Inspection on 08/10/07 for West Farm House

This inspection was carried out on 8th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 17/04/08

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 Key Unannounced Inspection 09:35 8 and 9th October 2007 th 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.V350410.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.V350410.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.V350410.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 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 in the role of registered manager, with responsibility for managing the day-to-day arrangements and the care of the service users. During the day the service users receive support from a permanent staff team. There are no staff members present in the building during the night. Mrs Burnett-Price and Mr Price provide sleeping-in cover from their own accommodation, which is next to the home. There is a call alarm system between the two properties. The current fee levels can be obtained directly from the home. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 8th October 2007 from 9.35am to 3.15pm. Mrs Burnett Price had appointments in the latter part of the day so the inspection continued on 9th October 2007 between 9.40 and 1.40pm. Mrs Burnet Price was present throughout the inspection. Three residents and two staff were spoken with. The care records, risk assessments, staff records, the rotas and medication records were inspected. We required an Improvement Plan following the last inspection of 30th January 2007. The Improvement Plan set out what must be done to comply with Regulations that had failed to be met at previous inspections. The registered providers were required to write to us about what they are doing to make the improvements and meet the requirements set out in the Plan. They were also required to tell us how they will make sure that what they are doing will be effective. We advised that failure to comply with each regulation was an offence, which could result in enforcement action. Mrs Burnett Price responded with her action plan. Mr Price and Mrs Burnett Price are considering the long term continuation of the care home. As part of the inspection process survey forms were sent to the home to gain the views of residents, staff and external healthcare professionals. Any comments can be found in the body of the 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: What has improved since the last inspection? West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 6 The ensuite facilities were cleaned to a good standard and the floor coverings were not stained. Medication records are being properly completed. All staff except one had Criminal Records Bureau certificates. This staff was reported not to have any contact with residents and was due to leave. Mrs Burnett Price has used the Annual Quality Assurance Assessment required by regulation to review the service provided rather than set up her own system. Information was available so that RIDDOR forms can be completed when any accidents need to be notified to the relevant authority. What they could do better: The statement of purpose and service users guide must be amended so that prospective residents and their families know what is currently provided in the home. Care plans must show the current needs of residents and how they are to be met. If needs change, the care plan must be reviewed at the time rather than wait until all the plans are reviewed each month. If a resident returns from hospital their care plan must be reviewed when they return to see if their needs have changed based on the assessment. Care plans must also cross reference to the risk assessments so that any risks can be noted and monitored. Wounds must be recorded to show progress in healing. Residents’ personal details must only be recorded in their personal files, not the daily diary. The medication trolley should be kept secured with the padlock provided. When administering medication all staff must follow the same procedure as defined in the home’s policy. Oxygen must be safely kept until it is returned to the supplier. Radiators in residents’ ensuite facilities remain unguarded. The hot water supply to the baths is not regulated to ensure that residents are not scalded if they run a bath. The bathrooms are now locked so that residents cannot use the baths without staff. The registered providers have not given us information from the plumber who stated technical reasons for not being able to fit temperature regulators to the hot water system to the baths. The lack of staff in the building at night means that residents remain at risk with no supervision if they fall, become ill or there is a fire and they cannot contact the providers who live next door. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 7 Mr Price and Mrs Burnett Price are required, in a separate letter, to carry out individual assessments of each residents night care needs, including different sleeping patterns and to copy them to us by 9th November 2007. Mr Price and Mrs Burnett Price have been advised to urgently engage waking night staff. The staffing rota must record which of the Proprietors worked, rather than “BP or HP”. The fire risk assessment must be reviewed and revised to show the arrangements for alerting the emergency services and evacuation whilst there are no staff in the building at night. The registered providers should consult with the Fire Authority for guidance. The Fire & Rescue Services have been informed of the findings of this inspection. We have sought legal advice on enforcement action to ensure the health and wellbeing of residents. 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.V350410.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.V350410.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 as no intermediate care is provided] Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although no long term residents have been admitted, those people who have used the respite service have had all their needs assessed. Prospective residents and their families are given a false impression of the care and support provided as the statement of purpose and service users guide states that 24 hour staffing is provided. EVIDENCE: Action had been taken to address the recommendation, brought forward from previous inspections, that information about the home is more readily available and accessible to residents and others. Information is available in the drawing room. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 10 There had been no permanent residents admitted, however some people had used the respite service. It could not be established whether they had been given a copy of the statement of purpose or the service users guide. Copies of the documents had not been reviewed and revised and still stated that staffing was available 24 hours of the day. Clearly this is not factually correct, with no staff in the building during the night. The files of those people who had used the respite service showed that they had had their needs assessed before a place was offered. Some action had been taken to meet the recommendation that assessment forms are completed in full to include the section on residents’ views and contribution. Contracts were on file. However the contracts had not been revised for some time as one filled out for June 2007 still referred to the Registered Homes Act 1984, repealed in 2000. West Farm House DS0000028653.V350410.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 poor. This judgement has been made using available evidence including a visit to this service. Not all care and healthcare needs are recognised in care plans. Residents can self medicate. Medication administration procedures were not being consistently followed. Residents are treated with respect and have good relationships with the providers and staff. EVIDENCE: Some action had been taken to meet the recommendation that the system of care planning and recording is developed further. Little action had been taken to include greater detail and information about all aspects of residents’ needs and how they are to be met. One resident, who had recently returned from hospital, had not had their care plan or risk assessments updated since their return. Clearly their needs were different as equipment was in place but the care plan did not refer to this. There was no record of one resident’s prescribed eye drops which they administered themselves. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 12 The record stated: “self medicates safely” but there was no evidence of how this decision was made. A file for a person who had used the respite service did not have a care plan in place. Little action had been taken to meet the recommendation that care plans identify, by cross-referencing, where risk assessments are undertaken in connection with individual residents. There was no indication in the bathing risk assessments as to whether residents could be left alone whilst bathing. Mrs Burnett Price said that residents were never left in the bathrooms alone. One assessment stated that the resident could get in and out of the bath without a hoist. One care plan with regard to pressure area management stated: “checked when bathed weekly”. There was evidence in the daily report that checks were made but the care plan did not state what should happen if concerns were noted. There was no evidence of assessment of the early indicators of risk of residents developing pressure damage. One record stated that an “area on right ankle being monitored and dressed”. There was no record of whether the skin was broken, the size or colour of the wound or evidence of progress of healing. The use of body maps was advised. Weights were regularly monitored each month but they did not relate to moving and handling assessments. An assessment for self-medication only recorded: “has been observed and monitored. Has proved herself capable”. There was no evidence of how this is monitored. A smoking risk assessment only stated: “able to smoke tidily”. One care plan stated that the resident had diabetes. The only reference to management of the condition was that they had a “light diet”. There was no indication as to what this meant or to other considerations to the care of someone with diabetes, for example, regular monitoring by the diabetic nurse. The daily report did state: “district nurse carried out diabetic check today.” We advised that staff should not record residents’ personal details in the daily diary. Action had been taken to produce a clear means of recording reviews of the care plans and progress with meeting residents’ goals and needs. However this monthly review was being recorded across the care-planning document, without the care plan being revised. Mrs Burnett Price was advised that the care planning format should be used as it set out the assessed need, how needs must be met, monitored and by whom. There was no evidence that action had been taken to address the recommendation, carried over from previous inspections, that regular assessment and monitoring was carried out of residents’ activities and routines during the night. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 13 Care plans and daily reports stated that all residents had ‘no needs at night’. There was no evidence of how this conclusion had been arrived at. Clearly without staff being available during the night, no proper assessment can be made. There are no waking night staff; Mr Price and Mrs Burnett Price carry out a sleeping in duty from their adjacent house. See standard 27 regarding staffing. Mrs Burnett Price said that if a resident was ill she would stay up with them. If a resident became ill during the night Mr Price and Mrs Burnett Price relied on them being sufficiently well enough to telephone across to the house. There was no provision for those residents who may not be well enough to make telephone calls if they were ill. The care plans and daily reports stated for each resident “no needs at night”. Without anyone present at night it would be impossible for the home to establish what residents’ actual needs were during that time. One resident spoken with said that staff gave any personal care when it was requested; “they fit in with me”. They went on to say that they had good access to their GP through the staff. As unsafe medication administration recording was found at the last inspection, we required an Improvement Plan. Action had been taken to address the Improvement Plan, which set out that the medication procedures must improve. There must be no misunderstanding about whether a resident had been given the correct medication as prescribed, which could result in the resident being put at risk. An accurate record must be made of any medication given together with an appropriate record of the adjustments made in the dose of an anticoagulant. Mrs Burnett Price confirmed in writing to us that no anticoagulant medication was currently prescribed. She also confirmed that the medication administration records were checked every day by the most senior member of staff. There was no written evidence of this. Medication administration records were found to be satisfactorily completed. Mrs Burnett Price was advised that although no anticoagulant was currently prescribed, in future, if medication is changed it is reasonable for the home to request written confirmation from the prescriber. Mrs Burnett Price reported that she would ask the GP to write any new dosage on the home’s medication administration record. The medication cabinet was not secured to an immovable object as required. A padlock was supplied but not used. All medication was checked as it was received from the supplying pharmacist. Medication is administered from the original packs stored in a plastic container for each resident. Mrs Burnett Price said that she would take the container to each resident, whilst some staff would only take those packs prescribed for that time of the day. We advised that there must be consistency in medication procedures to avoid the risk of error. All administrations must be in line with the home’s medication administration policy. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 14 We advised that records must be kept when medication is given to those residents who self medicate. The residents should sign to say that they had received the medication. If medication is delivered via an adhesive patch to be applied to alternate parts of the resident’s body, records must be kept of each different application. Unwanted oxygen cylinders were being stored outside in the garden. Mrs Burnett Price was advised that these should be kept in a locked facility, away from any potential risks, until they are returned to the supplier. They must also be assessed as part of the fire risk assessments. In a survey form one of the staff said: “We provide support to service users, friends and relatives etc., we provide help, care and support to service users encouraging & maintaining as much independence as is possible. At this time I don’t see that there is anything that could be done better to ensure the safety, comfort & assistance that we already provide.” Another staff said: “all support and needs of our service users are of the utmost importance to all staff within the home, information is communicated to all staff and written in care plans. At this present time, I don’t think our service and care are lacking”. One of the relatives said in a survey form: “I am very happy for my [relative] to be in their care and would recommend the home to anyone looking for superb personal care in a ‘home from home’ atmosphere.” West Farm House DS0000028653.V350410.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 but good with regard to meals provided. This judgement has been made using available evidence including a visit to this service. Residents are expected to follow their own routines. Consequently residents retain control over much of their daily lives. There is an expectation that family provide much of the residents’ social life. The lack of organised activities may not suit all of the residents. However those spoken with appeared to be satisfied with this. The atmosphere is quiet and relaxed which suited those residents currently living at the home. Residents liked the range and quality of the meals provided. EVIDENCE: Residents were encouraged to follow their own routines. The majority stayed in their bedrooms during the day. As there were little provision of activities and some residents had said that they would like to do more at the last inspection, an Improvement Plan was required. It set out that there must be a review of the provision of activities following consultation with residents so that residents can participate activities that meet their needs and preferences. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 16 Mrs Burnett Price confirmed in writing that residents had been consulted and activities reviewed. She also confirmed that residents were disinterested, except for monthly Holy Communion and the weekly mobile library. Mrs Burnett Price also confirmed that consultation with residents about activities was ongoing. She said that the residents had enjoyed the pianist that had come to play to residents. Residents spoken with were asked about things to do during the day. It was clear from talking with some of the residents that they did not want to have activities arranged for them. They said they liked reading their papers, doing crosswords, reading books delivered by the mobile library and watching television. They relied on families taking them out. One resident was looking forward to going out with a befriender from Age Concern. Another resident went out to lunch with their family. One resident went for regular walks in the locality and would collect the newspapers from the local shop. One resident said they were regularly taken to Marlborough shopping. A person from Age Concern came to do shopping for some residents. Whilst it is recognised that current residents may be happy following their own routines, consultation about activities should be ongoing. Some action had been taken to address the recommendation that residents are asked if they would like to receive a befriending service. Currently 2 residents were receiving a service. The home follows a four-week menu. On the first day of the inspection the lunch was lamb casserole with 3 vegetables. Two residents had their meal in the dining room and everyone else took theirs in their bedrooms. The meal was well presented and unhurried. The kitchen was well stocked including a good supply of snacks. In a survey form one of the relatives said: “Superb home cooking”. One of the residents spoken with said that the food was good with plenty of variety. They said their likes and dislikes were known but if they did not like the meal they would be given something else. Another resident said they generally liked the meals but on many occasions there were soup and sandwiches. The menus were examined. There were 2 evening meals in the monthly menu showing soup and only one evening meal showing sandwiches. Mrs Burnett Price was asked if residents were able to access the kitchen to make drinks or snacks during the time that there are no staff on duty. She said they were not. She went on to say that one resident had their kettle in their bedroom and the other residents had their own juices or water and biscuits if they were hungry. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 17 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. Systems are in place so that residents and their relatives can complain about the service. Staff are familiar with the procedure for Safeguarding Adults from any abuse. Failure to provide waking night staff leaves the residents unprotected. Failure to guard radiators, control hot water to baths and hot pipe work may leave residents at risk of scalding. EVIDENCE: The home has a complaints procedure, which is published in the statement of purpose and service users guide. One of the residents spoken with said they would see Mrs Burnett Price or tell their daughter if they wanted to make a complaint. Another resident said they thought there was a book in the kitchen to put any complaints. The complaints log recorded the last entry in 1999. Staff were asked about their actions if they were to discover any abuse of residents. It was clear from their response that they were familiar with the local Safeguarding Adults procedure and confident in reporting any concerns to the relevant authority. No action had been taken to ensure residents were well supervised at night. No action had been taken to ensure that residents were protected from risk of scalding from unguarded radiators. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 18 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, 22, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have a clean, warm and comfortable environment. The decoration and furnishing are in keeping with the character of the building. Residents are put at risk by the use of ‘door stops’, which do not comply with fire authority’s safety standards. Residents are put at risk of scalding as radiators in their ensuite facilities have not been properly assessed or guarded. EVIDENCE: There is a large garden set out with seating and tables for residents in the better weather. The décor of the building is well maintained. All the bedrooms are single occupancy. Mrs Burnett Price said that she regularly made a check of the building to address maintenance and risks. However there was no written evidence of these checks or maintenance log. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 19 As radiators in ensuite facilities had not been guarded to reduce the risk of scalding an Improvement Plan was required. This set out that these radiators must be included in the risk assessments of radiators and hot surfaces. It was also required that radiator covers were fitted where indicated by the assessments, so that residents are not at risk of being burnt from their contact with radiators and pipe work. Mrs Burnett Price confirmed in writing that these radiators had been included in the risk assessments. The radiators had not been guarded. The risk assessments stated that a towel had been placed on the radiators rather than be guarded. Mrs Burnett Price also confirmed that the radiators in the en-suite rooms were kept at a lower temperature that the large radiators. Mrs Burnett Price confirmed that the radiator temperatures are set and checked every day. However there were no records kept as evidence of this. The radiators in the sun lounge had been fitted with guards. As the hot water supply to baths was not regulated, putting residents at risk of being scolded, an Improvement Plan was required. This set out that individual thermostatic controls are fitted to the baths. The registered providers were required to inform us if this is not reasonably practicable for any reason, together with alternative arrangements to ensure a safe hot water supply. Mrs Burnett Price confirmed that a plumber had concluded that the controls could not be fitted due to the design of the system. We discussed this with the plumber at the last inspection and asked for the conclusions to be put in writing to us either by Mrs Burnett Price or the plumber so a view could be taken. No information was received. Mrs Burnett Price confirmed that staff draw each bath for residents and stay with them whilst they bathe. However there were no records of temperature checks of bathing water. It was noted that all the bathrooms were locked during the inspection. No action had been taken to address the recommendation, carried over from previous inspections, that residents are offered an automatic mechanism to be fitted to the bedroom doors to enable the door to be safely kept in an open position. No automatic door closure mechanisms were fitted to any of the bedroom doors. Mrs Burnett Price said that she had considered fitting these mechanisms. There were a number of ‘door stops’ noted on a tour of the home. Mrs Burnett Price said that they were only used whilst staff were carrying out cleaning of bedrooms. However some bedroom doors were being kept open without staff being present in the rooms. One of the residents smoked in their bedroom or in the garden, weather permitting. Staff who smoked did so outside by the laundry. In a survey form one of the relatives said: “excellent laundry service.” West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 20 Action had been taken to address the recommendation that checks are made of the bedroom and en-suite areas to ensure that they are in a hygienic condition with suitable floor covering. All of the bedrooms seen were found to be fresh and clean with no staining of floor coverings. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have good relationships with staff and are well supported by them. The lack of staff at night continues to put residents safety at risk. No action has been taken to address this so residents remain unsupported during the night. Residents are not protected by all staff being subject to appropriate checks on their suitability to work with vulnerable people. Staff benefit from mandatory training. EVIDENCE: On both days of the inspection Mrs Burnett Price was on duty during the morning with 2 staff. On the first afternoon Mrs Burnett Price left the home at 3.15 for some appointments. She reported that Mr Price was on duty from the office next door. However this left only one member of staff in the building. The rota for the hours between 8.00am to 9.00am and 2.00pm to 9.00pm stated that Mr Price or Mrs Burnett Price would be on duty. The rotas did not show who had actually been on duty. We advised that a true and accurate record must be kept of who actually worked. Staff undertake cleaning, laundry and cooking as well as care. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 22 As the home continued to have no staff in the building at night, only Mr Price and Mrs Burnett Price sleeping in their adjacent house, an Improvement Plan was required. This set out that the home informs us of their long-term arrangements for provision of additional support and supervision during the night. This is to ensure that residents can feel confident that they are safe at night and that their needs will be met according to their level of dependency. No action has been taken to address the failure to meet the regulation about having sufficient staff on duty at all times. Mrs Burnett Price confirmed in writing that there will be no long-term provision of addition support and supervision at night. Mrs Burnett Price gave mitigating circumstances for noncompliance with this regulation. Mr Price and Mrs Burnett Price are considering the future continuation of the care home. She went on to confirm that all residents were spoken to each day with special needs provided for. The staffing rota confirmed that residents are alone in the building from 9.00pm to 8.00am. Mrs Burnett Price told us that she would make her final checks at about 11.00pm before retiring to her house next door. This is a period of between 9 and 11 hours that residents are without direct staff support. Mrs Burnett Price told us that a member of staff slept in the home when she and her husband went on holiday. She also said that if a resident was ill a member of staff would be in the home awake at night. Mrs Burnett Price said that residents would telephone her if they were taken ill during the night. However no consideration is made for those residents who may not be in a position to use the telephone due to acute ill health. Mrs Burnett Price said that she had employed night staff in the past but they had been found to sleep on duty or wake residents up with their continual checking in bedrooms. As some staff had been appointed without safety checks on their Criminal Records Bureau status, an Improvement Plan was required. This set out that residents must feel confident that they are not supported or have contact with unsuitable staff. Mrs Burnett Price confirmed in writing that Criminal Records Bureau certificates were on file and that a casual employee had applied to the Criminal Records Bureau for a certificate. However no certificate was available for this member of staff. Mrs Burnett Price told us that this person’s employment was to be terminated as they were not reliable. She said that this person did not provide personal care and had no contact with residents. All the care staff had Criminal Records Bureau certificates. Staff recruitment files showed that all other documents and information required by regulation was being sought prior to appointments being made. There was a training matrix showing mandatory training that staff were required to undertake, for example, first aid, moving and handling, food hygiene and infection control. Staff had also been trained in dementia care, handling medication and continence. No updated training had been undertaken since November 2006. However some of the certificates stated that the training was valid for 3 years. One of the staff held NVQ Level 4. Four care staff held NVQ Level 2. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 23 All of the residents spoken with made very positive comments about their relationships with staff. One said “there is never a cross word”. They went on to say that staff always responded very promptly to use of the call bell. Another resident described the staff as “amusing” and “efficient”. They said staff respected their privacy. In a survey form one of the relatives said: “Very personal care from kind, gentle, friendly, and experienced staff. They are totally dedicated and nothing is too much trouble.” Another relative said: “its an excellent family run concern with staff who have been there ages and my [relative] is happy there.” West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is adequate but poor in the providers response to addressing issues of safety. 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. Improvements to ensuring residents safety and welfare remain outstanding. Staff benefit from regular supervision. EVIDENCE: 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. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 25 The Improvement Plan required that checks are made, for example, of accident reports and of the aids and facilities in residents bedrooms in order to identify any hazards needing assessment. This means that residents are not at risk of being harmed by facilities and equipment within the home. Some action had been taken in that some assessments have been made. However there was no written evidence that the accident reports were being monitored. Many of the accidents were recorded at times that staff were coming on duty. Two accident records stated that the times of occurrence were unknown. Evidence suggests that residents remain at risk of accidents during the times when no staff are present in the building at night. There was no portable hoist in the building. It was not possible to establish from the records how residents had returned to their feet after falls. Mrs Burnett Price said that a hoist was not needed as the residents were ambulant. There was a lifting aid that assisted the person to stand by being placed around their waist by 2 staff. However with the poor recording the home cannot evidence that a hoist is not needed. Many of the risk assessments with regard to radiators in ensuite facilities stated that towels were placed over the radiators to protect residents from scalding if they fell against them. The use of oxygen in one bedroom had not been assessed whilst it was prescribed. The nebuliser now in use in that bedroom had also not been assessed. There was no guidance in the resident’s care plan on its use and maintenance. Mrs Burnett Price said that she made daily checks of all the building to address risks and maintenance. She could not evidence these checks with any record. The fire risk assessment was dated September 2005. There was an amendment dated September 2005 in relation to residents bedroom doors. The assessment stated that there were “adequate staff in place around the building who are alert and mobile”. The fire assessment goes on to state that “the person discovering the fire must alert the emergency services”. Clearly neither of these statements are the case between the hours of 9.00pm and 8.00am when residents remain at risk. The Fire and Rescue Service has been informed of the lack of staff at night, the poor oxygen storage, the use of heavy objects to hold fire doors open and the failure to guard radiators or properly assess the risks. Action had been taken to address the recommendation that advice is sought about when RIDDOR forms were completed and returned when notifiable accidents occurred. An advice booklet was held in the accident file. Risk assessments with regard to the environment, any equipment and tasks that staff may undertake were written up to each member of named staff rather than identified as an individual area or task. We advised that the equipment, area or task must be evaluated rather than the individual staff. All staff had regular 2 monthly supervision with records kept. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 26 Action had been taken to comply with the requirement to report to us on the outcome of a review of the quality of services provided at the home. Mrs Burnett Price had completed the Annual Quality Assurance Assessment required by regulation. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 27 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X 2 X X 1 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X 1 West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 13(4) Requirement (Previous requirement not met: ‘Individual thermostatic controls must be fitted to the baths’) Individual thermostatic controls must be fitted to the baths (The Commission must be informed if this is not reasonably practicable for technical reasons and of the alternative arrangements to be made for ensuring that the temperature of the hot water supply to the baths is maintained at a safe level). Remains outstanding. 2. OP27 18(1)(a) (Previous requirement not met: ‘Additional night time support and supervision must be provided to ensure that service users are safe and their needs are met’) The Commission must be informed of the long-term arrangements to be made and of a date for completion / implementation to ensure residents are kept safe. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 29 Timescale for action 08/10/07 08/10/07 3. OP29 19(1) Criminal Record Bureau 08/10/07 disclosures must be undertaken in accordance with the Commission’s policy and guidance. (Requirement outstanding from previous inspections). One member of staff does not have a Criminal Records Bureau certificate. 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. (Outstanding from previous inspection). The registered manager must ensure that the radiators in the service users’ en-suite areas are included in the risk assessments of radiators and hot surfaces. Safety measures will need to be put in place, where indicated by the assessments. (Outstanding from previous inspection). That checks are undertaken, for example of accident reports and of the aids and facilities in the service users’ rooms, in order to identify hazards that need to be assessed to ensure that service users are not at risk of harm. (Outstanding from previous inspection). 08/10/07 4. OP12 16(2)(n) 5. OP25 13(4) 08/10/07 6. OP38 13(4) 08/10/07 7 OP7 12(1)(a)& (b) The person registered must carry 09/11/07 out a written assessment of each individual residents different night care needs. The Commission must be supplied with a copy of these assessments. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 30 7 OP1 4, 5 & 6 The person registered must ensure that the statement of purpose and the service users guide are updated to give currently correct information, for example, that there are no staff at night. The person registered must ensure that residents who return from hospital are assessed before they return so the home can decide whether their needs can still be met. Their care plan must be reviewed and revised on their return. 08/10/07 8 OP7 14 & 15 08/10/07 9 OP7 15 The person registered must 08/10/07 ensure that each care plans details all of the care needs of the resident and how they are to be met, for example, use of oxygen, administration of eye drops, risks, wound management and diabetes care. The person registered must ensure that the medication trolley is kept secured to an immovable object with the padlock provided when not in use. The person registered must ensure that all staff administering medication follow the same procedure in line with the home’s administration policy. 08/10/07 10 OP7 13(2) 11 OP7 13(2) 08/10/07 12 OP38 13(4)(c) 13 OP37 17(2) Schedule 4 para 7 The person registered must 08/10/07 ensure the safe storage of oxygen whilst it awaits collection from the supplier. The person registered must 08/10/07 ensure that the staffing rota shows which staff are actually on duty at different times during the day. DS0000028653.V350410.R01.S.doc Version 5.2 Page 31 West Farm House 14 OP19 OP38 23(4) The person registered must ensure that the fire risk assessment is reviewed and updated to include the arrangements at night when there are no staff in the building. 08/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations That the system of care planning and recording is developed further to: Include greater detail and information about all aspects of the service users’ needs and how these are to be met. Produce a clear means of recording reviews of the care plans and the service users’ progress with meeting their individual goals and needs. Identify in the care plans, e.g. by a system of crossreferencing, where risk assessments have been undertaken in connection with individual service users. (No progress had been made at 8/10/07) 2. OP27 That regular monitoring of service users’ activities and routines during the night is part of the assessment process (Carried over from previous inspections. Care plans and daily reports stated: “no needs at night”. However there was no written evidence of how this had been concluded). That service users are offered the opportunity to have an automatic mechanism fitted to their doors, which will enable the doors to be safely kept in an open position. (Carried over from previous inspections. Doors were being held open with pieces of plastic or heavy objects). Individual residents personal details should not be recorded in the daily diary. If medication is changed or varied, the home should request written confirmation from the prescriber. DS0000028653.V350410.R01.S.doc Version 5.2 Page 32 3. OP24 4. 5. OP37 OP9 West Farm House 6. OP37 7. 8. 9. 10. OP37 OP37 OP30 OP38 The care planning form is confusing if it is only used as a record of reviews. These statements do not give an up to date picture of residents’ current needs or how they are met and monitored. Records should be kept as evidence of safety checks, for example, tours of the building for maintenance checks, drug record checks and hot water temperatures. If medication is administered via an adhesive patch to different parts of the body each time, a record should be kept of the site at each application. The staff training matrix should be kept under review so that staff can receive regular updated training. The risk assessments should apply to tasks, use of equipment or the environment rather than individually named staff. West Farm House DS0000028653.V350410.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue 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. 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