that the resident’s family are since satisfied with the home’s internal investigation. Residents and staff confirmed that the registered manager and senior staff were always approachable and willing to talk about any problems that might arise and residents commented:
Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 16 • • If I had any concerns about anything at all, I wouldn’t hesitate to tell Freda (the registered manager) or talk to the staff if necessary” “I haven’t got any complaints about this place”. The home has a policy and procedure in place to respond to suspicion or evidence of abuse or neglect but as already stated, this is not always followed. The local Primary Care Trust (PCT) has provided previous adult abuse training, with the last one being in April 2004. Another session is planned for early this year. The registered manager confirmed that some vulnerable adult training is carried out with all new staff as part of their induction and sometimes as part of a morning teaching session for existing staff. A staff member currently on induction was able to adequately discuss their understanding of whistle blowing and adult protection issues and was aware of the Department of Health’s document, ‘No Secrets’. However, there is no way of recording staff members understanding and knowledge of these issues and the inspector advised that questionnaires and regular teaching sessions were made available by the home. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 17 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): Standard 26 Standard 19 was assessed at the last inspection. The home is well maintained providing a safe, comfortable, hygienic environment for residents, free of any unpleasant odours. EVIDENCE: All areas of the home were clean and there were no unpleasant odours. The laundry is accessed through the office but this appears to create a minimum of disturbance. The laundry was viewed and was in good order, with all equipment in working order and adequate to cope with the washing needs of the residents. The carers are responsible for residents’ laundry and all service users’ clothes were seen to be labelled and have a dedicated shelf for their clean clothes. Staff demonstrated a good understanding of infection control and adequate hand washing facilities and stores of protective clothing/gloves were seen in the home.
Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 18 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): Standard 28 & 30 Standards 27, 28 & 29 were assessed at the last inspection. Training for National Vocational Awards (NVQ) is on going to ensure that residents are in safe hands at all times. Arrangements for the induction of staff are good with documented evidence that new staff are trained and competent to do their jobs. EVIDENCE: It was noted at the last inspection that less than 50 of the staff have obtained a minimum of NVQ 2, although training to achieve this is on going within the home. Induction training was evident from records kept and discussion with staff, including a carer currently on induction. She was able to confirm that she had received training in manual handling, fire safety (including fire drills) and elder abuse and was just starting her NVQ 2 award training. Training records were available for all staff and there was evidence that individual staff members have training in various subjects including health and safety, manual handling and first aid. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 19 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): Standards 33, 35 & 38 Standards 31 & 38 were also assessed at the last inspection. The home does have some quality assurance systems in place to ensure that service users’ and their representatives’ views are listened to. However, these could be improved to ensure that the home is run in the best interests of the residents. . Residents’ financial affairs are well protected and records show that this is well managed. The home demonstrates that there are measures in place to ensure that the health, safety and welfare of residents and staff are maintained. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 20 EVIDENCE: During 2005 several quality assurance questionnaires regarding different issues within the home were issued to residents. These were seen and included meals, general surroundings, staff and social activities and domestic issues. Families and friends of residents are given a separate questionnaire annually, which is usually completed at the home with the activities organiser. It was discussed that a more impartial view may be obtained if relatives are able to complete these privately and anonymously if wished. Information received from these is verbally fed back to residents, displayed in a poster format in the communal hallway and any comments acted upon. There is no formal means of gathering other stakeholders’ opinions, such as GP’s and district nurses, although the registered manager does regularly speak with them and discuss any concerns or issues. There is also no annual development plan available, although it was apparent that plans and work are on-going in maintaining and updating the facilities and equipment available in the home. The registered provider could improve its quality assurance practice by formally documenting the opinions of stakeholders and having a written annual development plan available. The home does not manage large amounts of money for any individual resident on site although most deposit any allowances or benefits into a Post Office account held by the home. The registered manager who has the only access to the account manages this and the book for this was seen. The financial accounts of 2 residents were sampled and all receipts, transaction records and the monies held tallied. The home does not act as appointee for anyone and only 1 resident manages their own money. All aspects of health and safety were evidenced through discussion with the registered manager and in the tour of the premises. All staff fire training was seen to be up to date and training records viewed evidenced this. All of the home’s service certificates seen were in date and included alarm testing, electrics, nurse call system, gas appliances and lift servicing. Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 21 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 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 X X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement The registered person must ensure that all medication is suitably labelled to ensure residents’ safety. 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. Timescale for action 02/06/06 2. OP18 13(6) 02/06/06 Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 23 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 OP15 OP16 OP18 Good Practice Recommendations Residents’ dietary record sheets should be dated when completed or changed. The home’s complaints policy should be updated to accurately reflect the Commission’s current name and details. It is recommended that the home introduce questionnaires and regular training sessions regarding adult protection matters, to improve staff awareness and maintain residents safety. A minimum ratio of 50 of care staff should have the NVQ level 2 award in care or equivalent. Relatives and friends should have the option of completing quality assurance questionnaires privately and anonymously, if wished, to ensure impartiality is maintained. The home should devise a formal documented means of obtaining stakeholders’ opinions on the running of the home. The registered provider should provide an annual development plan to improve the home’s quality assurance procedure. 4. 5. OP28 OP33 6. 7. OP33 OP33 Farway Grange DS0000020462.V253740.R01.S.doc Version 5.0 Page 24 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
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