Inspection on 07/03/07 for Farway Grange

This inspection was carried out on 7th March 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 02/07/07

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 7th March 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.V331699.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.V331699.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.V331699.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th August 2006 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 March 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. See the following website for guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Farway Grange DS0000020462.V331699.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 7 March 2007 and was conducted by 2 inspectors, Jo Pasker and Gloria Ashwell, who spent a total of 10 hours at the home. The inspection team spoke to all residents, 5 staff members and gathered information from the manager and any documentation available. A tour of the premises was conducted and staff interaction with residents and the carrying out of routine tasks observed. Additional information used to inform the inspection process included formal notifications of events regularly provided to the Commission by the registered provider. No complaints have been made to the Commission since the last inspection. The Commission has issued no new comment cards or pre inspection questionnaire since the last inspection. 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. 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 an effective complaints policy and procedure in place, which ensures that residents and relatives concerns are well managed. Comments received reflected that residents and relatives were very happy with the overall care provided, including: • • • “A lovely warm, caring home” “I feel well looked after here” “The matron is very nice”. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? There have been some improvements in areas of medicine handling and administration since requirements were made following the last inspection. Specifically these are: • Medicines are now recorded when received; balances are carried forward; dates of opening are recorded on all boxes and bottles; out of date medicines are taken out of stock and stock is now well managed. • Medication reviews are now regularly undertaken and recorded; the medicines policy has been rewritten and read by the Commission’s pharmacy inspector and all trained staff have undertaken refresher courses in medicine administration and handling, provided by a community pharmacist. • Seizure management care plans have been implemented as well as care plans relating to PEG management and diabetes. Some training has been provided in communication skills, including Makaton and basic sign language, focusing specifically on the needs of the residents currently accommodated. The home’s activity organisers have now begun to document social care plans for all residents, listing their personal histories and interests. All complaints investigations, including their progress and outcomes, are now clearly documented. Risk assessments have been carried out regarding individual radiators and those, which present a high risk, have been fitted with an appropriate cover. 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. There have been some improvements in the handling of residents’ finances, with all money now being managed by families or appointees and the homes’ bank account is now only used by the registered person for managing activity money raised by the home. However, there remain serious lapses in the accurate recording of residents’ money leading to further requirements being made in this inspection. (See What the Home Could Do Better). The home now has a policy in place regarding the treatment of any resident sustaining an injury to the head, ensuring that medical advice is sought where appropriate. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 7 What they could do better: All recording of care related documentation and aspects of medicine handling must be improved, to ensure that staff have the necessary information available to direct and guide their care practice and to therefore provide good care to residents. Some improvements have been made regarding the management of medicines, however, there remain key shortfalls in safe administration, which have continued to be identified in the last 4 reports, including 2 by the Commission’s pharmacist inspector. Poor management of this area has resulted in unsafe practice and record keeping which has lead in some circumstances to residents being placed at risk and their interests not being fully safeguarded. Urgent action must be taken by the home to ensure that registered nurses follow safe and acceptable procedures surrounding the administration and recording of medicine. (This is further documented within the Health and Personal Care section of this report). Further enforcement action may be taken, as this is an area of practice that the home has failed on in the last 4 inspections. The Primary Care Trust (PCT) has also been asked to assess the competencies of registered nurses in this area of practice. The majority of staff have now had training in adult protection from an external trainer and another session is planned. 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. To ensure the continued safety of all residents, the home must continuously adhere to the established procedures for the control of infection and must ensure the safety and suitability of the premises, working practices and equipment. The home needs further maintenance and refurbishment to make it a more pleasant and safe environment in which to live. 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. The recruitment process must be fully followed so that residents can be assured suitable staff are providing their care. The home must obtain 2 suitable references for any newly employed staff, prior to them commencing work. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 8 The registered manager must demonstrate that she possesses or is working towards, a management qualification, which is equivalent to the Registered Manager’s Award to remain qualified and competent to run the home. 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.V331699.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.V331699.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 & 4 (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. Through recent training staff are now more equipped to meet the needs of residents. EVIDENCE: The records of a recently admitted resident viewed, included details of preadmission assessment which had been carried out by the registered manager when she visited the prospective resident at a previous address. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 11 In advance of making the decision to enter the home the closest relatives of the prospective resident received a letter from the manager, confirming that the home would be able to meet the persons’ needs and they then visited Farway Grange to view the premises because the prospective resident was too frail to do this personally. The home has also resourced some training in specific communication skills, following a requirement made in the last report. The manager has completed some Makaton training and all staff have access to a Signalong handbook-a basic introduction to sign language. This was evidenced through resources seen in individual resident’s rooms and through talking to staff. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The written plan of care for each resident does not provide staff with sufficient information upon which to base their care practice. Therefore the home cannot ensure that all the resident’s needs are sufficiently met. The standard of care is generally adequate. There is room for improvement with regard to the promotion of dignity and comfort with particular regard to the very frail residents who are dependent on staff for these aspects of their care. The systems for the administration and recording of medicines are poor and potentially place residents at risk. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 13 EVIDENCE: During the tour of the premises the inspectors drew the attention of the registered manager to the position of a very frail resident who was in bed, lying on a ‘air mattress’ with the head end of the bed raised and a variety of pillows and cushions used to further raise the chest and head of the person. The resident had slipped to the foot end of the bed and their ankles were lying on the exposed metal foot rail leaving the resident at risk of falling from the bed and at risk of developing pressure related damage or injury. The manager immediately directed staff to attend to the resident and when the inspectors returned to check, found the resident comfortably seated in an armchair. The care records of 4 residents were examined. At present the records are insufficient as they variously omit reference to some essential areas of care, including aspects of special need (e.g. diabetes management, urinary catheter management) and the means of reducing identified risks of accidental falling. Since the previous inspection the home has done much to improve the standard of care planning documentation but further improvements are needed. (On the 30 April 2007, the registered provider and registered manager wrote to the Commission advising that these areas have now been addressed. The Inspector will check to confirm this at the next inspection.) In particular it was noted that the body weight of one resident had been recorded during July 2006 with the instruction “Request from dietician that we weigh X weekly” but there was no record of any more recent weight measurement. Another resident has been weighed at monthly intervals and on each occasion since May 2005 the records show progressive weight loss. A nutritional assessment has been recorded and most recently reviewed during January 2007, identifying the resident to be at risk of malnutrition but the care plan makes no reference to this circumstance. The home has also not sought the advice of a dietician and has not introduced any dietary enhancements in attempt to stabilise the person’s weight. Medical advice from the person’s own GP should be sought when repeated and consecutive weight loss is observed and recorded. A resident recently admitted to the home had no recorded clinical assessments (other than some pre admission documentation) and no care plan. This person has extensive physical, emotional and psychological needs and there is insufficient evidence that these have been identified and are being met. Medication handling standards do not reliably indicate that residents receive prescribed medicines at the correct times and in correct amounts - those Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 14 wishing to do so, can manage their own medicines in accord with a risk assessment process. At the time of inspection, none of the residents managed their own medicines and registered nurses carried out all other medicine handling. A number of areas were identified during the inspection where improvement of medicine handling and recording standards are necessary: • During the tour of the premises the inspectors found in one bedroom, a plastic medicine pot containing what appeared to be a combination of two liquid medicine preparations which were prescribed for daily administration to the resident accommodated in that room, who was at the time in the lounge. In another bedroom, on the overbed table bearing the used crockery and utensils of breakfast, was a medicine pot containing two tablets which were prescribed for daily administration to the resident accommodated in that room, who was at the time seated in the room. It therefore appears that the medicines were left with these particular residents for them to consume, but they had not been properly supervised and the prescribed medicines were in consequence not taken, although the record had been signed to confirm they had. When a medicine is prescribed ‘as required’, the medicine administration record (MAR) should state the potential reason for administration (e.g. as required for abdominal pain). All handwritten instructions for medicine administration must be signed and dated by the author and countersigned by another member of staff who has checked the entry for accuracy. When a prescribed medicine is not administered the reason for omission must be accurately recorded. Established policies and procedures for medicine handling must be properly adhered to. On a number of occasions a medicine had been signed for to confirm administration, then ‘R’ later written against it to indicate the resident had refused it. The process of checking the MAR, dispensing the medicine, administering it to the resident and only then signing to confirm administration, had therefore not been accurately followed. The folder containing the MAR charts contains a high number of completed and indirectly associated documents and in consequence is not reliably simple to use. It was noted that during the day preceding the inspection (6 March 2007) the last three MAR charts in the folder bore a number of blank spaces where there was no signature to confirm administration of prescribed medicines to the three residents. Due to the small space for confirmatory signatures it is usual practice for nurses to use an abbreviated signature. In consequence the home keeps a record of the abbreviated signatures – this is good practice but it was noted that the list is incomplete, so there may be difficulties identifying the authors of some abbreviated signatures. DS0000020462.V331699.R01.S.doc Version 5.2 Page 15 • • • • • • • • Farway Grange • During the inspection the medicines trolley was seen to be left in the ground floor entrance hall unattended, locked closed, for prolonged periods while the nurse carrying out the mid-day medicine round was taking medicines to residents in their rooms on other floors. To ensure secure storage at all times of all medicines, it is recommended that this procedure be altered or arrangements made for the securing of the trolley. Improvements must be made to standards for medicine handling and recording to ensure residents receive medicines as prescribed and that there is a reliable audit trail for all medicines in the home. Further enforcement action may be taken, as this is an area of practice that the home has failed on in the last 4 inspections. The Primary Care Trust (PCT) has also been asked to assess the competencies of registered nurses in this area of practice. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. The meals in this home offer choice and variety ensuring that residents receive a wholesome diet. EVIDENCE: The home employs 3 part time activity organisers who provide and organise a range of activities and events for all the residents and are working towards documenting individual service user’s interests and hobbies with the assistance of their relatives. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 17 The current activity programme offers: • • • • aromatherapy hairdressing movement to music minibus trips At the time of inspection 2 residents had gone on accompanied outings and others were enjoying aromatherapy sessions. Farway Grange also has 2 vehicles that are used for outings and a list of planned trips over the summer period, was displayed in the hallway. The home continues to hold many events during the year, such as fetes and plays, which involve residents and their family and friends. At the time of inspection, residents were planning arts and craft events for an Easter Bonnet competition. The differing needs of residents’ faiths are also well met through attendance at church and services or visits to the home by representatives of preferred denominations. Visitors are welcome at any time and a visitor spoken with during the inspection confirmed satisfaction with the home saying “It’s like a big family…(with) lots of things going on in the summer…they take them shopping and to different places….a lovely warm, caring home…”. Several residents experience communication difficulties, however, staff spoken to demonstrated a good knowledge of these service users likes and dislikes. The manager, Freda Bonard, also takes the time to get to know residents well and is fully aware of their individual preferences. Each bedroom was filled with personal possessions and photographs and presented a very homely feel, however there was a lack of suitable storage space for residents as household linen for the home was seen stored in individual’s rooms. (See section on Environment). Several residents were sitting listening to the radio or music or watching televisions in their rooms or the communal lounge. However, the inspectors noted that in some rooms the televisions were not facing some residents who were unable to adjust their position without assistance and therefore, were unable to satisfactorily watch a programme. Meals provided by the home offer choice and variety, with a 4 weekly rolling menu plan in use. Alternatives are available and the home’s 2 chefs cater for any specific dietary requirements or personal preferences well. The kitchen was seen and appeared clean and tidy with plenty of fresh fruit and vegetables available. Lunchtime was observed during the course of the inspection and staff were seen to appropriately assist residents with meals and all pureed food was separately presented. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 Commission has received no complaints since the last inspection and the complaints procedure is clearly displayed in the home. The complaints log was seen and it clearly records all details of any complaint received by the home. It has been updated since the last inspection to include details of the progress of complaints investigations and outcomes. The home has adequate policies and procedures in place for the protection of residents from abuse or neglect. An external trainer has provided protection of vulnerable adult training to the majority of staff since the last inspection and plans to return in April to ensure all staff have received training. There has been 1 adult protection referral made since the last inspection and after investigation, this required no further action taken. Farway Grange DS0000020462.V331699.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 poor. This judgement has been made using available evidence including a visit to this service. Farway Grange is in need of extensive updating and refurbishment, and the provision of additional storage facilities. Residents’ bedrooms do not provide adequate furnishings and storage to allow them to have their own possessions around them in comfort. The home is generally clean and free from any offensive odours, providing a pleasant and hygienic environment. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 20 EVIDENCE: Farway Grange consists of 2 traditionally built houses, which are linked together and residents are accommodated on the ground, first and second floors. On the day of inspection there were no unpleasant odours and the home was generally clean, but many areas appear shabby and ‘tired’. For example the following poor standards are noted: • • • • • • • The decorative order of a number of bedrooms has become damaged and generally worn with age e.g. peeling and torn wallpaper, chipped paint and plaster work. Many bed sheets in use were very thin, threadbare and stained. (On the day following the inspection the registered manager informed the Commission that a number of replacement sheets have been ordered). Many pillows in use were misshapen and ‘lumpy’. Many towels in use were frayed, thinning, misshapen and discoloured. The blue/grey floor tiles of the ground floor shower room were grimy with brownish discolouration but the registered manager said this was staining; they should be thoroughly cleaned with a suitable product. The recliner chair in a first floor bedroom had stained fabric upholstery and could not be operated because the handle had broken off. The vinyl floor covering of the top floor bathroom does not fit the floor space, with the consequence that wooden floorboards are exposed and present a risk of infection because they are not impervious to fluids and cannot be effectively cleaned. A ground floor shared double bedroom contains a two-door linen cupboard for the storage of household linen in general use, therefore presenting control risks to the management of infection. It was noted that the doors of this cupboard bear a ‘Keep Locked’ sign to promote fire safety, but at the time of inspection they could not be closed because the cupboard was overfilled. Similarly, the bedroom of a resident on the first floor contains a wardrobe used to store household linen in general use. At the time of inspection a number of duvets and pillows were in the wardrobe and the cupboard above – the wardrobe doors had fallen open and linen had spilled to the carpet covered floor because the wardrobe was overfilled. Only items for the use of the resident/s accommodated in a particular bedroom may be stored in the bedroom. To store other items there is a misuse of the resident’s personal space and may present risks of infection and a fire hazard to this resident and others in the home. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 21 In the bedroom of a service user requiring particular clinical equipment, were 29 cardboard boxes containing additional supplies. These boxes were stacked on the floor against the wall and on top of the wardrobe. (On the day following the inspection the registered manager informed the Commission that the boxes have been moved from the room). Throughout the premises there was evidence of a profound lack of suitable storage space including a stepladder stored in the top floor bathroom and the waste bins of the ground floor sluice room being inaccessible, due to various items piled onto their lids. Appropriate separate storage areas must be provided for equipment and bed linen which is easily accessible to staff. There should be a major programme of redecoration and updating, to ensure the premises are in good condition and provide residents with comfortable and safe accommodation. Additionally, staff must observe adequate safety and control of infection standards. An assisted bath contained a very worn but also wet rubber bath mat with water pooling beneath it and presenting a risk of infection to the next user of the bath. On the window sill of this bathroom lay the broken fragments of a glass thermometer. These items were brought to the attention of the manager who arranged their immediate removal. (On the 30 April 2007, the registered provider and registered manager wrote to the Commission advising that many of these areas have now been addressed. The regulations inspector has not returned to the home yet to confirm this.) Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate but must be continuously reviewed to ensure safe practice is maintained. 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 and evidenced first day inductions. Recruitment practices do not reliably ensure the protection of residents from potentially unsuitable staff. EVIDENCE: The duty rota was seen during the inspection and it showed that the following numbers of care staff were employed to meet the needs of the residents. • 1 registered nurse and 4 healthcare assistants-early shift • 1 registered nurse and 4 healthcare assistants-late shift • 1 registered nurse and 2 healthcare assistants-night shift As stated in the previous report (14 August 2006), currently only 1 registered nurse is allocated to work on the floor throughout the twenty-four hour period and shortfalls in the home’s system for the administration of medicines reflect Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 23 the pressure on registered nurses’ time to get work done. However, since the previous inspection the manager has now increased her supernumerary hours to 18 each week to try and adequately supervise, lead and direct care staff. It is necessary that registered nurses’ time continues to be regularly reviewed to ensure that residents’ nursing needs are safely met. The manager must also review the levels of care assistants available to assist residents with such complex needs, especially at night, given the geography and layout of the two buildings, which are only linked at ground floor level. (On the 30 April 2007, the registered provider and registered manager wrote to the Commission advising that there were now 2 registered nurses allocated on duty. The time of day when this is proposed to occur was not specified. The inspector will review any changes made subsequent to this inspection to confirm that appropriate levels and mix of staff are in place to meet the assessed needs of residents throughout the 24 hour period). During the day the home also has a dedicated cleaner and chef or kitchen assistant on duty. However care staff continue to maintain the laundry. Currently 4 members of staff have achieved a National Vocational Award (NVQ) in care, 3 at level 2 and 1 at level 3. There are also 6 staff currently completing their NVQ 2 and 2 staff due to start their NVQ 3. The files of 4 staff members were viewed during the inspection. The following shortfalls were seen: • In 1 staff file there was no record of interview and one of the 2 references on which the decision to employ the person were based indicate it was ‘open’ i.e. written months in advance of this employment being sought. The staff member had recently worked in other care services, but the only reference sought by Farway Grange in the course of processing the employment application, was a personal not a professional reference. In another file there was only evidence of 1 reference. The registered manager confirmed that she had tried to contact a second reference given, but this person had moved on, however this was not documented anywhere. Advice was given that a character reference would have been appropriate in these circumstances and that all future prospective employees must have 2 references prior to starting work. • All other necessary documentation was present. There was evidence from staff files seen that new members of staff were undertaking a suitable Skills for Care induction programme. However, there was no evidence of any completed first day induction checklists in 2 new employees files. The manager confirmed that these had been carried out but admitted there was no documentary evidence to support this. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 24 There has been an improvement in training undertaken since the last inspection, with evidence available in individual staff files, the training matrix and confirmed by speaking to staff. Courses included the administration of medication, adult protection, health and safety and manual handling. All staff have now undertaken mandatory fire training. 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.V331699.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to 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. 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. Although the welfare of residents and staff are generally well promoted and protected, some key areas continue to present substantial risks to residents’ health and safety. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager, Freda Bonnard, has extensive knowledge of the management of the home and continues to provide a stable, cheerful environment for both staff and residents. She has not yet undertaken the Registered Managers Award but is expecting to receive a start date soon and will inform the Commission of this. Evidence was seen though of other further training that she has undertaken since the last inspection, including administration and safe handling of medication, health and safety, moving and handling, protection of vulnerable adults and emergency aid. As already stated in the Staffing section of this report, Mrs Bonnard confirmed that she has increased her supernumerary hours to 18 a week in order to carry out her management role. She demonstrates a firm commitment to improving areas of weakness within the home and has made definite improvements in practice within the last year, working in collaboration with the Commission and other bodies. However, there remain key shortfalls in the safe administration of medicines, which have continued to be identified in the last 4 reports, including 2 by the Commission’s pharmacist inspector. Poor management of this area has resulted in unsafe practice and record keeping which has lead in some circumstances to residents being placed at risk and their interests not being fully safeguarded. As previously stated in the Health and Personal Care section of this report, further enforcement action may be taken and the Primary Care Trust (PCT) has also been asked to assess the competencies of registered nurses in this area of practice. The home now produces questionnaires, which are given to residents, relatives and professionals involved in service users’ care. These are in a clear, easy to read format and information gathered from them is then made available within the home. The manager discussed the planned implementation of audit systems and evidence was seen regarding catheters, PEG feeds and infection control. An annual development plan was also seen from last year, showing what objectives had been met and this year’s plan was also viewed. Following a requirement made after the last inspection, all residents’ finances are now either held in an individual named account or are managed by relatives or financial representatives, such as solicitors or social services. The home continues to manage small amounts of money for residents to cover expenses for hairdressing, chiropody and other personal expenditure. Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 27 The financial accounts of 3 residents were sampled and although all receipts and transaction records matched for 1 of the residents, the monies held for 2 did not. The current system of storage for residents’ money consists of 2 different containers, which is confusing and impedes exact records being kept. Money taken out of here for activities expenses was also not being documented at the time but retrospectively, which made the records incorrect. It was also noted that hairdressing receipts were often not dated, therefore making them irrelevant. (On the 30 April 2007, the registered provider and registered manager wrote to the Commission advising that this has now been addressed. The Inspector will check to confirm this at the next inspection). All accidents are recorded; the home has a policy and procedure for accidents and periodically audits records of accidents to identify trends or patterns and subsequently to introduce measures to reduce the risks. To further minimise the risk of accident it is recommended that each accident/incident be thoroughly investigated with records kept. A number of beds have rails affixed to protect the particular residents from risks of accidental falling. The use of these rails is recorded in care plans, is in accord with the written agreement of the resident or their representative and the safe use of the rails has been assessed and recorded. However, many of these assessments were out of date and consequently, likely to be inaccurate. These should be reviewed and this recorded on a regular basis, in the interests of best practice. At the time of inspection the home was unable to supply evidence of safety/maintenance checks. (On the day following the inspection the registered manager informed the Commission that processes for the regular checking and recorded assessment of bed rails are being urgently introduced and draft paperwork has also been submitted to the Commission since). There are regular checks/tests of fire safety equipment. Assessments have been recorded for fire safety and the safety of the premises and working practices. It is recommended that these be extended to include the observed use of multiple electric socket bars. (On the 30 April 2007, the registered provider and registered manager wrote to the Commission advising that this has now been addressed. The Inspector will check to confirm this at the next inspection). Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 28 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 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X 2 2 X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 1 X X 1 Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 29 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 give accurate information to staff as to how needs are to be met. The registered person must make arrangements for the safe recording, handling, safekeeping and administration of medicines within the home. • Residents who rely on staff for the administration of prescribed medicines must be properly supervised to ensure they receive the correct medicines. • All handwritten instructions for medicine administration must be signed and dated by the author and Version 5.2 Page 30 Timescale for action 07/06/07 2. OP9 13 (2) 07/03/07 Farway Grange DS0000020462.V331699.R01.S.doc 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 must be recorded. When a prescribed medicine is not administered the reason for omission must be accurately recorded. At all times all medicines must be securely stored. • • This requirement was first made on 17/03/06. Failure to comply with this requirement may result in enforcement action. 3. OP10 12 (4) The registered person shall make 07/03/07 suitable arrangements to ensure that the care home is conducted(a) in a manner which respects the privacy and dignity of service users. • Staff must at all times promote resident’s dignity and comfort. The registered person shall with regard to the number and needs of the service users ensure that(b) the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; 07/09/07 4. OP19 23 Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 31 (c) equipment provided at the care home for use by service users or persons who work there is maintained in good working order; (d) all parts of the care home are kept clean and reasonably decorated; (l) suitable provision is made for storage for the purposes of the care home; (m) suitable storage facilities are provided for the use of service users. • The registered provider must ensure that the overall condition of the home, its décor, and repair, furnishings, fittings and storage facilities must be improved to achieve the minimum standard. 5. OP26 13 (3) The registered person shall make 07/05/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. • Measures to effectively minimise risks of infection are put in place and maintained at all times, with particular regard to the correct storage of items. The registered person shall, with 07/12/07 regard to the size of the care home, the statement of purpose and the number and needs of service users(a) ensure 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. DS0000020462.V331699.R01.S.doc Version 5.2 Page 32 6. OP27 18 Farway Grange • Registered nurse staffing levels must be continuously reviewed to ensure that at all times there are sufficient nurses to meet the complex nursing needs of residents’ accommodated. 7. OP29 19 Schedule 2 The registered provider must 07/04/07 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. A person is not fit to manage a care home unless(i) he/she has the qualifications, skills and experience necessary for managing the care home. • The registered manager must demonstrate that she possesses, or is working towards, a management qualification, which is equivalent to the Registered Manager’s Award. This requirement was first made on 14/08/06. The registered person shall 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. 07/05/07 8. OP31 9 (2) 9. OP35 17 07/06/07 Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 33 10. OP38 13 (4) The registered person shall ensure that(a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. • The home must ensure that processes for the safe use of bed rails, including evidence of regular assessment and safety checks, are implemented. 07/04/07 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. Refer to Standard OP9 Good Practice Recommendations When a medicine is prescribed for ‘as required’ administration the MAR should state the potential reason for administration (e.g. as required for abdominal pain). 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. The social care needs and circumstances of each service user should be assessed to enable the provision of individual stimulation and recreation. 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. DS0000020462.V331699.R01.S.doc Version 5.2 Page 34 2. OP9 3. OP12 4. OP28 Farway Grange 5. OP29 In advance of the employment of new staff an interview should take place with records kept, and references should be obtained by the home, including whenever possible one from the most recent employer. Reliance on ‘open references’ should not be avoided. Only one system of storage should be used for the safekeeping of residents’ money and all receipts should be dated. There should be 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. It is recommended that the Health & Safety assessment of the premises be extended to include the observed use of multiple electric socket bars. 6. OP35 7. OP38 8. OP38 Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 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. Extracts may not be used or reproduced without the express permission of CSCI Farway Grange DS0000020462.V331699.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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