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Inspection on 21/01/09 for Favordale

Also see our care home review for Favordale for more information

This inspection was carried out on 21st January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Before being admitted people had their needs assessed to establish if the service could provide the right care and support, before a placement in the home was offered. Records showed there was consultation with relevant people about the level and type of care required. Residents living in the home benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident`s also benefited from additional specialist support where needed, such as healthcare needs. Care planning helped staff to understand people as individuals needing some support in everyday living, and their needs were regularly reviewed. Residents living in the home were treated with respect and their dignity maintained. Staff are commended for their effort. Written comments from relatives included, `He is treated with respect and dignity. He is always clean and well looked after. They do everything to care for his needs`. Communication difficulties had also been considered such as poor hearing and sight. Residents lifestyle was centred on them, and residents did not have to conform to any institutional practice such as set times for getting up or going to bed. There was evidence activities had improved. Written comments from residents included, `I play dominoes, do arts and crafts and baking`. And `we have nice parties and meetings and go out`. One relative commented `I recently got married and asked for my dad to be with us. His carer brought him and looked after him wonderfully, pointing things out to him so that he did not miss out. Many friends and relatives commented on how well he was looked after`. Visiting arrangements were very good and the meals provided met with resident`s tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. People using the service had confidence to raise any issue of concern they may have. Information received at the Commission showed residents knew what to do if they had any concern. Residents were encouraged to say what they wanted and were asked regularly if everything was all right. Comments from relatives included `There is nothing to complain about`, and `No complaints`. Staff were trained in adult protection and knew their responsibility of care in this area. They had been trained to respond to protection issues, and follow correct safeguarding procedures when needed. They were required to work to a strict code of conduct and professional ethics as part of their contractual obligations. Residents liked their accommodation. They could arrange their bedrooms as they wished and needs of residents had been considered with floor covering and equipment made available such as specialist bathing facilities. The home was well maintained, safe, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff.Written comments from relatives included, `The staff are very professional and competent`, `The staff are always friendly and co operative`. And `the staff here are very caring and understanding`. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs effectively met. The training provided for staff was very good and the home is commended for the number of care staff having completed a National Vocational Qualification in Care. Written comments from staff included, `We are always offered on going training`. And `staff are helped to attend any courses as and when they come up`. Staff meetings were `good practice` focussed and staff received regular supervision. The manager skills had demonstrated that changes made for improvement in service delivery, the environment, and staffing was successful. Systems were in place to approach residents and relatives to give their view on the quality of services and facilities in the home. Residents had meetings and Quality Assurance carried out at the home showed `the registered manager does her job well`, and written comments from staff showed they felt supported in their work. The home was managed and run in the best interests of the people living there.

What has improved since the last inspection?

Residents care plans were detailed and included healthcare needs. This provided staff with information about how best to meet, monitor and respond to these needs and help residents to be cared for as they wish and require. Residents` dignity was considered and staff are commended for their efforts. Observations showed care and attention had been given to resident`s appearance, and staff showed how in the course of their duties they were respectful to residents. The goals in care planning included maintaining residents dignity, and self esteem, and residents could use a `privacy` notice to use when receiving personal care. Activities for residents had improved and took into account their wishes to enable them to have a lifestyle experience suitable to their needs. The overall provision of meals served had improved and provided residents with wholesome, and nourishing diet that met with their needs and expectations. To ensure issues of concern raised by residents were taken seriously, quality assurance monitoring had been completed and residents said they had confidence to use the complaints procedure. The patterned carpet in the dementia unit that had caused some residents problems had been replaced with a more suitable type. Bedroom floor coverings had also been reviewed and residents dignity was considered with the type of floor covering provided. Sufficient staff was employed to make sure the safety and welfare of residents is considered at all times and their needs are properly met. Requirements made at the last key inspection to comply with regulation had been dealt with in a satisfactory manner. Systems were in place to monitor practice and compliance with plans, policies, and procedures and make sure the home is run in theinterest of residents. Supervision of staff was given regularly to support staff to develop professionally and improve caring skills. Staff meetings were regular. Views of residents and staff were taken into account to support people influence the service provided.

What the care home could do better:

People using the service must be provided with clear information about the actual level of fees charged and details about the arrangements for paying the fees, within the contract. Plans must be reviewed properly in order for residents changing needs to be considered properly when measures have been put in place to monitor this. Linking care planning to essential needs should not be generalised by the new careplanning format. Whilst residents needs identified may be similar, how they are to be supported should place them at the centre of the plan and include their preferences and expectations and link to a daily living plan. This will ensure how their needs are met is personalised. To make sure residents are not placed at risk, for example falls, potential aggression, etc. a record of how to manage these risks must be available as a working document to inform staff how to give the right consistent support and have sufficient information at hand to safely minimise risk. This is particularly important for residents with dementia care needs. More care is required to ensure medication stock carried over to the next month is recorded. This will help to keep a clear audit of medication held in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Favordale Favordale Byron Road Colne Lancashire BB8 0BH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Dickinson     Date: 2 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Favordale Byron Road Favordale Colne Lancashire BB8 0BH 01282860449 01282866749 Debbie.Watson@careservices.lancscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lancashire County Care Services Name of registered manager (if applicable) Miss Deborah Margaret Watson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of 44 service users to include: Up to 30 service users in the category OP not falling into any other category Up to 14 service users in the category (DE) Within the total number of OP registered places, three named service users who fall into the category MD(E) may be accommodated Date of last inspection Brief description of the care home Favordale is registered with the Commission for Social Care Inspection to provide personal care and accommodation for forty-four people. The home is owned by Lancashire County Council and managed by Lancashire County Care Homes for Older People Page 4 of 29 care home 44 Over 65 0 3 30 14 0 0 Brief description of the care home Care Services. The property is a purpose built building, set back off the main road, with gardens to the side and rear. There is a central courtyard accessible to the residents. Accommodation offered is in single bedrooms. Some have en suite facilities provided. There are sufficient bathrooms and toilets, and various aids provided for residents to maintain independence throughout the home. The home is divided into two units for people requiring residential and dementia care. The residential unit is on two floors. The upper floor can be accessed via a passenger lift. Both units have lounge and dining areas. The home is staffed twenty-four hours a day, with a member of the management team on duty and on call at all times. Information about the service is available from the home for potential residents in a Statement of purpose and Service User Guide. Weekly charges for personal care and accommodation range between £366 and £413 per week. Residents are responsible for additional extras such as newspapers and toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection was conducted in respect of Favordale on the 21st and 23rd January 2009. An annual quality assurance assessment (AQAA) was sent to us by the manager prior to this inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe being carried out. Written comments were also received prior to the inspection from staff employed at the home who gave their views as to how well the home performed in supporting them Care Homes for Older People Page 6 of 29 in meeting needs of residents, and from residents or relatives giving their view on the service provided. Discussion took place with the manager, staff and residents during inspection. Documents including policies, procedures, and staff and residents records were looked at. The premises were inspected as part of the process. Areas that had been required to improve were looked at for progress made. The home was assessed against the National Minimum Standards for Older People What the care home does well: Before being admitted people had their needs assessed to establish if the service could provide the right care and support, before a placement in the home was offered. Records showed there was consultation with relevant people about the level and type of care required. Residents living in the home benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident’s also benefited from additional specialist support where needed, such as healthcare needs. Care planning helped staff to understand people as individuals needing some support in everyday living, and their needs were regularly reviewed. Residents living in the home were treated with respect and their dignity maintained. Staff are commended for their effort. Written comments from relatives included, He is treated with respect and dignity. He is always clean and well looked after. They do everything to care for his needs. Communication difficulties had also been considered such as poor hearing and sight. Residents lifestyle was centred on them, and residents did not have to conform to any institutional practice such as set times for getting up or going to bed. There was evidence activities had improved. Written comments from residents included, I play dominoes, do arts and crafts and baking. And we have nice parties and meetings and go out. One relative commented I recently got married and asked for my dad to be with us. His carer brought him and looked after him wonderfully, pointing things out to him so that he did not miss out. Many friends and relatives commented on how well he was looked after. Visiting arrangements were very good and the meals provided met with residents tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. People using the service had confidence to raise any issue of concern they may have. Information received at the Commission showed residents knew what to do if they had any concern. Residents were encouraged to say what they wanted and were asked regularly if everything was all right. Comments from relatives included There is nothing to complain about, and No complaints. Staff were trained in adult protection and knew their responsibility of care in this area. They had been trained to respond to protection issues, and follow correct safeguarding procedures when needed. They were required to work to a strict code of conduct and professional ethics as part of their contractual obligations. Residents liked their accommodation. They could arrange their bedrooms as they wished and needs of residents had been considered with floor covering and equipment made available such as specialist bathing facilities. The home was well maintained, safe, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Care Homes for Older People Page 8 of 29 Written comments from relatives included, The staff are very professional and competent, The staff are always friendly and co operative. And the staff here are very caring and understanding. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs effectively met. The training provided for staff was very good and the home is commended for the number of care staff having completed a National Vocational Qualification in Care. Written comments from staff included, We are always offered on going training. And staff are helped to attend any courses as and when they come up. Staff meetings were good practice focussed and staff received regular supervision. The manager skills had demonstrated that changes made for improvement in service delivery, the environment, and staffing was successful. Systems were in place to approach residents and relatives to give their view on the quality of services and facilities in the home. Residents had meetings and Quality Assurance carried out at the home showed the registered manager does her job well, and written comments from staff showed they felt supported in their work. The home was managed and run in the best interests of the people living there. What has improved since the last inspection? Residents care plans were detailed and included healthcare needs. This provided staff with information about how best to meet, monitor and respond to these needs and help residents to be cared for as they wish and require. Residents dignity was considered and staff are commended for their efforts. Observations showed care and attention had been given to residents appearance, and staff showed how in the course of their duties they were respectful to residents. The goals in care planning included maintaining residents dignity, and self esteem, and residents could use a privacy notice to use when receiving personal care. Activities for residents had improved and took into account their wishes to enable them to have a lifestyle experience suitable to their needs. The overall provision of meals served had improved and provided residents with wholesome, and nourishing diet that met with their needs and expectations. To ensure issues of concern raised by residents were taken seriously, quality assurance monitoring had been completed and residents said they had confidence to use the complaints procedure. The patterned carpet in the dementia unit that had caused some residents problems had been replaced with a more suitable type. Bedroom floor coverings had also been reviewed and residents dignity was considered with the type of floor covering provided. Sufficient staff was employed to make sure the safety and welfare of residents is considered at all times and their needs are properly met. Requirements made at the last key inspection to comply with regulation had been dealt with in a satisfactory manner. Systems were in place to monitor practice and compliance with plans, policies, and procedures and make sure the home is run in the Care Homes for Older People Page 9 of 29 interest of residents. Supervision of staff was given regularly to support staff to develop professionally and improve caring skills. Staff meetings were regular. Views of residents and staff were taken into account to support people influence the service provided. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process ensured peoples needs were properly assessed, which informed staff how to look after them properly Evidence: There had been admissions to the home since the last key inspection, and records made of the process showed how this was managed. People had an assessment from social care professionals and an assessment carried out by a representative from the home. Both assessments showed essential information was recorded to provide staff with sufficient information about the residents circumstances and level of support required to give the right care. They included for example, personal care, and physical and mental health wellbeing. Information received from the manager stated those residents who were privately funded are informed in a letter of the cost of staying in the home. There was no Care Homes for Older People Page 12 of 29 Evidence: written statement of terms and conditions that included fees payable, on resident files to show this. The specialist care residents require, and the skills, ability, and knowledge of staff that will be caring for them had been considered. Records showed staff were given training to help them to develop and know current good practice issues in caring for older people and people with dementia care needs. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had care plans, risk assessments, and a named key worker, which supported their health and personal care needs being met and their privacy dignity and independence promoted. Medication was managed safely. Evidence: Staff work to a key working system, which meant they had particular responsibilities for a number of residents. Needs assessed on admission were written into a plan of care how those needs would be met. New care planning had been introduced and information recorded included a brief record of peoples past history. This helped staff to understand people as individuals needing some support in everyday living. For example, a goal written was To maintain individuality and see her as the person she is not just how the dementia affects her. Needs identified such as personal care, mobility, communication, personal safety, medication, medical, and social were listed. How identified needs are to be supported was generally clear. For example, supporting residents who required assistance with getting dressed and when having a bath. Care Homes for Older People Page 14 of 29 Evidence: Particular attention staff must give to residents when providing care was recorded such as Does not like to feel rushed and Staff to go at her pace. Linking care planning to essential needs however should not be generalised by the new care-planning format. Whilst residents needs identified may be similar, how they are to be supported should place them at the centre of the plan and include their preferences and expectations. Two out of four care plans seen appeared to be standardised text for personal care. Care plans were reviewed, however this did not always show how measures taken to support residents with difficulties were managed. An example of this was the introduction of food intake charts to monitor weight loss, but the information had not been evaluated at the next review. Residents benefited additional specialist support where needed. This included healthcare. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. This included visits from the district nursing team for nursing intervention required such as applying dressings. Pressure care was promoted and pressure-relieving aids were used on medical advice. Risk assessments had been completed for moving and handling. People at risk of falls, pressure sores, poor nutrition and other risks had also been identified. However whilst staff had the risk assessment information regarding the level of risk, the management of risk was not readily available to use as a working document. These were kept in the office as confidential information. This meant staff would not necessarily have a consistent approach, or sufficient information to give the right support in minimising risk. This is particularly important for residents with dementia care needs. Observations were made of wheelchairs being used safely. Staff were instructed on the basic principles of care. Staff and management are commended for their efforts in maintaining peoples dignity in the home. Observations showed care and attention had been given to residents appearance, and staff showed how in the course of their duties they were respectful to residents. The goals in care planning included maintaining residents dignity, and self esteem. Residents were provided with privacy notice to use when receiving personal care. Written comments from relatives included, The Favordale care has been fantastic. He is treated with respect and dignity. He is always clean and well looked after. They do everything to care for his needs. Staff interviewed had knowledge and an understanding about the needs of residents they cared for. Complimentary remarks were made about the staff, such as very good, and helpful. One resident said staff were absolutely perfect’, and one resident wrote the staff are always helpful, respectful, jolly and I get on with them all. Communication difficulties had also been considered such as poor hearing and sight. Care Homes for Older People Page 15 of 29 Evidence: The home operated a monitored dosage system for the administration of medication. Information received at the Commission showed a number of staff had been trained in medication procedures. Residents had the opportunity to say how they would like their medication managed. Consent to medication had been recorded. An appropriate recording system was in place to record the receipt, administration, and disposal of medication. However more care is required to ensure medication stock carried over to the next month is recorded. This will help to keep a clear audit of medication held in the home. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social, recreational activities, and lifestyle, generally met with residents needs and expectations. Catering arrangements were satisfactory in providing for individual taste, and choice. Visiting arrangements were good. Evidence: Information received at the Commission from the manager stated residents enjoyed a planned programme of activities offered each day. Comments from residents returned to the Commission as part of the inspection show everyone thought there were usually activities arranged by the home they could join in. They said, I play dominoes, do arts and crafts and baking. Although care plans did not include a daily living plan with preferred routines recorded to support residents personalise their day, observations in the dementia unit showed residents appeared to have freedom of choice over their lives within their capability. For example residents got up when they wanted and went to bed when it suited them. Activities for residents were organised and offered variety. Residents were observed doing a jigsaw, reading, playing dominoes, and generally socialising with staff on duty. Monthly trips out were provided and there was evidence residents from the dementia Care Homes for Older People Page 17 of 29 Evidence: unit had been included in these. Residents said they had enjoyed Christmas and local schools had provided entertainment. Birthdays and festive dates were celebrated. Aromatherapy sessions were held for those residents wishing to pay for this service. Residents meetings had been held and topics included for example, their right to be protected and their privacy and dignity considered at all times. Church services were held in lounges or residents bedrooms. Representatives from local Churches, mobile library, and hairdresser helped maintain good community links. Written comments from residents included, we have nice parties and meetings and go out. One relative commented I recently got married and asked for my dad to be with us. His carer brought him and looked after him wonderfully, pointing things out to him so that he did not miss out. Many friends and relatives commented on how well he was looked after. Residents were able to receive visitors at any time and were able to entertain their guests in private. There was evidence seen in care records that relatives regularly visited the home and contact with relatives and friends supported. Observations of relatives visiting showed how staff were considerate to their needs and made them feel very welcome. Residents were also supported to continue with their chosen religion. This was recorded in residents assessment. Residents bedrooms were personalised. They were able to bring in personal belongings and arrange their rooms how they wished. Residents could choose where to eat their meals. Those residents spoken to during inspection said the food was usually good. They said they had choices and milky drinks, tea, coffee and fruit juice available at all times. Residents in the dementia unit where provided with supplements such as finger foods snacks day and night. Menus seen were planned over a four week period to alternate meals provided, and ensure variety, choice and good nutrition. Residents who provided written comments for this inspection considered they usually liked the meals. They said, The meals are very good here, and meals are really good. However one resident thought there was room for improvement. Staff were observed providing good supervision and support to residents in the dementia unit who required assistance at meal times. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure was available and used properly, which helped residents and other people have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. Evidence: The complaints procedure was given to residents when they were admitted to the home. A complaints recording system was in place. The procedure gave clear directions on whom to make a complaint to and the timescales for the process. There had been no complaints received at the Commission. Lancashire County Care Services as part of quality assurance on the service provided had carried out a survey. The results showed most people knew how to make a complaint. They had an opportunity to speak to staff and managers and were generally happy with the response. The complaints procedure was displayed in the home and residents were asked during their meetings if there were any issues of concern they would like to raise. Residents who provided written comments for this inspection and those spoken to said they knew who to speak to if they had any concerns, and who to speak to if they were not happy. They said they generally had no concerns regarding their care by staff, but had raised issues with the area manager and manager of the home regarding for example the standard of food, and lack of staff. They were satisfied they had been taken seriously and there had been some improvements. Care Homes for Older People Page 19 of 29 Evidence: Staff working at the home said they were trained in adult protection and were aware of the written abuse policies and procedures, which included whistle blowing. They knew their responsibility in this area and were confident they would report bad practice if ever the need arose. In addition to this staff training was provided regularly to ensure new staff understand procedures. Staff are required to work to a code of conduct and professional ethics, and contractual arrangements for staff ensures compliance with the homes policies and procedures for example the ruling on non-acceptance of gifts, or being involved in wills or bequests. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well maintained, safe, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Evidence: Favordale is a large purpose built home. It is divided into two units, residential and dementia. Entrance to the home and dementia unit is by security keypad access only. An enclosed seated area is available for visitors waiting to access the home, and hand sanitising provision to reduce the risk of infection being transmitted into the home by visitors. There are parking facilities at the side of the home. The home is set in its own grounds with garden areas for residents to sit out, weather permitting. Accommodation is in single bedrooms, some of which are en suite on two floors with access to the upper floor via a passenger lift. The home is divided into two units, residential and dementia. All bedrooms on the dementia unit are on the ground floor. Accommodation on the upper floor can be accessed via a passenger lift for people with difficulty managing the stairs. Outdoor areas were pleasant with decking and seating areas in the garden for residents use during good weather. There were plans to improve the enclosed garden for residents in the dementia unit and create a safe outdoor area for their enjoyment. Care Homes for Older People Page 21 of 29 Evidence: The home was furnished and fitted to a very good standard. Residents were pleased with their accommodation. There was an easy access into the building for people in wheelchairs. Residents were provided with a smoking room, away from dining rooms and bedrooms. Bedrooms that were seen were personalised and met with resident needs for their comfort. Floor coverings provided matched residents needs in safety and health and hygiene. The lounge carpet in the dementia unit had been replaced. Bathing and toilet facilities were very good. Information received at the Commission from the manager showed essential maintenance was carried out. The home was found to very clean and fresh smelling during inspection. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs effectively met. Evidence: The home was staffed in accordance with the requirements of Lancashire County Care Services. Rotas were kept of the staff deployment in the home. These showed improvements in staffing arrangements for the dementia unit. Written comments from staff acknowledged this. Comments included due to the 8 - 11 shift our workload has eased, and, at the moment the staff levels are good. A number of staff did express concern over proposals to reduce the night carers in the home. Staff files showed recruitment checks to be complete and met with legislative requirements for Criminal Record Bureau CRB and Protection of Vulnerable Adults POVA register check being applied for, prior to employment. Staff who provided written comments for the inspection said they had received induction training, and training relevant to their role as carer. Records showed induction and other training provided included for example fire safety, food hygiene, health and safety, abuse and POVA, infection control, nutrition, safe handling of medication, and dementia care awareness. The percentage of staff trained to a National Vocational Qualification in care level 2 or above was excellent. Care Homes for Older People Page 23 of 29 Evidence: Staff interviewed expressed job satisfaction within a good team environment. They considered they were supported in their work and generally appreciated for their work they did. Written comments from staff included, We are always offered on going training. I have recently been offered to do my NVQ level 3 and moving and handling, health and safety are updated yearly. And staff are helped to attend any courses as and when they come up. Equality of opportunity was demonstrated with training, and learning opportunities such as dementia care were very relevant to the homes purpose. Written comments from relatives included, The staff are very professional and competent, The staff are always friendly and co operative. And the staff here are very caring and understanding. One relative considered the home could improve by having a junior carer to help patients with feeding and drinking. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed and run in the best interests of the people living there. Evidence: Information received at the Commission for this inspection informed us the registered manager holds a professional trainer certificate, and has kept up to date with new information and ideas on all aspects of the care of the elderly such as Mental Capacity Act training. She has over 20 years experience of working in a residential care setting. The management structure of the home includes support from a team of officers in addition to line management support from an area manager who oversees the overall management of the service. Quality assurance had been carried out in the home and relatives, and residents, were given the opportunity to have their say. The most recent customer care survey indicated the registered manager does her job well. Records showed how the introduction of a new care planning system had made improvements in resident care Care Homes for Older People Page 25 of 29 Evidence: and the increased number of care hours supported this. Meetings for residents and staff had increased and staff were given specialist training for example, dementia care and Protection Of Vulnerable Adults which promoted a non discriminatory practice. A newsletter had been produced. It was chatty and contained for example birthday wishes, jokes, and stories etc. Written comments from relatives included It is an excellent home. The staff are very patient and caring. Residents written comments included I think everything is grand, and I like living here. All the records required for the efficient running of the home were available to look at. They were stored securely, readily available for this inspection, and organised. Records showed staff supervision was given providing staff with an opportunity to individually express themselves, their concerns, and their plans for the future or to receive feedback on their performance. Staff meetings were usually held at regular intervals during which staff received information on polices and procedures and had an opportunity to voice their opinion and share information. Observations made during the inspection showed staff worked as a team, and were well thought of by the residents. Information received at the Commission showed regular auditing of fire, water temperatures, wheelchairs and hoists etc. had been carried out. General risk assessments were completed and taken into account in planning the care and routines of the home. Individual risk assessments to support residents and staff health, safety, and welfare had been completed to take into account planning the care and diverse needs of residents, such as an emergency evacuation. The home had access to professional business, legal, and financial advice and had the necessary insurance cover in place to fulfil any loss or legal liabilities that may occur. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 Privately funded residents should have a contract issued to them by Lancashire County Care Services informing them of the fees they will pay. To make sure residents are not placed at risk, for example falls, potential aggression, etc. a record of how to manage these risks must be available as a working document to inform staff how to give the right consistent support and have sufficient information at hand to safely minimise risk. This is particularly important for residents with dementia care needs. Linking care planning to essential needs should not be generalised by the new care-planning format. Plans should be reviewed properly in order for residents changing needs to be considered properly when measures have been put in place to monitor this. More care is required to ensure medication stock carried over to the next month is recorded. This will help to keep a clear audit of medication held in the home. Residents should have a personal daily living plan to support person centred care that has considered their wishes and expectations. 2 7 3 7 4 8 5 14 Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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