CARE HOMES FOR OLDER PEOPLE
Favordale Favordale Byron Road Colne Lancashire BB8 0BH Lead Inspector
Mrs Marie Dickinson Unannounced Inspection 10:00 31 July & 2 August 2007
st nd 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 Favordale DS0000035216.V340581.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. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Favordale Address Favordale Byron Road Colne Lancashire BB8 0BH 01772 563002 01772 562304 karen.mason@careservices.lancscc.gov.uk 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) Lancashire County Care Services Miss Deborah Margaret Watson Care Home 44 Category(ies) of Dementia (14), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (3), Old age, not falling within any other category (30) Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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 31st July 2006 Date of last inspection Brief Description of the Service: 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 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 £342 and £392 per week. Residents are responsible for additional extras such as newspapers and toiletries. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took place on the 31st July and 2nd August 2007. The inspection involved getting information from an Annual Quality Assurance Assessment provided by the manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the manager, and an inspection of the premises including residents bedrooms.. Sixteen relatives and ten residents provided written comments direct to the Commission giving their view of the services provided. The home was assessed against the National Minimum Standards for Older People. What the service does well:
Before people are admitted to the home their needs were assessed. They were consulted about the level and type of care they required and could visit the home to look for themselves at the facilities offered. Important information needed to support them in every day living was recorded and used to decide if Favordale could provide the right care and support by staff for them. Residents living in the home benefited the support of a named worker referred to as a Key worker who took responsibility to make sure care needs for individuals was personalised. They also benefited additional specialist support where needed that included health and mental healthcare need. Staff caring for people with dementia had training in this specialist area of work. Relatives thought the care staff ‘always give excellent care and attention.’ Staff were also described as ‘friendly and helpful’. And overall staff at Favordale deserve high praise’. Residents were supported to keep in contact with relatives and friends. The manager said residents were supported if possible to continue to use community resources as they did prior to moving into the home. One written comment from a relative stated, ‘I enjoy going to visit mum because all the staff make you welcome (it’s like an extended home).’ There were no rules in the home and routine was personal to each resident. Arrangements were made for representatives from different religious beliefs to visit residents as they wished. Residents had regular meetings and were kept Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 6 informed of relevant policies and procedures that could affect them directly such as smoking and protection. The complaints procedure was easy for residents and relatives/visitors to use. Residents were confidant staff would listen to them. Adult protection was given a high profile with staff training and contractual arrangements to protect residents. Written comments from the manager showed a ‘zero tolerance’ with poor practice. Accommodation for residents was good. The home was tastefully decorated and furnished to a high standard. Aids required to assist people to be independent was provided. Residents generally had a good opinion of staff. Relatives who sent written comments described them in terms of, ‘The staff are very helpful and friendly’. ‘The staff on my mums unit work very hard. They are friendly, caring and do an excellent job with the limitations they have.’ ‘All the staff are caring and the staff appear happy in their work which is reflected in their attitude to the residents.’ Gender issues were considered by having a male carer. The training provided for staff is very good. Staff interviewed showed they had good knowledge in understanding the needs of older people. Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home. Small amounts of money held on behalf of residents were managed well. What has improved since the last inspection?
Before people are admitted to the home a complete assessment of their needs is carried out. This meant staff had sufficient knowledge to write a plan of care aimed at meeting resident’s needs. Contracts given to residents funded by the Local Authority were properly signed. This meant their legal rights were protected. Disclaimers required by the home were signed by the resident/relative, and a list of resident’s belongings was completed for all new residents moving into the home An improvement was noted regarding the return of resident’s personal clothing after laundering. Residents meetings were being held regularly which meant they had a better say in how they wanted the home run. Bedrooms were odour free and floor covering suitable to deal with continence management had been fitted.
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 7 Residents were protected by improved recruitment practice that required two written references, and a full employment history, together with a satisfactory written explanation of any gaps in employment. What they 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. All residents must have a care plan. The plan must detail all the needs of the resident, including their healthcare needs. This is to provide staff with clear information about how best to meet, monitor and respond to these needs and help residents to be cared for as they wish and require. Plans must be reviewed properly in order for residents changing needs to be considered. To make sure residents are not placed at risk, for example falling, risk assessments must consider all areas that can affect a person, such as medical history and medication. Residents’ dignity must also be considered by making sure there is enough staff available at all times to attend to their personal needs. To make sure staff recognise symptoms to administer ‘when required’ medication prescribed by doctors, this should be recorded in more detail, particularly when people are unable to tell someone. Residents must be supervised better when given medication as there is a danger of other residents picking up medication left on a plate, or residents not receiving essential required doses. Activities for residents must improve and take into account their wishes and prevent people from being ‘bored’. Arrangements must be made to allow people visiting the home easier access within a reasonable time span. The overall provision of meals served must improve. Supervision and assistance given to residents must increase in order for residents to receive a balanced nutritious diet. The weight loss of residents must be more effectively monitored and managed. Some residents in the dementia unit are confused with the patterned carpet. Consideration should be given to replacing this with a plain carpet. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 8 Sufficient staff must be employed to make sure the safety and welfare of residents is considered at all times and their needs are properly met. Requirements made to comply with regulation must be dealt with in a satisfactory manner. Systems should be in place to monitor practice and compliance with plans, policies, and procedures and make sure the home is run in the interest of residents. Supervision of staff should be given regular. This will help staff develop professionally and improve caring skills. 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. Favordale DS0000035216.V340581.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 Favordale DS0000035216.V340581.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): 1,2,3,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information and opportunities to visit the home were given to people that helped them decide if the facilities and services could meet needs and preferences. Contracts issued, informed them about the terms and conditions of living at the home, although not everyone benefited this. Assessments were completed properly which helped plan personalised care. EVIDENCE: Records showed that new residents in the home had their needs assessed before they were admitted. The assessments showed essential information was
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 11 recorded to provide staff with sufficient information about the resident’s circumstances and level of support required to give the right care. It was the homes policy that before anyone is admitted they are given an opportunity to visit and look at the home and meet the staff. Sometimes this is not possible and a representative of the resident is invited to look around on their behalf. Comments sent to the Commission from residents and information recorded on the pre inspection assessment completed by the manager showed that not everyone had been issued with a contract. Residents placed in the home by the local authority were given a contract for financial arrangements for payment. This was in addition to the service user guide, that outlined the terms and conditions of residency in the home. Privately funded residents had signed an agreement to pay the higher rate in fees, however the amount payable was not identified on this agreement. The range of needs of residents had been considered. Staff training programme-included full induction and essential training for example, moving and handling, and protecting vulnerable adults. Training staff was ongoing as part of staffs development in providing care. Records kept, showed staff consulted other professionals such as visiting district nurses and consultant psychiatrist. Favordale DS0000035216.V340581.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. A lack of consistency in the care planning process meant that staff were not always provided with information they needed to meet peoples needs, and keep them safe. Residents felt the staff treated them with respect. Medication was managed reasonably well, however more care in administering medication was needed. EVIDENCE: The new format for care planning was good, outlining identified need, action to be taken to meet needs, frequency, and person responsible. Completing these for the benefit of residents and staff still required further development. How identified needs are to be supported was not always clear as no action for staff was recorded, or identified who would be responsible, such as all staff, key worker, or manager.
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 13 One resident was identified to need ‘a toileting programme’. However there was no indication on how this would be managed, and no link seen in daily records showing a planned support programme. Other shortfalls included risk assessments where all indicators that impact on the level of risk had not been considered. For example medication and medical problems, considered important in the management and prevention of falls had not been rcorded. Sensory checklist statements were used and entries included ‘supposed to wear glasses for reading’. Observations showed one resident dependent on staff support to prepare for the day, did not have these readily available, although he ‘enjoyed reading’. Other records were better detailed such as ‘how they would like their hair done’. A brief record was made of residents past history. This helped staff to understand people as individuals, their likes, and dislikes. Some residents had a night care plan that showed how care was to be provided during the night. Reviews of care plans were not regular. One resident who had lived in the home since last September had no care plan written properly. One review had taken place, which did not take into account a significant change in need, or sustained weight loss. Observations made during inspection showed that although the resident enjoyed food, little was eaten, as the texture of the food for biting was not appropriate for him. Relatives, who sent written comments for the inspection, thought they were usually kept informed of matters that involved their relative. One relative said this never happened and found it quite distressing’. ‘I would dearly like to be informed about issues relating to mum’. Most people thought the staff did an excellent job, however comments included ‘Would benefit more staff, as there are periods when residents is left waiting for assistance to go to the toilet or get back from the toilet, also to assist getting dressed.’ Residents also thought they had to wait for the assistance they needed. Staff worked to a key worker system, having responsibility to make sure care needs are personalised for residents. Resident’s benefited additional specialist support where needed. This included healthcare and mental health care need. Pressure care was promoted and pressure-relieving aids were used where need was identified. Better recording of doctors’ visits was required and care plans should be updated if needed. Staff had access to training in health care matters and those staff caring for people with dementia had training in this specialist area of work. The aims and objectives of the home clearly show the importance of treating individuals with respect and dignity. Residents thought staff in the home was mindful of their privacy when giving personal care. There were policies and procedures and practice guidance, for staff responsible for medication administration. The home operated a monitored dosage system
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 14 for the administration of medication, which was dispensed into controlled dose packs by a local pharmacist. Medication records were fully completed. Better care must be taken to ensure people actually take medication given to them. Residents are given the support they need to manage their medication. If individuals prefer or where they lack capacity, medication is managed by the home. Staff responsible for handling, recording and administering medication had been trained. Medication given as when necessary requires more detail as to when this would be given, particularly when the medication perscribed is for people with dementia. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Resident’s lifestyle could be improved upon. Residents were generally satisfied with their care in the home, although activities were limited. Catering arrangements were not satisfactory to meet individual need. EVIDENCE: Residents who sent written comments to the Commission for this inspection gave a mixed opinion as to their daily life within the home. Comments included, ‘The staff are very friendly and helpful and nothing is too much trouble’. ‘Some staff listen and act on what they said and some don’t.’ ‘Not enough staff to be available all the time when needed’. ‘I usually receive the care I need, but sometimes I have to ask several times.’ Staff listen and act on what they said, ‘but only because they have to’. I have to insist at times that they are available’. ‘All the staff are good, they listen and act on what I say’, and ‘Very helpful’.
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 16 Relatives also had mixed views. ‘The lack of staff only allows time for the absolute necessities.’ ‘Would benefit more staff as there are periods when residents is left waiting for assistance i.e. going to the toilet or to get back from the toilet, also to assist with getting dressed.’ ‘My mother has occasionally mentioned to the manager that some staff are less than efficient or perhaps a little ‘short’ because they are overstretched’. Residents choice in relation to daily living was observed. People were up for the day at different times and residents said there were no rules imposed on them such as when they went to bed or got up in the morning. They had their own routine personal to them. ’Residents considered staff gave them as much time as they could but said they were ‘run off their feet’. Staff said it was at times difficult to manage activities, due to managing residents personal care and other activities. An additional member of staff had been employed to ease the situation. A record of residents’ interests and preferences was held on theirassessment, although this could be included in care plans better. Activities in the dementia unit were not person specific for everyone. Information received at the Commission from the manager stated, ‘There is a planned programme of activities, which is offered each day. There is a trip out arranged every two weeks. A resident continues to go out with Pendle Stroke Club every two weeks as she did when living in her own home. Three residents go to the day centre a couple of times a week to have a tea or coffee with friends they made whilst attending day care. Residents are consulted of their choice of clothing, their daily lifestyle, and activities’. Observations made during inspection showed a small group of residents did jigsaws. Records kept of activities showed a limited programme offered. Residents generally thought activities could improve and not very good. Comments included, ‘There isn’t much going on’. ‘Not enough staff’, ‘played dominoes sometimes.’ And ‘They do take me outside in my wheelchair to sit at the door. I have to wait though’. Relatives had concerns about the lack of activities and put this down to a lack of staff. ‘Increased numbers of carers not only would ensure greater safety, but they would be able to provide more stimulating activities and increased levels of care.’ ‘My wife likes to go for short walks, but I don’t think they take them out.’ I would like to see more day to day activities, she is bored a lot of the time. ‘I feel that it would be very nice if they had more outings in the summer months.’ And ‘There should be an opportunity for individuals to visit community facilities, i.e. markets, café, or just a walk out on a regular basis. Visiting arrangements were good and several residents talked about their family visiting. Staff were thoughtful offering drinks and were friendly. Birthdays were celebrated with family in the home where possible. Visitors to the home said they ‘never had any problem when calling in the home.’ One written comment stated, ‘I enjoy going to visit mum because all the staff make
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 17 you welcome (it’s like an extended home).’Another visitor found the time waiting at the door for someone to open it, excessive. Residents were supported to continue to practice their chosen religion. Representatives from local churches visited the home on a regular basis for prayers and communion. Arrangements were made for residents to have meetings. Agendas included for example activities, health and safety, smoking, and menus. Written comments from residents about the food were varied. Some felt they were all right, but some thought for example, ‘food cheaply produced and not to my taste’, and ‘like them most of the time. Sometimes not too keen.’ Sometimes at breakfast there is not enough milk for cereal, or cereal has run out, or the excuse is its downstairs, but overall the food is good.’ Relative’s comments included Sometimes they are robust. ‘I feel that an improvement in the quality and taste of the meals would be greatly appreciated. The dinners could be warmer at times, but its not bad only a few. 90 are good. Residents spoken to, felt the meals could be improved, as sometimes they were cold. Staff were observed offering support to those people who could not manage to eat their meal without assistance. However when one staff had a break, residents did not get the support they needed. The number of residents in the dementia unit requiring assistance with eating required more staff for this purpose. Observations were made of one resident slumped over her food several times during the meal and one resident clearly struggled to eat. Menus were discussed with the residents at their meetings. Choices were given at meals. Menus seen did offer choice for residents and appeared to be nutritious and varied. Favordale DS0000035216.V340581.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 good This judgement has been made using available evidence including a visit to this service. The complaints procedure was clear which helped residents/relatives 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, and welfare was promoted. EVIDENCE: Complaints made at the home had been dealt with properly. Not all residents and relatives who sent written comments to the Commission said they knew how to make a complaint. However a copy of the complaints procedure was given to residents when they were admitted to the home, and a copy was displayed in the home for visitors to see. Most people knew whom they could speak to, such as The carers I feel confident to speak to and yes care staff and talk to a member of staff. Residents said they had no complaints against the staff. Most were described as being ‘very good’. Relatives visiting said they would know who to speak to if they were unhappy about anything. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 19 Information received at the Commission showed the managers response to abuse was dealt with efficiently and involved other agencies such as health and social care professionals. Staff working at the home said they were trained in adult protection and were aware of the abuse policies and procedures, which included whistle blowing. Staff confirmed they had regular contact with the area manager of Lancashire County Care Services and could approach her with any problem. Staff contracts precluded them from financial reward or assisting in or benefiting from the service users’ wills. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 20 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a clean, warm, comfortable, well-maintained, safe environment that suited most of their needs. EVIDENCE: The home is divided into two units, residential and dementia. Entrance to the home and dementia unit is by keypad access. This can be difficult to access as staff and management dealing with residents needs are not always available to answer the bell within a reasonable time. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 21 Both units have lounge and dining room combined. The patterned floor covering in the dementia unit was observed to cause some confusion for residents. Residents who enjoyed a cigarette were given a corner area near to the kitchen where they were allowed to smoke. Although provided with easy chairs, the area lacked the feeling of ‘home’, and reflected institutional living. Aids and adaptations have been provided to meet with residents needs. These include a passenger lift, ramped pathways, grab rails and aids specific to support independence in toilets bathrooms and bedrooms. Bathing facilities were very good with the provision of specialist baths and shower facilities. Some bedrooms were en suite and every resident had been provided with new furniture. Some residents had their own furniture in their rooms they had brought with them. All rooms were lockable and residents held their own key where possible. Residents said they liked their rooms and thought the home was kept clean. The entire home was found to be very clean and fresh smelling during inspection. The laundry was clean and organised. Water temperatures were monitored Written comments from relatives included, ‘The home is kept clean and presentable.’ ‘Following the refurbishment, the upstairs unit has been left without a lounge with windows that residents can see through when sat down’. Residents’ comments included, ‘ Room buzzers don’t always work (so staff say), and the waiting time can be distressing’. ‘Doesn’t appear to be regular maintenance checks on bulbs, broken toilet seats and the like. Staff seem to rely on them being told, but residents memory is not always good enough for this. Favordale DS0000035216.V340581.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. The level of staffing was not satisfactory to meet the needs of residents. Recruitment practices were good and protected residents. Staff were trained to care for residents safely. EVIDENCE: Written comments received at the commission in regards to the staff included, ‘The staff are very helpful and friendly’. ‘The staff on my mums unit work very hard. They are friendly, caring and do an excellent job with the limitations they have.’ ‘All the staff are caring and the staff appear happy in their work which is reflected in their attitude to the residents.’ ‘The staff display patience, and genuine kindness under at times the most trying conditions.’ However concerns were also expressed regarding the staffing numbers. ‘The lack of staff only allows time for the absolute necessities.’ ‘Would benefit more staff as there are periods when residents is left waiting for assistance i.e. going to the toilet or to get back from the toilet, also to assist with getting dressed.’ ‘As always some carers are better than others but the overall staff at Favordale deserve high praise’. ‘The staff are splendid and cope with the difficulties in caring for elderly admirably’. The home should ‘get more staff’. ‘I would say
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 23 90 are very good. The other 10 are not quite so good, but they will do.’ ‘Staff in the main are very caring and helpful but need at least three on each unit to be able to give the necessary care and support that is required’. Residents also thought ‘there was not enough staff’. Some residents said staff did not have enough time for them. Residents were generally very happy with the staff in the home, however comments such as ‘Not enough staff to be available all the time when needed’. And ‘when appointed key worker is on holiday or ill, care seems to deteriorate such as not getting bathed regularly, bed not changed’,’ were made. The home was fully staffed during the inspection. The current level of staffing had serious implications in residents care needs not being met. Observations made during inspection showed there was a lack of supervision and support for residents such as at meal times. Staff were observed working on their own, and residents requiring the assistance of two staff to move to easy chairs had to wait until staff were available to help. There had been new staff employed and records showed good recruitment practice was carried out. Staff files showed recruitment checks to be complete. Satisfactory references and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. On appointment members of staff were issued with a contract of terms and conditions of employment. In addition to induction training, all staff were trained in essential mandatory training such as moving and handling. Senior staff were also trained in medication administration. The percentage of staff having completed NVQ level 2 and above was over 50 . All employees had other training. Specialist training in dementia care was provided. Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,37,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home was not always run in the best interests of residents. Resident’s financial interests were protected. The health and safety of residents and staff was considered. EVIDENCE: Assistant managers are employed to support the registered manager to maintain a management presence in the home at all times. The manager is qualified and experienced to run the Home. Part of her role is to manage within
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 25 the corporate business plan and budget for the home. Lancashire County Care Services as Registered Provider have overall responsibility and senior management visit the home unannounced every month; looks at records, interview staff and residents, and send a report of this visit to the Commission. The manager has responsibility to make sure staff are competent and knowledgeable to care for the residents. However more development is needed to make sure monitoring practice and compliance with the plans, policies, and procedures of the home is efficient. There was evidence the residents are involved in the running of the home. Residents meetings are regular and company policies and procedures are discussed with them. Quality assurance systems are in place, such as using questionnaires. Written comments from relatives in relation to what the home does well included, ‘The staff at Favordale are extremely kind and caring’ and ‘I am writing to express my sincere thanks for all the excellent care given to my Grandma. She was always very comfortable and the standard of care given was well beyond the standards expected.’ And ‘the registered manager does her job well’. Relatives thought the home could improve by ‘providing more staff’. Not all requirements made at the last inspection have been addressed in a satisfactory way. Lancashire County Care Services promotes equal opportunities for staff and residents. Staff meetings were held, however there was a lack of regular staff supervision to monitor staff and help them develop professionally. Relationships between staff and those living in the home were observed as positive. Insurance cover was in place to meet any loss or legal liabilities. The home encouraged residents/relatives to manage their own financial affairs. Residents who are able manage their own finances continue to do so. Small amounts of money are managed for residents wanting this service. Records were kept of transactions made on behalf of people providing a clear audit trail. The health, safety, and welfare of residents and staff had been considered. The home had a good range of policies and procedures and practice aimed at keeping everyone safe. Risk assessments should be completed to take into account planning the care and routines of the home. Written working procedures and training opportunities were available to support development of good care practice. All new staff members were receiving induction and essential training. Arrangements had been made for some essential mandatory training to be renewed. Information received at the Commission indicated that essential services such as gas and electricity were regularly serviced. The storage of cleaning products was satisfactory. Management kept the Commission informed of any significant incident.
Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 3 2 Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP2 OP7 Regulation 5(b)(c) 15(1)(2) Requirement People using the service must be informed in writing of the cost of staying in the home. Residents must have care plans. The plans must include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. The plans must be kept under review and revised accordingly with the involvement of the residents. 01/09/06 Risk assessments must be completed showing how to manage, reduce, or eliminate potential risks. 01/09/06 Suitable arrangements must be made to ensure the dignity of residents is respected by staff being available to attend to personal needs at all times. 01/09/06 Improvement in activities is required for residents individually and as a group. Previous timescale of 31/03/06. 29/09/06 not met. Arrangements must be made for visitors to be allowed reasonable
DS0000035216.V340581.R01.S.doc Timescale for action 26/10/07 14/09/07 3 OP7 13(4)(c) 14/09/07 4 OP10 12(4)(a) 26/10/07 5. OP12 16(2)(m)( n) 26/10/07 6 OP13 16(2)(m) 26/10/07 Favordale Version 5.2 Page 28 7 OP15 16(2)(i) 12(1) (a)(b 8 9 OP20 OP27 23(2) (g)(h) 18(1)(a) 10 OP33 10(1) access to the home. Residents must be provided with suitable, wholesome, and nutritious food, which is varied and available as required. Residents requiring assistance at meal times must be given proper care and supervision. 01/09/06 Residents who smoke must be provided with a comfortable area, equipped for this purpose. Lancashire County Care Services must employ sufficient staff to meet the needs of the residents. Previous timescale of the 30/04/06, 29/09/06 not met Areas where improvement is required must be responded to within the timescales given by the Commission. 14/09/07 26/10/07 26/10/07 26/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP9 OP19 Good Practice Recommendations Residents should be supervised when given medication. It is recommended medication prescribed to be administered when necessary be detailed as to the circumstances it would be given. It is recommended the patterned carpet in the dementia unit be replaced with a plain carpet to support residents who are unable to differentiate between a pattern and something on the floor to be picked up. It is recommended a system is in place to monitor practice and compliance with plans, policies and procedures. It is recommended supervision of staff is kept up to date. Risk assessments for safe practice should include care and routine of the home. 4 5 6 OP32 OP36 OP38 Favordale DS0000035216.V340581.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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