Inspection on 17/04/08 for West Farm House

This inspection was carried out on 17th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

West Farm House 08/10/07

West Farm House 30/01/07

West Farm House 30/01/06

West Farm House 13/06/05

West Farm House 21/03/05

West Farm House 26/08/04

West Farm House 19/11/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE West Farm House Collingbourne Ducis Marlborough Wiltshire SN8 3DZ Lead Inspector Sally Walker Unannounced Inspection 09:30 17th April 2008 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 West Farm House DS0000028653.V359739.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. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Farm House Address Collingbourne Ducis Marlborough Wiltshire SN8 3DZ 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) 01264 850224 Mrs Helen Burnett- Price Mr Barry Price Mrs Helen Burnett- Price Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th October 2007 Brief Description of the Service: West Farm House provides personal care and accommodation to up to ten older people. The home is situated in a quiet village location. Village amenities, including a convenience store, are within walking distance of the home. West Farm House is a two storey, period property, with some adaptations that have been made to meet the needs of older people. There is a large well-kept garden with a lawn and seating areas. The communal areas of the home consist of a sitting room and a dining room, with a sun lounge extension. The residents individual accommodation is on the ground and first floors. A passenger lift is available. All bedrooms have an en-suite facility. The registered persons, Mrs Burnett-Price and Mr Price, are both involved in the running of the home. Mrs Burnett-Price is the registered manager, with responsibility for managing the day-to-day arrangements and the care of the residents. Mrs Burnett-Price and Mr Price have now moved into the home and provide sleeping-in cover. The current fee levels can be obtained directly from the home. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place on 17th April 2008 between 9.30 am and 4.00pm. Three staff were on duty with 6 residents. One staff was about to leave, having served breakfast. Mr Price was in his private accommodation and assisted with access to some of the paperwork. Mr Price asked for the inspector to give feedback on the findings of this inspection to Mrs Burnett Price on her return from leave. We spoke to Mrs Burnett Price about our findings on Monday 21st April 2008 over the telephone. We spoke with all 6 residents and two staff. We looked at care records, accident records, the staffing rotas and the medication administration record. We made a tour of the building. Following the last inspection of 8th October 2007, we then sent the providers an Improvement Plan setting out what they must do to improve the service. Mrs Burnett Price wrote to us to tell us the progress they had made in addressing the requirements. Actions taken are reported upon in the summary and body of this report. As part of the inspection process we sent survey forms to the home for residents, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Residents have good relationships with staff and the providers. Residents are well supported by staff. Care plans were in place for recently admitted residents. Residents can administer their own medication. Residents can have a bath whenever they want. Residents enjoyed the range and quality of the meals provided. Residents are confident in making complaints about the service. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 6 Residents are encouraged to personalise their bedrooms. The accommodation is cleaned to a high standard and comfortable. The majority of the staff have completed NVQ Level 2 or above. One staff has NVQ Level 4. Staff are regularly updated in mandatory training. What has improved since the last inspection? What they could do better: We must be informed when any significant changes are made to the way the home operates. The statement of purpose must be regularly reviewed and revised to show details of the current service. Copies of the service users guide must be made available to residents so that they can know about the service. Residents should be informed that we inspect the home and may wish to talk to them about the service. The contract should be revised so that outdated legislation is not referred to. As well as listing assessed care needs, care plans must show detailed guidance of how those needs are to be met and monitored. Medication brought in by residents on admission must be checked to establish whether it is currently prescribed. Also to confirm that any special administration instructions are carried out. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 7 Newer residents told us they wanted to have more opportunities to be engaged in activities. The radiators in the six ensuite facilities must now be guarded or fitted with guaranteed low surface temperature radiators. Bedroom doors must not be wedged open. If the door needs to be held open, then automatic self closing devices must be fitted. This is critical when residents are smoking in their bedrooms. Call alarm lead extensions must be made available to residents if needed so that they can use the system where they are sitting. Staff should have regular opportunities to receive training in subjects related to the care needs of the residents. Records required by regulation must be made available for inspection. The home’s fire risk assessment must be reviewed and updated in accordance with the guidance of the Fire and Rescue department. 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. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 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 West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Standard 6 is not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information and contracts given to residents or their relatives are not kept up to date as the service and legislation changes. Residents are not necessarily at the heart of all admissions with decision making mainly done by relatives. EVIDENCE: The Improvement Plan required that the statement of purpose and service users guide are updated to give currently correct information, for example that there are no staff at night. Mrs Burnett Price wrote to us to tell us that there are now two staff in the building at night, one waking one sleeping. However we saw that the rota identified a waking night staff only during the time that Mrs Burnett Price was on leave. We saw that the current statement of purpose was dated March 2008. It stated that that two “staff are on duty twenty four West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 10 hours a day – at night one waking and one sleeping”. The rotas did not support what we had been told. The statement of purpose stated that the home was registered for 10 older people. However the maximum number of bedrooms that could be occupied was six, given that the providers had moved from their adjacent house. The statement of purpose must be further amended to show this. Mrs Burnett Price told us that one of the residents wanted to know what authority inspectors had to interview residents when carrying out an inspection. We advised that these details could be incorporated into the service users guide or admission process. This would enable residents could know about our remit to inspect and talk with residents during the inspection if they wished. We saw that copies of contracts still referred to the Registered Homes Act 1984, repealed in 2000. This document should be revised so that the correct legislation is identified. The document did however make reference to the Commission for Social Care Inspection. Pre-admission assessments had been carried out with those recently admitted residents. Information had been gathered from family about residents’ care and medical history. Care planning documentation had been compiled in time for the resident’s admission. One of the residents told us that although they had not visited prior to their admission. Their family had visited a number of homes in the area and chosen this as being more suited to them. They said staff had not been able to visit them prior to admission as they had been abroad. Another resident told us that they had not been able to visit because they had moved from a different part of the country. We asked recently admitted residents if they had received any information about the service on admission to the home. None of the three residents said they had received any information about what the home provides. Mr Price told us that service users guides had been given to residents. He told us he presumed relatives may have taken the information. We found a copy of the home’s brochure in one of the resident’s files. There was a copy of the service users guide dated 2006 in a file in the kitchen. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff being available at night means that residents care needs are now better monitored. Care planning documentation is now more ordered and consistent. Care plans do not always evidence how assessed care needs are to be met and monitored. Residents have access to local health care professionals. Residents are able to administer their own medication. Residents are not protected by adequate checking of their medication on admission. Staff uphold residents rights to privacy, dignity and respect. EVIDENCE: Action had been taken to address the requirement in the Improvement Plan that we are provided with copies of the assessments of each individual resident’s care needs at different times throughout the night. Mrs Burnett Price sent these to us. Some action had been taken to address the good practice recommendation we made at the last 2 inspections that regular West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 12 monitoring of residents routines during the night forms part of the assessment process. We saw that there is now more detail in daily reports and on some residents’ night care routine charts about staff observations of residents during the night. Mrs Burnett Price confirmed to us that the current night staffing arrangements would remain even if they moved back to their own adjacent accommodation. Action had been taken to address the good practice recommendation we made that residents’ personal details should not be recorded in the daily diary. The diary only recorded appointments and day to day planning unrelated to residents. Little action had been taken to address the requirement in the Improvement Plan that care plans must detail all residents care needs. This related to: the use of oxygen, administration of eye drops, risks, wound management and diabetes care. Oxygen was no longer prescribed. None of the current residents had diabetes. However there was no information about administration of eye drops, wound management or how assessed risks were managed and monitored. One resident’s care plan stated that they were taking an antibiotic for a bite. Their care plan did not give any detail of the wound, dressings or its progress in healing. Action had been taken to address the good practice recommendation we made that the care planning form was confusing if it was only used as a record of reviews. As the review was being written on the care plan form it did not give an up to date picture of the residents’ current needs or how they are to be met and monitored. This has now been addressed. We found information about managing behaviours, bathing and nutrition on moving and handling risk assessments rather than in the care plan. At the last 2 inspections we made a good practice recommendation that the system of care planning should include greater detail about all aspects of residents needs and how they are to be met. The system should also include records of reviews, progress and cross referencing to risk assessments. At this inspection we found some improvements in the detail of assessed needs. However there was little guidance on how needs should be met or monitored. When we talked to staff it was clear that they knew how residents care and support needs were to be met. This information must be recorded in residents care plans. The records were generally more organised at this inspection. The information was recorded on the appropriate forms. Care plans were in place for those recently admitted residents. Mrs Burnett Price told us that photographs would be provided for those recently admitted residents. All the residents were regularly weighed. There was some good evidence of individualised care and routine preferences in care plans, for example, support with eating, when going to bed and with personal care giving. There was also good detail in daily West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 13 reports of residents’ daily routines, contact with family, how they had slept and what they had done during the day. It was clear from talking with staff that they were working in a person centred way. Action had been taken to address the requirement we made in the Improvement Plan that oxygen awaiting collection must be safely stored. The oxygen had been returned to the supplier. We required in the Improvement Plan that residents who returned from hospital must have their needs assessed before their return. Their care plan must be reviewed and revised on their return. Mrs Burnett Price wrote to us telling us that a policy was in place. At this inspection we saw that the policy was dated March 2007. Clearly the home was not following its own policy at the time of the last inspection in October 2007. No residents had been into hospital since the last inspection. Pressure relieving equipment was in place. All of the residents were visited in their bedrooms. They had a drink within easy access. We saw that two of the female residents had some facial hair. This was sufficiently long to be causing them a problem. Mrs Burnett Price told us that this was a delicate issue normally addressed when residents were having personal care, for example, hairdressing or a manicure. One of the residents told us they were “suitably impressed. I’m looked after very well”. One of the staff showed us the arrangements for administration of medication. Only one of the residents administered their own medication. They had brought their own monitored dosage system. We found that the prescribing instructions accompanying the pack had not been checked thoroughly when received. The resident had a prescribed medication with specific administration requirements. Whilst it is acknowledged that the resident had probably not been taking the medication as prescribed when living in their own home, the home should have checked the medication instruction sheet accompanying the resident’s dosset box. We advised that a risk assessment must be in place where residents are self medicating. Also that residents should sign when receiving their medication. Some of the care plans stated ‘homely remedies’. There was no record of what these remedies were. Mrs Burnett Price told us that residents GPs were asked to confirm whether some homely remedies could be taken along with prescribed medication. She went on to say that the newer residents were in the process of registering with a local GP and homely remedies would be discussed with them. We advised that details must be recorded in care plans. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 14 Action had been taken to address the requirement in the Improvement Plan that the medicine trolley must be secured to an immovable object with the padlock provided when not in use. We saw that the trolley was secured when we first arrived at the home. We also saw that staff secured the trolley when returning it. Action had been taken to meet the requirement in the Improvement Plan that all staff administering the medication following the same procedure in line with the home’s administration policy. We advised that staff should also take the medication administration record with them rather than waiting until returning to the drug trolley to sign that the medication had been given. At the last inspection we made a good practice recommendation that if medication is changed or varied, the home should request written confirmation from the prescriber. This related to an anticoagulant that is no longer prescribed. We also made a good practice recommendation that where a medication was administered via an adhesive patch a record should be kept of the different sites to which it is administered. The resident who was prescribed this medication no longer lives at the home. Residents’ comments in survey forms included: “All the carers are very willing to give any help when needed.” Relatives comments in survey forms included: “Excellent personal care from dedicated owners staff, in ‘home from home’ surroundings.” “Gives competent and committed care.” Staff comments in survey forms included: [Does well?] “Keeps relatives up to date with anything that concerns their service user. Has very good relations with the doctor’s surgery.” One health care professional commented in a survey form: “I have no concerns over the standards of care at West Farm House. My involvement with the patient care is limited to few patients over its years of operation. Thank you for asking me.” West Farm House DS0000028653.V359739.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 adequate This judgement has been made using available evidence including a visit to this service. Some residents are content to follow their own established routines. Opportunities for recently admitted residents to engage in activities both at the home and in the community are very limited. The home relies on relatives to take residents out. Residents generally enjoyed the meals provided. EVIDENCE: The Improvement Plan stated that the provision of activities must be reviewed with each resident to ensure that their individual needs and preferences are met. Mrs Burnett Price wrote to us saying “can only do this with co-operation of residents”. We talked with three of the recently admitted residents. One of these residents told us that they read and went out with their families. They told us that they did not necessarily want to go shopping or for long walks. They said they were very sociable and often invited some of the other residents to their room for a drink before supper. They said that they were bored at other times. They said that staff did not have time to sit with them and be sociable. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 16 Another recently admitted resident told us that they liked to read and had been to the local shop. They said that there was not much else to do. We found no published activity programme. Two of the residents who had lived at the home for some time told us that they were happy with their own interests and did not want to have activities planned for them. One resident told us they liked to go to the pub for lunch with their family. They said they liked to watch television or do the crossword. Another resident told us they liked to read a lot and were a member of the mobile library. They said they liked crosswords and sitting in the garden. One resident told us that the home “doesn’t feel institutionalised”. It was clear from discussions with staff that they spent time chatting with residents, longer when they bathed residents or did their hair. We discussed with staff about the new opportunities for providing social activities with the recently admitted residents. Mrs Burnett Price told us that she had considered providing more activities for the newer residents. These included walks, work in the garden with bedding plants and reinstating the Communion services, which had been stopped through lack of interest. Mrs Burnett Price said there were also a number of events held in the village that residents could be involved in. One of the residents told us that the telephone in their bedroom was complicated to use so their family were going to get them a mobile phone. There was not much evidence in the records of how residents were supported to make decisions about their lives. One of the residents told us that they went to the dining room for lunch and supper. They said that the food was not bad. They described the suppers as dreary, saying that the home did not cook at night. We looked at the four weekly menus. There was a cooked meal for most of the evening meals. We also talked to staff and to other residents who were having lunch. One resident said there had not been sandwiches on the menu that week. Staff told us that often residents liked to have soup and sandwiches. Residents told us that they had their breakfast in their bedrooms. One resident told us that there was “always good food”. They said that if they did not like any of the meals they would be given something else. Another resident told us “they are always coming in with cups of tea”. Another resident told us about the beef casserole and vegetables that they had enjoyed. The staff member who was cooking the lunch that day told us that all meals were ‘cooked from scratch’. They said they would change the menu according to seasonal availability or the weather. The lunch was home cooked lasagne with courgettes and banana sponge for pudding. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 17 Residents’ comments in survey forms included: “I am not interested in activities. I prefer to read, do the crosswords in the paper or go for a walk. The meals are always excellent with plenty of variety.” Relatives’ comments in survey forms included: “Delicious freshly cooked meals.” “Would have been good when my [relative] was less disabled to have more activities in which [they] could have joined.” Staff comments in survey forms included: [Do better?] “Provide more entertainment and social events.” West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that they can make complaints to the providers about the service. Staff are trained in the local safeguarding adults procedure. The provision of staff in the building at night means that residents can feel more supported at night. EVIDENCE: The home provided a copy of the complaints procedure when the contracts were given to residents or their families. Mr Price told us that if residents did not have copies of the service users guide containing details of complaints in their bedrooms, they had probably been taken by families. One of the residents spoken with told us they would speak to Mrs Burnett Price if they wanted to complain about the service. Another resident said they would approach their family to act on their behalf. One resident said “I couldn’t grumble if I tried”. They said a problem with their bed had been sorted out immediately and another problem with glasses had been addressed. The complaints log recorded the last entry as 1999. Staff had received training in the local safeguarding procedure. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 19 Residents’ comments in survey forms included: “I have been very happy here…and have never had any cause for concern.” [Know how to complain?] “Not an official one”. Relatives’ comments in survey forms included: [Know how to complain?] “Not in official capacity.” Staff comments in survey forms included: “If and when service users have any concerns, they are dealt with promptly and in a efficient way.” West Farm House DS0000028653.V359739.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 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents enjoy a clean, comfortable and pleasant environment. Residents are no longer at risk of being scalded when bathing. Residents remain at risk from poor fire safety measures when doors are wedged open. EVIDENCE: Three of the registered bedrooms were taken up by the providers now that they had moved out of their adjacent house. Residents’ bedrooms were personalised and individually furnished. We asked residents about using the call alarm system in their bedrooms. Some of the bedrooms had a cover over the call point, which had to be lifted before use. Mrs Burnett Price confirmed that extension leads were available for the alarms so that residents did not have to go to the call point to use the alarm. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 21 One of the residents told us that they would like the unoccupied bed in their room removed so that they could bring some of their own furniture and rearrange the bedroom so they had more room. We advised them to talk with the providers. Action had been taken to meet the requirement we made in the Improvement Plan that thermostatic controls must be fitted to the baths. This was because residents are at risk of being scalded if the hot water temperature is not maintained at a safe level. One of the staff told us that the controls had been fitted to the upstairs bathroom. They showed us the bathroom upstairs which was kept locked. Staff told us that residents could not bathe without staff being present. We tested the running hot water supply by hand. It remained at a temperature that was comfortable. The staff told us that the downstairs bathroom was now used exclusively by the providers now that they had moved into the home. We saw that staff had been recording the hot water temperature checks in the diary before the controls were fitted. One of the residents told us that if they wanted a bath, they just asked. Another resident said they had a bath every Tuesday. The Improvement Plan required that risk assessments are carried out of the radiators and hot surface in the residents’ ensuite areas. This meant that safety measures will need to be in place as indicated by these assessments. Risk assessments had been carried out, yet the outcome was to place a towel over the radiators and reduce the thermostatic control valve to a lower setting. This clearly does not protect anyone who may fall against the radiator. We require this to be addressed. We agreed with Mrs Burnett Price that as a priority, guards would be fitted to the radiators in the six ensuite bedrooms currently occupied. We agreed that this work would be carried out by the 30th June 2008. We made a requirement in the Improvement Plan that the fire risk assessment must be reviewed and updated to include the arrangements when there are no staff in the building. This has been resolved since the providers are now sleeping in the building at night. The Fire and Rescue department has also given advice to Mrs Burnett Price on reviewing and updating the fire risk assessment. At the last 2 inspections we found doors found doors were being held open with wedges or heavy objects. This means that doors do not automatically close in the event of a fire. We made good practice recommendations that residents are offered automatic self-closuring devices to their bedroom doors. We wrote to the local Fire and Rescue informing them of the risks we had found with regard to bedroom doors being held open with plastic wedges or heavy objects. A Fire Safety Officer recently inspected the home and a copy of their report has been requested. At this inspection we saw that one bedroom door was being wedged open. All the other doors were closed. This bedroom West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 22 door being held open with a rubber doorstop. We talked to Mr Price about the risks particularly as this resident smoked in their bedroom. Mr Price told us that this resident was aware of the risks and should not have the door open whilst smoking as the smoke annoyed the other residents. We also saw a number of heavy objects or door stops by some of the closed doors. Mr Price told us that these were only used when staff vacuumed the rooms. Mrs Burnett Price told us that she had considered different closing devices. She said she had also discussed the wedge with the resident as the smoke was escaping to the rest of the house. We asked Mrs Burnett Price whether she had discussed the matter with the fire officer during the inspection. She told us she had not. We advised that she discuss with the fire officer which devices were approved by the local Fire and Rescue department. We looked at the laundry arrangements. The room was clean and well organised. One resident told us that “washing comes back beautifully ironed”. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 23 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 adequate This judgement has been made using available evidence including a visit to this service. Residents are now supported by staff being in the home over a 24 hour period. Staff complete regular basic training but there is no future planning of training opportunities associated with the ageing process. Staff have established very good relationships with residents. Staff were competent and knowledgeable about meeting residents needs. EVIDENCE: Action had been taken to address the requirement in the Improvement Plan that the providers must tell us of their progress in providing night staff in the building throughout the week. Mrs Burnett Price wrote to us to tell us: “two staff on the premises nightly – one waking”. Mr Price and Mrs Burnett Price have moved into the home and are occupying one of the registered bedrooms downstairs. The rotas did not support what we had been told. That week, Mrs Burnett Price was on leave and one of the staff was carrying out a waking night duty. We saw that the rota identified a waking night staff only during the time that Mrs Burnett Price was on leave. The other rotas identified the providers as being on duty during the period 9.00pm to 8.00am. One of the day staff told us they had also carried out waking night duty whilst Mrs Burnett Price was away. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 24 Little action had been taken to address the requirement we made in the Improvement Plan that the staffing rota must show which staff are actually on duty at different times during the day. This related to the rota showing “HP or BP”, either Mr Price or Mrs Burnett Price, not who actually worked. We saw on the rota for that week that a line had been drawn through HP (Mrs Burnett Price), identifying that Mr Price was working. Previous rotas however, still showed HP or BP and did not identify who actually worked. We found that the staff member doing the cooking was not on the rota that day. Staff also told us that they would also stay on to cover some shifts. This was not identified on the rotas. Only one staff and Mr Price were identified as working that morning, apart from the person preparing breakfast. We advised Mr Price that the rotas must be up to date and accurate. During our telephone conversation with Mrs Burnett Price, she told us that Mr Price mainly managed the business. He did not provide any personal care but would liaise with relatives, help with breakfast or give medication. She said that staff ran the shifts when she is not there. We advised that correction fluid should not be used on records, including the rotas. We stated in the Improvement Plan that the providers must undertake Criminal Records Bureau disclosures in accordance with our policies and guidance. Mr Price told us that the staffing records could not be located. He said that much of the paperwork that had transferred across from his office in their adjacent home was stored in the loft. He said Mrs Burnett Price would know its exact whereabouts. Mr Price told us that he had not employed any new staff since the previous inspection. He told us that the person without a Criminal Records Bureau certificate at the last inspection had ceased to be employed. The gardening was now contracted out and no contact was made with residents by the contractors. We made a good practice recommendation that the staff training matrix should be kept under review so that staff can receive regular updated training. Mr Price told us that he could not access the records that had been brought across in their move. Staff told us that they had not received any training since September 2007. They did not know whether there was any training planned for the near future. Mrs Burnett Price told us that staff were up to date with mandatory training such as: health and safety, food hygiene, moving and handling and infection control. We asked about training in other subjects related to the ageing process. Mrs Burnett Price told us that staff had been trained in dementia, bereavement and the local safeguarding adults procedure. She told us that no other training was planned for the near future. One of the staff told us they had NVQ Level 4. Mrs Burnett Price told us that all of the staff except two have NVQ Level 2. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 25 Residents made very positive comments about the staff. One resident described the staff as “wonderful and kind.” Another resident described the staff as excellent. One resident said that staff provided care “in an unobtrusive way”. Staff comments in survey forms included: “All staff respect the wishes and choices of our service users, and in doing this create a happy and caring environment for them.” “Any changes are reported to the staff right away. I did have my CRB later on in my employment. We had a long chat…of how things were to run and the working of the home. Mr and Mrs Price arrange courses for us to attend so we are kept up to date. When new ways come out we are taught them. My role isn’t so vital, but I have chats every morning with Mrs Price and she fills in a form for complaints etc. If someone wishes to know anything we are able to get Mrs Price anytime of day, but we know all our patients well. Before I leave my shift I have plenty of time to relay the residents well being to next shift. We are easily covered by each member of staff as we can call on each other anytime. We are a small home and we do our best to make sure it is kept like a home not an institution. Our residents are treated as friends and extended family so they feel happy and secure with us. I feel small homes like ours should get support to keep open.” West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 26 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, 37 & 38. We did not inspect key standards 33 regarding quality assurance and 35 regarding staff supervision. This was because our priorities were to consider progress in meeting the requirements of the Improvement Plan. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Management continues to ensure good continuity in the day to day running of the home. Progress is being made in ensuring residents safety and welfare. Record keeping does not necessarily evidence what we are told about how the service operates. Records required by regulation are not made available for inspection. EVIDENCE: West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 27 Mrs Burnett Price was originally registered with Wiltshire County Council, when she was considered to meet the standards in respect of supervisory experience, qualifications and competence. She has completed the NVQ Level 4 in management and care. Staff continued to make sure that residents were well supported in Mrs Burnett Price’s absence. Mrs Burnett Price told us that Mr Price is the finance and business manager. She said he provides no personal care but will liaise with relatives, help with breakfast, may give medication or do some washing up. Mrs Burnett Price told us that staff run the shifts when she is away. Mr Price and Mrs Burnett Price did not initially inform us that they had moved from their adjacent house on 1st March 2008. They are occupying three of the registered bedrooms and the downstairs bathroom. One bedroom was being used as a sitting room, one as an office and one as the providers’ bedroom. This restricts the registered beds. Only 6 can be occupied. The providers must now apply for a variation to reduce the number of registered beds to 6. They have been informed of this and have been sent a copy of the application in a separate letter. We must be informed of any future changes, for example, if the providers move back into their adjacent house. Action had been taken to address the requirement in the Improvement Plan that checks are made to identify hazards so that residents are not at risk of harm. We saw a form dated 7/4/08 with details of reviewing accident records, hot surfaces, window openings on the first floor and consideration of the layout of a bedroom. Four accidents had been recorded recently. At the last inspection we made a good practice recommendation that records should be kept of safety checks. This was because we were told that regular checks were carried out in respect of maintenance, medication administration records and hot water temperatures. The home could not produce records to show evidence of their checks. At this inspection Mr Price told us that the records would probably be with the boxes of records that came across in the move. He could not access them during this visit. Mrs Burnett Price confirmed that a log of these checks was kept in the kitchen. She told us that these were the daily checks made last thing at night. We also made a good practice recommendation that risk assessments should apply to: tasks, use of equipment or the environment rather than individually named staff. Mrs Burnett Price told us that these records were also part of the records that had not been unpacked since their move. She told us these risk assessments had been carried out. West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X 2 2 West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement Timescale for action 17/04/08 2 OP9 13(2) 3 OP9 13(2) 4. OP12 16(2)(n) The person registered must ensure that the statement of purpose is updated as the service changes. This document and the service users guide must be made available to residents so that they can know about the service. The registered person must 17/04/08 ensure that all medication received from residents or their relatives is checked on admission so that correct prescribing instructions are followed. The registered person must 17/04/08 ensure that a written risk assessment is carried out with residents who wish to continue to administer their own medication. The registered person must 17/04/08 ensure that the provision of activities in the home is reviewed following consultation with each service user to ensure that their individual needs and preferences are met. (This was identified at previous inspections. Some progress). DS0000028653.V359739.R01.S.doc Version 5.2 West Farm House Page 30 5. OP25 13(4) 6. OP7 15 7. OP37 17(2) Schedule 4 para 7 8. OP19 23(4) 9 OP19 OP38 13(4)(c) 10 11 OP31 OP37 37 17(3)(b) The registered manager must ensure that the radiators in the residents’ en-suite areas are guarded or fitted with guaranteed low surface temperature radiators. The person registered must ensure that each care plan identifies all of the care needs of the resident and in particular, how they are to be met. (This was identified at previous inspections. In some progress. Assessed needs were generally identified. More work needs to be done to record guidance to staff on how those needs are to be met and monitored). The person registered must ensure that the staffing rota shows which staff are actually on duty at different times during the day. (This was identified at previous inspections. Remains outstanding at this inspection). The person registered must ensure that the fire risk assessment is reviewed and updated. (Guidance has been given to the home by the local Fire and Rescue department). The person registered must ensure that residents and staff are not at risk in the event of a fire. If bedroom doors need to be held open for any reason, an automatic self-closing device that is triggered in the event of a fire must be fitted. The person registered must inform us of any changes in how the home operates. The person registered must ensure that the records required by regulation are always available for inspection. 30/06/08 17/04/08 17/04/08 31/05/08 17/04/08 17/04/08 17/04/08 West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 31 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 Refer to Standard OP1 OP2 Good Practice Recommendations Consideration should be given to informing residents of our role in carrying out inspections of the home. Consideration should be given to updating the contract and deleting reference to the Registered Homes Act 1984 and inserting the Care Standards Act 2000, the current legislation which applies to registered services. Consideration should be given to providing the extension leads available for the call alarm in residents’ bedrooms so that they can use the alarms where they may sitting. Consideration should be given to ways of sensitively ensuring that female residents are supported in managing facial hair removal to ensure dignity at all times. Consideration should be given to recording when residents who self medicate receive their medication. This could either be with the resident’s signature or a signature of the staff handing them the medication. The staff training matrix should be kept under review so that staff can receive regular updated training in subjects related to the needs of the residents and the ageing process. The risk assessments should apply to tasks, use of equipment or the environment rather than individually named staff. 3 4 5 OP22 OP10 OP9 OP37 6. OP30 7. OP38 West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI West Farm House DS0000028653.V359739.R01.S.doc Version 5.2 Page 33 - 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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