CARE HOMES FOR OLDER PEOPLE
Platters Farm Lodge Highfield Road Rainham Gillingham Kent ME8 0EQ Lead Inspector
Lucy Ansell Unannounced Inspection 28th February 2006 10:00 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 Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 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. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Platters Farm Lodge Address Highfield Road Rainham Gillingham Kent ME8 0EQ 01634 377579 01634 260791 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) Medway Council Mrs Jennifer Christine Broom Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Conditions of registration shall be made up of the following and will exclude all previous conditions of registration. 1. 18 permanent residential care beds with age range 65 and over. 2. 9 short stay residential beds with age range 65 and over. 3. 14 intermediate care beds providing nursing care with age range 55 and over. 4. 2 intermediate care beds providing residential care with age range 55 and over. 25th August 2005 Date of last inspection Brief Description of the Service: Platters Farm is a Linked Service Centre owned and managed by Medway Council. The home provides care and accommodation for a maximum of 43 older people. It has a new intermediate care unit, which is registered to provide intermediate nursing care. A new six-bedded en-suite facility has also been built for long stay residents and is now in use. There is off road parking on site and private garden areas around the Home that service users can use and enjoy. The home has a hairdresser on site during weekdays and an activities co-ordinator who works in the home Monday to Friday. The Home also benefits from its own transport. The Home is situated in a residential area of Rainham and within walking distance of a bus route. The home is approximately ¾ of a mile from Rainham Town Centre and 1 mile from the main line railway station in Rainham. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection under the terms of the Care Standards Act 2000 carried out by one inspector Lucy Ansell who was in the home from 9.30 to 1.30 on the 28th February 2006. During the inspection the Manager and the unit manager of the intermediate wing were both Spoken to. Documentation and records were read, including care plans. A tour of the premises was undertaken. The inspectors spent time talking with 10 service users. The focus of the inspection was to assess the Home in accordance to the National Minimum Standards for older persons and to seek residents and representatives views of the home. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Some Standards were not inspected in full and the last report should be read in conjunction to obtain a full picture. What the service does well:
The home’s staff undertakes in depth assessments of the residents prior to admission and this continues following admission. The information gathered is then used to formulate care plans which detail the care staff are required to deliver to meet the residents’ individual needs. The home offers a range of activities and sessions of rehab to help motivation residents either to return home or for stimulation in the residential home; activity staff and care staff carry this out. As part of the home’s integrated working with outside agencies they run an outreach falls clinic once a month and work closely with the rapid response team. There was good feedback from the service users and relatives and the home was recognised as being on the whole able to provide an excellent service. The managers and staff are approachable and the home well managed. Service users were complimentary about the staff and about the way in which their service was provided. Comments received included ”shown immense kindness and patience” “like a five star hotel”. The food was also praised as “excellent and very tasty” with lots of choice offered. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
In practice there is still a delay in the occupational therapists seeing new admissions particularly if over a weekend. This is due to the lack of OT’s in the Rapid Response team and existing OT’s having a large area of responsibility to cover. The home is looking at how to address this problem. A recommendation was made to ensure written evidence of agreement to share a room is kept on their care plans. The daily recordings need to ensure that no gaps or lines are left between each record of events, and that times are well recorded. The monthly reviews of care are detailed but need to be consistently happening every month. The risk assessments the inspector viewed had not been reviewed since July 2005. There needs to be clear evidence of dates recorded on action plans and updated care plan inserts. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 7 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. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The home’s statement of purpose and Service User guide contains the required information for residents and families to make an informed decision about moving into the home. EVIDENCE: The home yearly reviews and revises its statement of purpose. It is clear and concise with all relevant information included. The home has its statement of purpose and service users guide together in one folder. It is clear and concise with all relevant information included and is accessible to all residents who have their own copies, in a format which is user friendly. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10,11 Care plans are well written and detail the care needs of the resident, however they are not always being reviewed monthly. Residents benefit from being treated with respect and their privacy is upheld. Residents benefit from being consulted, regarding their wishes concerning terminal care and arrangements after death. EVIDENCE: The care plans were generally well written, detailing the residents care needs. Most of the care plans seen were written on admission, and had been reviewed by staff several times since then with additions added to the care plans, but these were not always dated. The monthly reviews were very detailed but have not always been happening on a regular monthly basis. There was no evidence seen that when residents are re-assessed a new care plan is written. Evidence seen of care plans indicated that the resident had been fully involved in the process. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 11 The risk assessments were clear and concise, however not reviewed regularly. A good practice recommendation was made where a resident will be sharing a room to get agreement from both residents signed and kept on their files. The home uses acute issues sheet, which highlights any areas of concern clearly for all staff to see. The home operates a key worker system where residents have an identified staff member. The daily record sheet, records when events and care delivery occurs throughout the day. A detailed and comprehensive record is kept, however the use of times needs to be improved. The staff needs to be aware that they are leaving gaps and spaces between each recording. This could mean that at a later date something could be added to their notes, so to avoid this sign after the recording and draw a line to the end. Arrangements are made for the resident to have visitors, whether it is a family member or a health professional, to be seen in the privacy of their bedroom or in one of the quiet areas within the home. It is left to the residents to choose where they will sit. The pay phone is on a corridor wall in the centre of the home. Some residents have put phones into their own rooms, and this is done at their own expense. Shared rooms have curtains dividing the areas to give privacy. Staff were seen knocking on doors before entering service users bedrooms. The staffs on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. Residents gave positive feedback during the inspection about the approach of the staff team, comments included “nothing is too much trouble for the girls” and “they are lovely”. All residents spoken to agreed the staff were very “professional and respectful of their dignity and right to privacy”. Residents are consulted regarding their wishes concerning terminal care and arrangements after death and this is recorded on their care plans. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Residents have access to a range of appropriate social activities, which improves their quality of life. EVIDENCE: The home employs a dedicated person who is a trained Occupational Therapy assistant to work five days a week. She appeared to be very aware of the needs of her client group and keen to promote their independence. In house activities now being provided include bingo, arts and crafts, knitting group and flower arranging. The home also has the luxury of being able to access the day centre, which is also on site, and use the OT kitchen for cooking cakes once a week. A local vicar, deacon and Catholic priest come in to the home, and a church service is held every two weeks. The home also has access to a minibus for trips out and entertainers come into the home. A hairdresser is based on site and has a salon there. The residents all appreciated the high levels of activities and commented there is always something to do. The residents in the intermediate wing also have daily rehabilitation exercises every morning. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 Residents have access to a clear complaints procedure, which is acted upon by the home when necessary. The residents benefit from all staff knowing how to report appropriately any possible abuse, and what immediate action to be taken to protect residents. EVIDENCE: The home has a clear step-by-step procedure that meets the requirement of the regulations. The complaints procedure includes the stages and timescales for the process, and names and numbers of who to contact. All residents and family and staff had been given a copy and evidence was seen of it included in the statement of purpose and service user guide. The home has received no complaints since the last inspection; evidence was seen of a copy of the complaints form. The home ensures the residents are safeguarded from any abuse, neglect or harm by robust policies for the home. The homes nominated Adult Abuse trainer has completed the Practitioner role level 2 and would like to do further training to undertake investigations at Level 3. The staff attends yearly courses in the Local Authorities protocols on Adult Protection, as well as the home having a copy of the updated policy on file. Staffs when questioned were able to give comprehensive replies to what they would do in case of suspected harm to a resident. The home has a whistle blowing policy and a policy on gifts and gratuities. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23 Residents benefit from living in a safe, well maintained, clean and homely environment in which there are good standards of décor, furnishings and fittings. EVIDENCE: A tour of the home was carried out during the inspection. The intermediate unit’s lounge was specifically looked at due to concerns that it may not have been large enough to seat all the residents of the unit comfortably. Ten chairs where seen and most of the time these were all full plus walking equipment and footstools. There have been specific moves to look at this room and several options are being considered to give them more space. The home’s two residential units mean there are three further communal lounges spread across the building, one smaller one on the short-term residential wing. One larger one split into a quiet room, another for viewing the television or activities area. The lounges also have a kitchen area and dining area, residents can also choose to eat in their rooms. Several residents spoken
Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 15 to commented “On the welcoming feeling of the home”, all residents when questioned enjoyed feeling part of a busy home. Six rooms in the new wing have ensuite toilet/shower facilities and rooms where these are not included a suitable bathroom/toilet is located nearby. The home has sufficient toilet and bathroom facilities for the number of service users. Bedrooms seen had all been personalised by the service users. The rooms were all clean and well decorated. Bedrooms have sufficient space to accommodate the required furniture. The home has high standards of cleanliness and cleaning staff has rotas of which rooms to deep clean daily and no odours were detected in the house. The home is undergoing a programme of redecoration and corridors were seen being redecorated. There is a plan for all the rooms to be re-painted. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 18 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x 3 x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP35 Regulation 20(1a) Requirement The Registered Person shall not pay money belonging to a service user into an account unless the account is in the name of the service user or any of the service users to which the money belongs. Timescale for action 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP35 Good Practice Recommendations The following is recommended: Southampton City Council have managed to find a good solution to the issue around reg 20, and the need to avoid pooling service user monies. The system theyre adopting is called Clients Monies Service (CMS) from Nat West. It involves one account, with separate sub-accounts within it. The subaccounts carry their own number and are interest bearing, therefore ensuring interest is calculated on the amount in each account etc. Monies can be managed in relation to each sub-account by the authoritys finance department through a modem link to the bank.
DS0000036837.V283790.R01.S.doc Version 5.1 Page 20 Platters Farm Lodge 2 3. OP7 OP6 4. 5 6 OP10 OP24 OP7 The daily recordings need to ensure that no gaps or lines are left between each record of events and times are clearly recorded. It is strongly recommended that the Home look at ways of ensuring that rehabilitation programmes can commence on admission to the service and delays of 2 to 3 days are avoided. It is recommended that the home look at ways of ensuring that all residents have easy access to a telephone. A recommendation was made to ensure written evidence of agreement to share a room is kept on their care plans. The monthly reviews of care are detailed but need to be consistently happening every month. The risk assessments need to be reviewed. There needs to be clear evidence of dates recorded on action plans and updated care plan inserts. Platters Farm Lodge DS0000036837.V283790.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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