Care Home: Farm Lane Care Home

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What the care home does well The Manager has a clear commitment to developing the service for the best outcomes for people who live there. He is experienced and models good practice and leadership to the staff team in constantly working to enhance standards. The new Clinical Lead is skilled and working well alongside the Manager developing practice and involving outside bodies in training. They have created new competencies for nursing staff and are focused on areas that need to be improved, such as discharges from hospital into the home. There is an open culture and an open door policy where both the Manager and Clinical Lead are available without the need for appointments The people who live in the home were relaxed and were involved in the planning of their support and care. Care practices observed showed that staff supported people with respect and at the persons own pace. There is a very good dedicated Rehabilitation Unit which offers a short intensive stay with occupational therapy and physiotherapy for people from hospital. There are close links with community agencies to enable people to maximise their rehabilitation potential and return to their own environment. The on line system allows senior staff to monitor residents` care records, including daily care notes. Care UK`s clinical governance team also regularly audits residents` records. The home have developed excellent end of life care plans which highlight the discussions taken place with residents and their relatives about how they wish to be supported and their wishes regarding their final arrangements What has improved since the last inspection? The Manager and Deputy Manager have worked hard to achieve meeting all the many requirements set at the last inspection. They have developed the management structure with the introduction of a new Deputy Manager/ Clinical Lead who is working very well and pro actively to enhance the service. The staffing levels have been increased since the last inspection. The PCT (Primary Care Trust) facilitated extra nurse on am shift for first and second floor units and an extra nurse for a full day on the rehab unit in recognition of the higher dependency levels. There are two nurses on each unit on the morning shift one nurse on in the afternoon shift on the first two floors. Each unit of the units have five carers throughout the day. Farm Lane has put in place excellent procedures to ensure that all medication is received and administered correctly. There are nurses allocated solely to accept all medication, to check that it is correct and follow up and resolve any queries. This enables consistency across the home and has drastically cut down the errors. People are getting the correct medication more quickly. Boots have been giving training and has been regular meetings to iron out any issues. Pre admission assessments have improved with a more overall profile of each person, their social, as well as physical and health needs. The care plans seen were much more person centred with a greater sense of how each person wished to be supported, their preferred routine, and leisure activities. The detail and level of recording of daily notes has also greatly improved and is more meaningful. The number of staff undertaking NVQ level 2 and further training has increased, to the benefit of the people who live in the home as well as the staff. What the care home could do better: The Manager and Deputy Manager,Clinical Lead, are aware of the ongoing need to consolidate the work that they have achieved to ensure continued good outcomes for people. When Unit Managers go on planned long term leave, plans must be in place to replace them immediately for the safety and continuity of care of the residents. The practice of relying on existing staff with already a key management role is not appropriate. Although the system for recording peoples money is more accessible there is still a need to have a clear understanding of who has the ultimate responsibility for people`s monies. As with one of the residents, whose care was tracked, it was not known from whom their money came from. Whilst the whole tone and presentation of the care plans has greatly improved those specifically seen on the first floor need to reach the standard found on the Dementia Care Unit. Although supervision is much improved and there is now a structures in place to monitor, follow up on issues noted and training needs, there is still a need, particularly due to absence of the Unit Manager on one floor, for it to be regular. Key inspection report Care homes for older people Name: Address: Farm Lane Care Home 17 - 25 Farm Lane Fulham Broadway London SW6 1PX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ann Gavin     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Farm Lane Care Home 17 - 25 Farm Lane Fulham Broadway London SW6 1PX 02073864180 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: manager.farmlane@careuk.com www.careuk.com Care UK Community Partnerships Ltd care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 66 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Farm Lane is a care home providing accommodation and nursing care for older people, people with dementia and people in need of rehabilitation before returning home after a stay in hospital. The home opened in September 2005 and is located in a residential area of Fulham, close to shops and other local facilities. Accommodation is provided on the ground, first and second floors and there is a large attractive roof garden and conservatory. Passenger lifts enable people living in the home to use all parts of the building. Care Homes for Older People Page 4 of 35 Over 65 0 66 66 0 2 0 0 1 2 0 0 9 Brief description of the care home The weekly fee for the service ranges from #650 to #900 Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out by two inspectors, Ann Gavin and Jane Ray and health care assessor Abu Suleiman on the 16th December and by Ann Gavin and an expert by experience on the 17th December 2009. An expert by experience is a person who, because of their experience, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Experts by experience do not need to have experienced an identical service. Time was spent talking with people who live in the home, with relatives, both nursing and care staff, one of the maintenance team, administrator, the Therapy Lead for the Rehabilitation Care Unit and Unit Manager of the Dementia Care Unit. The Manager was on leave but came in to join the inspection on the second day. The Deputy Manager was in the home on both days. Care Homes for Older People Page 6 of 35 The care of nine people who live in various units within Farm Lane were tracked. This involves talking with them, the staff involved in their care, reviewing their care plan and all other documentation linked to them. The expert by experience toured the home with the Deputy Manager, Clinical Lead. They then spent time talking with residents and their visitors, sharing lunch with residents on the Elderly Frail Unit on the first floor. Their feedback is included within this report The Manager had completed a detailed Annual Quality Assurance Assessment (AQAA) which was also used to inform the inspection. The visit to Farm Lane evidenced that the managers and staff have worked hard to achieve good outcomes for the people who live in the home. However with the absence of a Unit Manager on planned maternity leave and pending loss of Dementia Care Unit Manager the outcomes for people could become compromised unless the posts are filled quickly. The Commission will be monitoring the situation closely. People spoken with were happy with the care and support they received. The staff were seen to be respectful and caring towards people and the environment was fresh and welcoming. Current fees at Farm lane range from £670 - £ 950 per week Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? The Manager and Deputy Manager have worked hard to achieve meeting all the many requirements set at the last inspection. They have developed the management structure with the introduction of a new Deputy Manager/ Clinical Lead who is working very well and pro actively to enhance the service. The staffing levels have been increased since the last inspection. The PCT (Primary Care Trust) facilitated extra nurse on am shift for first and second floor units and an extra nurse for a full day on the rehab unit in recognition of the higher dependency levels. There are two nurses on each unit on the morning shift one nurse on in the afternoon shift on the first two floors. Each unit of the units have five carers throughout the day. Farm Lane has put in place excellent procedures to ensure that all medication is received and administered correctly. There are nurses allocated solely to accept all medication, to check that it is correct and follow up and resolve any queries. This enables consistency across the home and has drastically cut down the errors. People are getting the correct medication more quickly. Boots have been giving training and Care Homes for Older People Page 8 of 35 has been regular meetings to iron out any issues. Pre admission assessments have improved with a more overall profile of each person, their social, as well as physical and health needs. The care plans seen were much more person centred with a greater sense of how each person wished to be supported, their preferred routine, and leisure activities. The detail and level of recording of daily notes has also greatly improved and is more meaningful. The number of staff undertaking NVQ level 2 and further training has increased, to the benefit of the people who live in the home as well as the staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Farm Lane have developed a more comprehensive assessment of peoples needs prior to admission which now includes more of peoples social and cultural aspirations. The home has an excellent, well managed and equipped rehabilitation unit, which promotes independence enabling people to return home. Evidence: The staff arranged care for me when I returned home making every provision for my safety and peace of mind. All aspects of rehabilitation were absolutely brilliant, especially confidence building. Excellent. Many, many thanks Quotes from exit questionnaires made by people who used the rehabilitation unit. Care Homes for Older People Page 11 of 35 Evidence: I wasnt well enough to visit Farm Lane but my family visited for me Quote from resident Farm Lane has developed their assessment of people who wish to be admitted to the home. Everyone is visited either in hospital or in their own home and a more thorough assessment of their needs is carried out which complements the information received from the referring teams. All are given an opportunity to visit the home and those who are unable are given information on the home and their relatives or friends can, and do, visit on their behalf. The Manager said in their AQAA Potential service users and their relatives are always invited to view the home so that they can be shown around and have the opportunity to ask any questions that they may have. The home seeks to know what their first impressions are as well. An honest and open approach is taken by the manager and all staff. On the first floor, The Elderly Frail Unit the care plan of one of the most recent people admitted to the home reflected the new breadth of information gathered prior to admission. This information is helping people have a better experience of the major move into a care home. Any facilities needed to support people are put in place prior to their admission. The addition of social and cultural aspirations has helped staff to make people feel at home more easily. On the Dementia Care Unit there were full comprehensive assessments in place. One person who was admitted recently had all their discharge reports in place from NHS and a full Social Services assessment and care plan. They did not visit the home but they knew it as they had previously been in the home for respite care. Their relatives did visit prior to their admission. The Manager spoke about a person with dementia who when they had been admitted was happy but then kept asking if they would be allowed to stay. Therefore the Manager suggested that the family bring in more things from home so that the person would know it is their own home. The Manager is now encouraging post admission meetings, with residents and their relatives, separate from those required by Social workers at six weeks from admission. All of the residents contracts seen had the number of their room specified. Care Homes for Older People Page 12 of 35 Evidence: The home has a dedicated rehabilitation unit with physiotherapists, occupational therapists and a speech and language therapist. The unit is well equipped to enable people to work on regaining independence in everyday activities. Assessments for suitability to the unit are done with Therapy Lead and nurse unless it is a referral from a therapist in which case the nurse goes alone to complete a nursing and social assessment. The unit is having good success in meeting its aims. The aim is to provide short term, one to six weeks, intensive, residential intermediate care, in a homely environment. To prevent unnecessary acute admission to hospital and to long term care, facilitate safe and timely discharge from hospital, provide an environment for assessment of living accommodation needs edited extract from quarterly report completed by therapy lead. The unit now has two nurses on duty all day together with carers and rehabilitation assistants and one nurse at night also with a carer. The unit will be having an extra rehabilitation assistant for the winter period. The Therapy Lead has just completed competencies for rehabilitation assistants. They will be developed around a rolling learning programme involving joint sessions with therapists, carers and supported by seminars. Time was spent talking with the therapy lead of the unit, some of the staff, talking with two people in the unit and tracking their care. Both of the people seen spoke highly of the level of care and support offered in a discreet way. One said how The staff are very attentive and responsive.They also commented on the privacy that the unit also gave. One person had a special bed and chair brought into the unit prior to their admission to enable them to access the rehabilitation. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Farm Lane is developing more comprehensive and personalised assessments of peoples health and social care needs to optimise the level of care and ongoing support available to them. There are good links with community health and social care teams. The audits and administration of medication has significantly improved and on going training for staff is in place. Evidence: All said they were well looked after: as good as a first class hotel one resident said. Extract from report by expert by experience There continues to be a big involvement from a multi disciplinary point of view. This includes, GP visits twice weekly, close working with Dieticians, speech and language therapists and tissue viability nurses. The PCT has also commissioned a Consultant Geriatrician Dr. I. Walton to provide an enhanced service to the home. Over and above providing prescriptive treatment for Service Users, the benefits of this range from being able to meet with relatives and advocates to providing learning for nurses Care Homes for Older People Page 14 of 35 Evidence: through group talks and facilitating training in the hospital setting. Extract from AQAA completed by the Manager People spoken with were happy with the care they received. One person spoke of how the staff were always popping in, they make sure that things were always within their reach. A number of visitors were in the home and the atmosphere was relaxed. One resident said how they received their care when they wanted it and that their family was able to give a list to the staff of the things that they liked to do and how they like to be supported. The pace of care and support observed on all units was unrushed and at the persons pace. Speaking with people looking at care plans and observation also showed that care was flexible. The care of nine people across the home was tracked and in all the care planning, recording of daily notes were much more individualised. How people wished to be supported, what and where people ate, what they did during the day were all included. Peoples preferences about rising and bedtimes were noted and respected according to the residents spoken with and the staff. Reasons were given if the support given was different from that of the care plan. A range of assessments are undertaken including Barthel, levels of independence, and Waterlow,for assessing risk of developing pressure sores. People at high risk of pressure sores are nursed on a special nimbus mattress. The home works closely with the tissue viability nurse. Peoples weight is monitored, normally monthly and if there were any issue about diet or weight loss medical or dietician help was sought and fluid and food charts in place. The any and and care plans seen on the Dementia Care Unit were very detailed especially about challenging behaviour. The daily notes were detailed. The presentation was clear accessible. They were easy to read with an at a glance resume of peoples likes support needs along with a photograph and social profile. The care plans seen on the first floor whilst greatly improved they need to reach the standard found on the Dementia Care Unit. Diaries have been introduced on the Dementia Care Unit for relatives so that they can see what their family member has been doing and who visited. Talking with residents, relatives confirmed that people are able to approach the staff and talk through ideas Care Homes for Older People Page 15 of 35 Evidence: wishes to ensure that their needs are met. Residents care plans are updated with them and their relatives, if they wish, on a regular basis. All care plans seen had an assessment of areas that might present a risk to the person, from the environment, falls, behaviour etc. The assessments included peoples mobility and how they need to be supported with details of type of hoist or specifying if they need supervision with their walking. A person who needed to be supported with bed rails had good assessments of the reasons why they were needed and how best to manage any risks. However the home is currently running two systems of risk assessments one handwritten assessment and another on the electronic system. The system for risk assessments need to be reviewed so that people do not have to complete risk assessments in two places which doubles their work and could lead to errors. The home have developed excellent end of life care plans which highlight the discussions taken place with residents and their relatives about how they wish to be supported and their wishes regarding their final arrangements. Farm Lane plans to start the Gold Standard Framework in end of life care in January linking in with Trinity Hospice. The Clinical Lead has a special interest and expertise in this area. The health care needs of people have also improved. The Consultant Geriatrician was visiting the home on the first day of the inspection and spoke of how he was just building up his contact with the home. He visits weekly and is able to spend time with people and help with the complex situations that arise. The impact his contact with the sister home St Vincents has greatly enhance the experience of the people who live there. Farm Lane also receives increased input from the Community Mental Health Team. They visit monthly for sessions with the people in the home as well as training and development for staff around managing challenging behaviour. Farm Lane had a Dementia Care Mapping of the home and staff have now commenced on Dementia Care Training. The staff are happy about the training saying how much it helps in their awareness and knowledge of supporting someone with dementia. Training covers in depth topics such as understanding dementia, self awareness and empathy, communication and challenging behaviour. Care Homes for Older People Page 16 of 35 Evidence: Farm Lane has put in place excellent procedures to ensure that all medication is received and administered correctly. There are nurses allocated solely to accept all medication, to check that it is correct and follow up and resolve any queries. This enables consistency across the home and has drastically cut down the errors. People are getting the correct medication more quickly. Boots have been giving training and has been regular meetings to iron out any issues. The medication on the dementia care and the first floor unit was looked at. Much work has gone into medication which has improved significantly. There is now a clear audit trail with the medication administration record (MAR) sheet completed without errors. There were no controlled drugs on the Dementia Care unit but there were on the first floor. Although there were no errors, and all the drugs were all signed for by two people the controlled drugs book needs to be organised more clearly, or as the Manager has said, a new one purchased. The Manager said that they have booked CD training for staff in January. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Farm Lane has developed a range and level of activities available to people who live in the home. There are growing links with the community and peoples spiritual and cultural needs are catered for. Evidence: You can chose where you eat and what you do depending on how you feel Quote from a Resident Residents seemed well able to choose to join in activities or not as they pleased and quite a number had a morning paper and sat in their rooms. In the day room four were playing cards with a member of staff. They were quite willing to chat but did not give me much information apart from saying they were happy and well looked after. Extract from report by expert by experience Farm Lane has a full time and a part time activity coordinator as well as a volunteer voluntary worker who assists in the day to day activities and helps out at meal times as well. Care Homes for Older People Page 18 of 35 Evidence: The activities coordinator takes the lead in planning with the residents the type of activities they would like and an activity programme is displayed on all units. The activity coordinator discusses the programme with those people who would not be able to access a written programme The coordinator has been completing a getting to know you questionnaire with residents and relatives. These help in creating more personalised care plans and activities. The questionnaires seen in the care plans were much improved and gave a good profile of people and the activities they enjoyed. This was matched up in the activities people undertook. The recording of activities was also more detailed and personal. Peoples cultural and spiritual preferences were seen to be catered for. Staff are being encouraged to spend at least one shift per month or more frequently working as an activity coordinator assistant so that they can enhance their skills in Activity provision for residents. Due to moving away from the area the activities coordinator is leaving at the end of December and residents and staff spoke of how much they will miss her. The post is being advertised. Peoples preference of times of going to bed, of breakfast in bed are all noted and people said that they are respected. On first day of the inspection it was good to observe that many people were able to still be in bed at nine thirty. The majority of people prefer their breakfast in bed. Through the social profile a persons love of dogs was discovered. Dogs now are brought to visit and the person gets great pleasure. Apart from more information being available about peoples lives, staff are now acting on the information and linking it into daily care to enhance peoples experience of living in the home. One persons activity plan said I would like to help staff with folding serviettes and setting the table this person said they have been helping staff lay the tables. Another person spoke of how they enjoyed the baking session. Another person was written how they enjoyed gospel and soft music. I like knitting was written in their care plan and they are able to do this with support from staff. There was a good variety of Christmas entertainment for people. On the first afternoon there were carols from an operatic company, a Christmas party was planned Care Homes for Older People Page 19 of 35 Evidence: as well as various services. The expert by experience made the following observation about activities. There are occasional outings for some of the residents. One attends a day centre regularly, Nubian Life, which she had attended before coming to the home. Some go for lunch at the Age Concern centre next door. London Oratory School, which is nearby, sends pupils in and invites residents back to concerts. The local Anglican priest visits and conducts services. There is a memory room with an iron fireplace, probably around nineteen hundred and furnishings like a living room. It seemed a bit too early in style for the residents and did not have bits and pieces around which could have stimulated memories more. The pictures were photos from about nineteen hundred The comments made about the style and period of the reminiscence room and various ideas about local cultural societies were discussed at the inspection. The managers were delighted at such helpful and good input and took notes so as to act upon the suggestions. Pupils from the Oratory School visit regularly and read, or sit and talk to the residents. They were present at the concert talking with people and helping in different ways. Residents spoke of how much they enjoy their company how they will read a book to them or play board games or enjoy just talking. The plans to turn the roof terrace into a sensory garden where residents can plant flowers is still ongoing and links have been made with local organizations. Farm Lane are also in the process of coordinating arts based workshops in the home which will be run by external trained artists and teachers who have specialties ranging from home learning to crafts and using the environmentally friendly reusable materials. Mealtimes were observed on the Dementia Care Unit people were seen being assisted with respect and discretion. Those who were requiring support were given it at a pace suitable for them. Those in bed were supported by carers who sat beside the bed and went at the persons pace. Observing lunchtime on the other two units showed that the dining room was well set up and welcoming. The expert by experience joined residents for lunch on the first floor. There were three choices for lunch and people had chosen the day before. I had chicken and leek pie, which was good, and mashed potato, broccoli and carrots, which were a bit soggy. Others had beef stew and saute potatoes. Pudding was yogurt or Care Homes for Older People Page 20 of 35 Evidence: fresh fruit, of which there was a bowl on the table to choose from. Both my companions had yogurt and took away an apple and a banana respectively. The staff were attentive and respectful. Extract from report by expert by experience One Caribbean person spoke of how her family gave a list of Caribbean foods she likes to the staff and it is then provided. They were very happy with the care they receive and the pace of lunch which was served and supported with whilst in bed. Different ethnicity needs are catered for through the cooked chilled food system Staff they said that people would have snacks of biscuits or toast during the day and evening. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are acted on quickly with clear documented on actions taken. The home has safeguarding policies which have been updated. All staff have been involved in interactive training on safeguarding Evidence: Farm Lane has a complaints procedure displayed throughout the home. It has contact details for both the local authority and the CQC. They also have a suggestion box in the reception area for any one to place their comments. All complaints are recorded within the computerised system. The complaints seen were well documented with a clear outcome and action. Communication with relatives and advocates has improved as the nurse who takes the lead in someones care make regular contact. This helps prompt relatives to bring up concerns they have which can be preempted before requiring a formal complaint. People are encouraged to make their concerns and complaints known. Farm Lane have enhanced their safeguarding training through dedicating a days training led by the Companys Customer Experience Manager. This training is much more interactive and based on scenarios and case studies. Staff spoken with said how much they drew from it and understood so much more. Flow charts on what to do if were seen throughout the home. Speaking with staff about what they would do they were clear of how to act. Debriefing sessions are now Care Homes for Older People Page 22 of 35 Evidence: held on any significant incidents. Since the last inspection there have been five safeguarding referrals. One involved a missing cheque though at present there are no implications for staff, another involved someone whose disinhibited behavour was causing concern. Another involved someones skin integrity though the outcome was seen to because of the persons condition. In each case the local authority and CQCI have been informed. The Manager has ensured that all situations have been dealt with in depth and speedily. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Farm Lane has good spacious accommodation, which is clean, pleasant and accessible to all. There are a range of communal areas which offer residents choice. The building is cleaned to a good standard and is well maintained. An extensive redecoration and refurbishment of the home is planned for January. Evidence: The rooms were all attractive and well-cared-for. The rooms were all of a good size and had good windows and, surprisingly, for an area so near Fulham Broadway, there was a good garden on two sides of the building with trees so the outlook was good from all rooms. Few of the rooms showed personal possessions although I was told residents could bring small items of furniture. It looked a bit institutional but all tastefully arranged and well-kept. Extract from report by expert by experience Farm Lane provides an attractive and pleasant environment, in a location close to local services and public transport. Many of the residents previously lived in the area and relatives and friends are able to easily visit. Farm Lane is a purpose built care home which opened in 2005. It has all single spacious ensuite rooms with accommodation over three floors. A range of sitting areas are provided on each floor. In addition there is a sensory room, reminiscence room and hairdressing salon. The home is accessible with specialist equipment such as hoists, electronic baths, and Care Homes for Older People Page 24 of 35 Evidence: pressure relieving equipment available throughout. There is also a loop system in the communal lounges for those who are hearing impaired and wear hearing aids. On the two days of the unannounced visit the home was fresh, clean and bright and was generally more homely and welcoming. The dementia care unit had some changes especially to some of the small lounges. The whole home is going to go through an upgrade of redecoration and refurbishment in January. A copy of the improvement plan was received. Bedrooms are spacious and some are personalised well and looked more comfortable. The expert by experience commented There were a number of people who had very little of their own personal effects in their room this was discussed with the Manager. The Manager spoke about a person with dementia who when they had been admitted was happy but kept asking if they would be allowed to stay. Therefore Manager suggested that the family bring in more things from home so that they will know it is their own home. There is a need to evidence that people are encouraged to bring in any small personal effects or furniture The dining rooms looked more comfortable and inviting with well laid tables with tablecloths. Farm lane employ two full time maintenance people for day to day upkeep of equipment and facilities in the home.Talking with one of the team they spoke of how they record all maintenance jobs that require doing and maintain all health and safety checks. The home have made contact with Hammersmith and Fulham volunteer centre and plans to have raised flower beds on our roof garden for residents could now come to fruition. The home intends residents to be involved in developing the area for more stimulating use. Its acknowledged that this process will not start immediately due to the weather. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home had confidence in the staff who support them, The number of nurses has increased and the level of training has increased to the benefit of the people who live in the home. Care must be taken to ensure that Unit Managers vacancies are filled quickly to ensure continuity and support to residents and staff. Evidence: Staff are very nice they laugh a lot Quote from resident We have lots of training which is very good Quote from nurse The staff were all respectful of the residents. They all obviously knew the residents well. Quote from expert by experience The staffing levels have been increased since the last inspection. The PCT ,Primary Care Trust, facilitated extra nurse on am shift for first and second floor units and an extra nurse for a full day on the rehabilitation unit in recognition of the higher dependency levels. There are two nurses on each unit on the morning shift one nurse Care Homes for Older People Page 26 of 35 Evidence: on in the afternoon shift on the first two floors. Each unit of the units have five carers throughout the day. The night cover for each unit is one nurse and two carers. The Unit Manager of the first floor has been on maternity leave since October 2009 and the Clinical Lead has taken on the management role. There is now an internal advert in place. When Unit Managers go on planned long term leave, plans must be in place to replace them immediately for the safety and continuity of care of the people who live in the home. The practise of relying on existing staff already with a key management role is not appropriate. The Manager on the dementia care unit will be leaving in the New Year. These posts need to be filled as soon as possible to maintain good outcomes for people. The Manager said that would approach a specialist agency for recruitment. The files of six staff were look at, three new employees and three longer standing. All information was in place, there was a query re a CRB,Criminal Records Bureau, check but confirmation of it been done was sent during the inspection. Training records in the staff files were not clear. This was explained by the Manager who is trying to encourage staff to take ownership of their files and the training they do. An overall picture of the training each staff member has undertaken and requires or is due to complete was held in the Managers office. This analysis shown by the Manager showed more investment has taken place over training. One future plan is to have nurses involved in the induction of new care staff by giving a training session on specific area of care so as to have a more practical element.One of the carers was on a three day training the trainers course with one of the nurses on moving and handling. Links have been made with University of Buckinghamshire who provided a tailor made basic life support course. Further training is to be provided to nursing staff by the University. The clinical Lead is completing competencies on all nurses and plans are in place to introduce the same with care assistants. Staff spoken with confirmed the training they received, that it included an induction period and they showed that they were clear about their roles and the way that people wished to be supported. The home wish to consolidate the training and competency levels of the nurses prior to developing the role of the senior carers. There are regular staff meetings and the staff Rota is often a subject. The Managers wish to reduce the number of agency staff at weekends for the benefit of the residents Care Homes for Older People Page 27 of 35 Evidence: as a high number could make residents more vulnerable. Many staff do not wish to work weekends so the staff and management are working through to arrive at a solution. Observation of care practices, talking with residents, relatives and staff showed that staff are more involved and contributing to the support of the residents and the home as a whole. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Farm Lane is well led by an experienced and motivated Manager who has a clear commitment to developing the service for the best outcomes for people who live there. There are good health and safety checks in place for the safety of the people who live in the home and the staff. There is a need to be clear about a need to have a clear understanding of who has the ultimate responsibility for peoples monies to ensure that each person has the right monies available to them Evidence: The Registered Manager has an RMA qualification, a Diploma in Dementia Care and has most recently commenced an honours degree in management. He has over 9 years nursing home care experience. The Clinical Lead is a Qualified Registered Nurse,RGN, who recently completed a BSc Hons Degree in Cancer and Palliative Care. She has been nominated to complete the Leadership & Management in Care Services ,LMCS Award. The management structure has improved. The Deputy Manager ,Clinical Lead, is enthusiastic and proactive in implementing new ideas and competencies levels to enhance the support offered to the people who live in the home and the staff. Care Homes for Older People Page 29 of 35 Evidence: Cover of the reception has increased and it is now opened from Monday to Friday 9.30am to 5.pm and at weekends 10am to 5pm. This extra cover enables visitors and phones to be responded to quickly and easily and takes the pressure of the nurses and carers who can give more time to supporting people. There is now also an extra member of staff on Mondays to complete payrolls Initially there was no evidence that supervision of staff had been carried out regularly. However supervision notes are currently being kept by the managers in order to monitor, pick up points, issues and input ideas. The Manager has put in place some group interactive supervision to help staff focus and take responsibility of their learning and contribution to the home. Staff spoken with said they found it helpful. Although supervision is much improved and there is now a structures in place to monitor and follow up on issues noted and training needs, there is still a need, particularly due to absence of unit Manager on one floor, for it to be regular. Farm Lane has a policy for managing residents money, valuables and financial affairs. The administrator manages the records of those residents who require assistance with managing their money. A safe is available in the home for safekeeping and records of all transactions maintained. The records seen were clear and well kept. However it is still unclear about where some peoples monies come from or who has court of protection. As with one of the residents, whose care was tracked, it was not known from whom their money came. This needs to be clarified to ensure people receive the correct monies and are appropriately protected. The health and safety records were checked during the inspection with one of the maintenance team. All the record keeping was clear and individual records easy to find. They were up to date, showing that equipment is regulaly serviced and checked. All fire checks are carried out regularly. The Manager held a health and safety specific staff meeting to go through the reviewed fire safety policy, the prevention of falls. All the Incidents and accidents records were well kept all had actions and follow through. The manager said that all incidents or accidents now have a debriefing session with the named nurse to see what could have been done differently and to identify and action any areas of learning or training to prevent further occurrences. One of these debrief sessions involved a person who was getting upset as they were hearing voices. At the debrief it transpired that they could trace the voices to people walking by their room but they could not see them. Therefore the position of their bed Care Homes for Older People Page 30 of 35 Evidence: was changed so they could see people as they walked passed and the incidents decreased. Farm Lane has a good Quality Assurance system and Customer Satisfaction surveys are done annually. Feedback from these is collected centrally by the Customer Experience Manager. The last annual questionnaires were sent to the home in January 2009. It was noted that one of the monthly person in control monitoring visits were done remotely by looking at the files on the computer system. These visits must involve a site visit to ensure that the visit person in control has a good understanding of the home and that they gain the views of the people who live there. It is requested that a copy of these visits be sent to the commission Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 When unit managers go on planned long term leave, or leave, plans must be in place to replace them immediately for the safety and continuity of care of the people who live in the home 31/01/2010 2 33 26 The person in control monitoring visits must involve a site visit to ensure that the person in control has a good understanding of the home and that they gain the views of the people who live there. 31/01/2010 3 35 16 Although the system for recording peoples money is more accessible there is still a need to have a clear understanding of who has the ultimate responsibility for peoples monies 31/01/2010 Care Homes for Older People Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to ensure that each person has the right monies available to them Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans, specifically seen on the first floor whilst greatly improved they need to reach the standard found on the Dementia Care Unit. The system for risk assessments need to be reviewed so that people do not have to complete risk assessments in two places which both doubles their work and could lead to errors. Although there were no errors and all the drugs were all signed for by 2 people the controlled drugs book needs to be organised more clearly, or as the Manager has said a new one purchased. Although some rooms are personalised with peoples own furniture or belongings some show no signs of peoples identity. Work could be done to help people create rooms that help express their taste and preferences. Although supervision is much improved and there is now a structures in place to monitor and follow up on issues noted and training needs there is still a need, particularly due to absence of unit Manager on one floor, for it to be regular. 2 8 3 9 4 24 5 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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