Inspection on 04/11/08 for Place Farm House

This inspection was carried out on 4th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Place Farm House 25/01/07

Place Farm House 15/12/05

Place Farm House 30/06/05

Place Farm House 18/01/05

Place Farm House 17/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Place Farm House Ladies Mile Road Patcham Brighton BN1 8QE The quality rating for this care home is: Two star good service A quality rating is our assessment of how well a care home 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 full assessment a ‘key’ inspection. Lead inspector: Gwyneth Bryant Date: 0 4 1 1 2 0 0 8 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. They reflect the things that people have said are important to them: 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 25 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 Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): Older People Number of places (if applicable): Under 65 0 Over 65 20 Mrs Margaret Winifred Tomlinson Mrs Margaret Winifred Tomlinson Care Home 20 Place Farm House Residential Care Home Ladies Mile Road, Patcham, Brighton, BN1 8QE 01273 563902 01273 508911 placefarmhouse@yahoo.co.uk Additional conditions: Date of last inspection: Brief description of the care home: 2 5 0 1 2 0 0 7 Place Farm House is a family run home registered to provide personal care for 20 older people, the registered provider and manager, for over twenty years is Mrs Margaret Tomlinson. The home is situated in a residential part of Brighton within easy reach of local transport and amenities. There is unrestricted car parking in the roads around the home. The home is on two floors both served by a shaft lift and accommodation is provided in eighteen single and one shared room. All rooms have en-suite facilities. There is a good range of communal space, which includes a spacious lounge and dining room, with level access to small well-maintained garden areas. Many of the rooms provide views of the Downs and surrounding areas. The current fees range from £525.00 to £625.00. These fees include all extras such as toiletries, chiropody, Care Homes for Older People Page 4 of 25 hairdressing, newspapers, activities etc. Residents are offered the option of having a private telephone installed in their room and these fees are payable by the resident. Care Homes for Older People Page 5 of 25 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 How we did our inspection: This was an unannounced inspection and took place over 5.5 hours. The purpose of the inspection was to check compliance with key standards and other standards. There were fifteen people in residence on the day of which five were spoken with. The Deputy Manager, a carer, one relative and the administrator were also spoken with. A tour of the premises was carried out and a range of documentation was viewed including care plans, personnel and medication records. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). 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. This was provided and the information included in this report as necessary. Care Homes for Older People Page 6 of 25 The last inspection was carried out on 25 January 2007 and an Annual Service Review was conducted on 29 January 2007. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 25 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 9 of 25 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the pre-admission process to provide documentary evidence that Place Farm House can meet the needs of people admitted to the home. Evidence: Pre-admission documentation was viewed for recent admissions and not all parts had been completed, nor did they include how the home will meet assessed needs. One person had not been assessed prior to moving into the home. It is important that the home can demonstrate it can meet the needs of residents. Therefore the pre admission assessment needs to be sufficiently detailed and robust to ensure that where necessary needs can be accurately assessed by telephone if required by a series of pertinent questions. Following the site visit the Registered Provider stated that prior to the admission of one person the GP provided an assessment. It is also important to ensure the prospective resident is also consulted as one person spoken with said that the manager had asked a relative about their likes and dislikes. Following the site visit the Registered Provider stated that both residents and their relatives are consulted. Care Homes for Older People Page 10 of 25 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning systems need to reflect the current needs of people living in the home and improvements need to be made to the risk assessments process and the recording and administration of medication Evidence: Five care plans were viewed in conjunction with other documents such as medication administration charts, daily notes and discussion with the Manager and staff. While care plans included all aspects of care needs they did not include clear direction to staff as to how to meet those needs. It was of concern that one person did not have a full care plan, only a briefer respite care plan, as they were undecided about staying in the home, however as the person had been living in the home since May 2008 a full care plan should have been developed to provide direction to staff in meeting assessed needs. After the site visit the Registered Person has confirmed that a full care plan has now been developed. One person is registered as blind but their care plan did not include information in assisting them to overcome this such as the provision of talking books. Following the site visit the Registered Provider stated that the person in question manages to read books and continue with their daily routines. There were a number of shortfalls found in care plans as not all needs had been fully assessed, nor were there directions to staff in meeting care needs. Reviews tended to be just a date and a signature which does not inform the reader whether or not all parts of the plan had been reviewed especially as other documents indicated that needs had changed. It is important to demonstrate that all parts of the plan are regularly reviewed and therefore reflects current care needs. Discussion with the manager found Care Homes for Older People Page 11 of 25 that there are activities provided but the daily notes for individuals did not always reflect participation in activities or whether they were enjoyed. Daily notes were often brief and did not fully reflect how the individual spent their day. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan, however terms such as washed and dressed- slept well is not helpful or adequate. Daily records when well written help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. Two people were noted to have lost weight and the action was for staff to keep an eye on them. This is inadequate as it does not give clear direction to staff to monitor food intake and add supplements or additional snacks to ensure a good nutritional intake. However, there was good information on other healthcare needs such as opticians, chiropody and dentists. There was some indications that care plans are generic in that all care plan summaries were identical although care plans showed that residents had different needs and capabilities. Although the goals and objectives may be similar it is crucial to ensure all care planning documents relate to the individual to ensure they are person centred. It was of concern that detailed manual handling risk assessments had not been carried out for all residents although all needed some assistance if only with bathing. In addition risk assessments for falls had not been carried out even though some residents had a history of falls. It is important to ensure that risks to residents well being are identified and action taken to reduce the risks. Medication Administration Records (MAR) were viewed and generally recording needs to be improved. Throughout the records there was evidence of signatures scribbled out or overwritten and a number of gaps. There were two signatures missing in the controlled drug register although the medication had been administered and accounted for. Although all staff who administer medication have received appropriate training, the shortfalls in the recording suggests that all staff who administer medication have their competency assessed by a suitably qualified person to ensure good practice is followed. The Registered Provider has asked that it be acknowledged that the drugs book and medication practices are checked suitably qualified pharmacist regularly and she has not found fault with the current system. Care Homes for Older People Page 12 of 25 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience by people living in the home does not always match their expectations, choice or preferences Evidence: There was little information in care plans in respect of their daily routines, social and leisure preferences. However, the activity programme in the dining room showed that some activities are provided but not every day. It is important to ensure that residents are provided with something planned each day especially for those residents who are unable to access the wider community so are dependent on the home to provide activities. People spoken with said that they would very much like an activity each day and one person said that they really enjoyed the arts and crafts sessions and would like them more often. Discussion with the manager found that staff do not record the activities and this needs to be rectified to facilitate identification of preferred activities. It was of concern that due to behaviour of one resident all exit doors have had to be locked and this impinges on the freedom of other residents. This was discussed with the Manager who agreed that this person is due to move to another home which is better suited to their needs. One resident said that they could only have breakfast between 8 and 8.30 am and that they must have it in their bedrooms although they, personally, did not mind having breakfast in their room. This was discussed with the Manager who said that residents are welcome to come to the dining room for breakfast and that it can be served at a time of their choosing. The Manager agreed to ensure all residents are aware of their choices and to ensure they were recorded in care plans. Some residents are independent and go out into the community and detailed risk Care Homes for Older People Page 13 of 25 assessments need to be completed to reduce any risks associated with disabilities such as unsteady gait or eyesight problems. There is an open house visiting policy with visitors welcome at all reasonable times. The visitor spoken with on the day said that they were always made welcome and could stay for meals. Staff were highly praised as really caring and ready to answer any queries. Comments were it’s great and I can’t fault it and I have no concerns at all. The menus for the week was viewed and it indicated that meals are varied and well balanced. However on the day of the site visit it had to be changed as the Registered Provider could not do the shopping. This should be reviewed as it is important to ensure residents are given the advertised meal; however residents spoken with said the food was very good. Comments included: - I feel very lucky to be here as I couldnt wish for a better home. - The food is ok - I am not keen on some of the fancy food as I like good plain English food but I do have a choice. - Breakfast is between 8-8.30 and you have to have it when they say - there is no choice but I dont mind it at that time. - I am very happy here, I love the arts and crafts and now others join in its great. - The food is really good and the staff are wonderful. Care Homes for Older People Page 14 of 25 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 the 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 has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: The AQAA indicated that there are policies and procedures for both complaints and Safeguarding Adults and that residents are provided with a copy of the complaints procedure. All complaints are logged and include actions taken and outcomes and are collated by the administrator as part of the quality monitoring process. The CSCI have not received any complaints and those logged by the home tended to be of a minor nature such as a meal not being satisfactory. There was one complaint logged in respect of one resident wandering into other residents’ rooms but the manager said the person has now been moved to a ground floor room so that they could be easily monitored during the night when they had a tendency to wander. All Safeguarding Adults information is in place according to the AQAA and staff have received this training. The Manager confirmed that the issue of safeguarding adults is included in the induction process to raise awareness for new staff until accredited training can be arranged. Care Homes for Older People Page 15 of 25 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 the 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 standard of decor within the home is good, providing people living in the home a safe, homely and comfortable environment. Evidence: A tour of the premises was carried out with a random selection of rooms inspected. The environment is very good with all parts of the home well maintained and in good decorative order. The home continues to provide a safe, pleasant and comfortable place in which to live. Individual bedrooms were well maintained and pleasingly decorated and it was evident that people are able to bring in their own possessions in order to personalise their bedrooms. Residents spoken with said that they very much liked their rooms and were very comfortable. There are gardens to the front and rear of the home which are attractive, well maintained and accessible. In response to requests from residents to increase use of the garden a summer house has been provided to allow residents to enjoy the garden even if the weather is not good. Staff were seen to be wearing gloves and aprons when necessary and it was evident that gloves and aprons were disposed of in the rooms in which they were used. Not all bins used for the disposal of gloves and aprons were lidded and good practice suggests that they have lids to reduce the risk of cross infection. The laundry facilities are satisfactory and washing machines are able to wash clothes at temperatures that control the risk of infection. Staff are trained in infection control and it was good to note that there were clear instructions to staff in the use bags for transporting soiled laundry. Care Homes for Older People Page 16 of 25 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient staff with the skills and competency to meet the needs of people living in the home and recruitment practices are robust ensuring that people using the service are protected. Evidence: The staff rota shows there are three carers for each daytime shift with two carers for the evening shift then one night waking staff and one on call. The home prides itself on not using agency staff with existing staff filling in during holidays and sickness. Residents spoken with all spoke highly of the staff for their care, kindness and competence. Recruitment records for the last three people to be employed were viewed and these showed that all the required information had been provided including Criminal Record Bureau and Protection of Vulnerable Adults checks, two written references and proof of identity. There is a comprehensive staff induction and foundation training programme in place that meets the Skills for Care requirements and ensure staff are familiar with working practices at the home. One person has yet to do the induction but is due to begin this and new staff do not work alone until they have completed all the mandatory training. Information in the AQAA showed that of the 18 care staff, nine have already achieved National Vocational Qualification at level 2 in care with a further five in the process of gaining this qualification. On the day of the site visit the administrator said that a further three new staff have registered to the National Vocational Qualification at level 2 with one registered to begin the course at level 3. The administrator maintains a comprehensive staff training matrix is comprehensive to ensure all staff have the training to enable them to do their job and to provide a check to ensure training is updated. Comments from residents included: Care Homes for Older People Page 17 of 25 - Staff all very good and seem very well trained and know what they are doing. - I can’t speak highly enough of all the staff and managers - they are just great. Care Homes for Older People Page 18 of 25 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 the 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 service is well managed and all aspects of the welfare, safety and health of people living in the home are protected and promoted Evidence: Currently the Deputy Manager is responsible for the day to day management of the home and in order to ensure there are clear lines of management responsibility there is a need for her to either submit an application to become the Registered Manager or for the current Registered Manager to resume day to day management of the home. It should be noted that the Deputy Manager has the required qualifications, skills and experience to effectively manage the home. Following the site visit the Registered Provider confirmed that the Registered Manager is in the home seven days and is also on call. The Registered Provider also confirmed that the deputy manager intends to apply to become the Registered Manager. Although a number of requirements have been made as a result of the visit each aspect was discussed with the Manager and she was aware of the importance of ensuring shortfalls are addressed and how to rectify them. There is a quality monitoring process in place that includes resident and staff meetings, surveys for both residents and relatives in addition to the monitoring of complaints and review of policies and procedures. Care Homes for Older People Page 19 of 25 The home does not manage the finances of people living in the home, they handle their own or their families or solicitors do so on their behalf. The Manager said that on the rare occasions residents need some shopping staff would do so and ensure a receipt is provided. Accident records are maintained in line with good practice and are collated by the administrator as part of the quality monitoring process to ensure accidents are avoided. Information in the AQAA demonstrated that all policies and procedures are updated annually and all safety checks are carried out on gas and electrical appliances and systems. There is an on-going programme of maintenance, upgrading and renovation of all parts of the home, including individual rooms as they become vacant. All staff receive regular fire safety training and a fire risk assessment has been carried out to ensure no part of the home poses a fire risk. Regular fire drills are carried and fire alarm systems regularly tested ensuring neither staff nor people living in the home are at risk in the event of fire. Self-closing devices, triggered by the fire alarm are fitted to all internal doors that require them. Care Homes for Older People Page 20 of 25 Are there any outstanding requirements from the last inspection? Yes x No 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 1. OP31 8(1)(b) That the manager undertakes 25/04/07 the formal CSCI process of becoming the Registered Manager of Place Farm House. Care Homes for Older People Page 21 of 25 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 1 3 14 That the pre admission assessment be expanded to include detailed information as to how the home will meet care needs. To ensure the home can meet service users needs. 04/12/08 2 7 15 That all service users have a 04/12/08 detailed plan of care and that daily notes accurately reflect the current condition of service users. To direct staff in the provision of consistent care and to facilitate the review process. 3 7 13 Risk assessments undertaken for those at risk of falls, manual handling, accessing the community and tissue breakdown must include the management of the risk and be regularly reviewed. To reduce risk to service 04/12/08 Care Homes for Older People Page 22 of 25 users. 4 9 13 That all medication administration records are clear accurate and up to date. To ensure it is clear whether or not medication has been administered and by whom. 5 9 13 That all people who self 04/12/08 medicate have a detailed risk assessment that demonstrates the person understands their medication and that it is regularly reviewed. To ensure service users are not at risk of medication error. 6 12 16 That a daily programme of activities based on service users preferences is devised and implemented. To ensure service users leisure preferences are met. 14 12 That service users preferred daily routines be recorded and adhered to as required. To ensure service users daily routines are identified and respected. 7 26 13 That all bins used for disposal 04/12/08 of gloves and aprons have lids. To reduced the risk of cross infection. 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 04/12/08 04/12/08 04/12/08 Care Homes for Older People Page 23 of 25 Care Homes for Older People Page 24 of 25 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. ©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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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