Care Home: Farmhouse Residential Rest Home

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What the care home does well We found that The Farmhouse offers a satisfactory commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carers and those people using the service. Comments received from surveys and talking with people during the inspection include: "Looks after my mum very well, and they always tell me about if they have had a doctor out for her. I have nothing but praise for them, and they also keep an eye on all the other residents". From our examination of care records we established that there are effective pre admission assessment, and care planning of individual needs, which are meaningful in formulating a satisfactory standard of personal care. When we discussed the quality of care with those people using the service and visitors, it was made clear that they appreciated this highly personable attitude and approach to care. Comments we received from relatives during the inspection include: "I`m very happy with the way that mum is looked after here". "Helps with personal hygiene and dressing, always dignified. Asked for preferences for meals" and "Looks after and gets on well with visitors, good interaction with family". We recognized that the housekeeping, catering and support services have all contributed significantly to the team approach in supporting the caring process. We acknowledge the arrangements made to appoint the appropriate calibre of staff through a sound recruitment and induction programme, complemented with an extensive training opportunity and meaningful staff supervision. We considered that the overall management style directed by the Care Manager demonstrated a satisfactory approach in maintaining a caring environment fit for care of the elderly. What has improved since the last inspection? We have recognised that resources have been allocated to upgrade facilities and services to create a more homely and pleasing environment for people to live in, although much remains to be done. There is recognition that a more person centred care approach has been generated, and a greater involvement by people who use the service and their relatives. We were informed that a greater emphasis in receiving people`s opinion has resulted in an awareness of the insufficiency in providing meaningful activities and social interaction, There is evidence of staff having taken on board the importance of socialisation, with two staff members being trained and recognised as activity instructors for the `over fifties`. There remains much to develop, especially in providing time and resources to people with dementia care needs.There has been significant progress made in staff training and supervision, with a result that care staff are more involved in promoting person centred care to a significant level. We were satisfied that the Registered Provider has complied with requirements, and have dealt with, or are in the process of dealing with, those recommendations made at the last key inspection. What the care home could do better: Consideration should be given to present the Service User Guide in audio and large print versions, to help those people challenged with poor eyesight to make an informed choice. We considered that activities need to reflect the individual assessed needs of people in a more robust and regular manner. This would meet the declared objectives of improved internal and external activities for all people using the service. There needs to be more variety in indoor and outdoor activities, especially for people with dementia and other cognitive impairments. We recognise that people`s care plans need to be reviewed in a consistent manner, to provide the basis for personal care. Consideration of people`s needs when faced with the challenges of dementia are to be reinforced by looking at social and environmental circumstances. We have recognized a substantial improvement in the administration of medicines, although it was observed that several small areas of practice need to be reinforced. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Farmhouse Residential Rest Home Farmhouse Care Limited Talke Road Red Street Newcastle Staffordshire ST5 7AH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Keith Jones     Date: 0 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Farmhouse Residential Rest Home Talke Road Farmhouse Care Limited Red Street Newcastle Staffordshire ST5 7AH 01782566430 01782564424 farmhousecare@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Farmhouse Care Limited care home 21 Number of places (if applicable): Under 65 Over 65 0 21 dementia old age, not falling within any other category Additional conditions: Age: Dementia (DE) age 55 and above. 6 0 The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 6, Old age, not falling within any other category (OP) 21 Date of last inspection Brief description of the care home The Farmhouse is a private care home situated in Red Street in Newcastle. Mr Sukvinder Kandola and Mr Pargan Dhadda, who purchased the home in September 2004, own the home and operate under Farmhouse Care Limited. Mr Dhadda is the Responsible Individual. The homes manager is Mrs Mandy Peever who has been approved as the Registered Manager. The home is registered for 21 older people, 5 of Care Homes for Older People Page 4 of 33 Brief description of the care home whom may have a physical disability and 6 may be mentally frail. At the time of this unannounced key inspection 17 people who use the service occupied the home. During this inspection, we made an assessment of the dependency of people who are using the service, and it was felt that current dependency levels are commensurate with the homes Categories of Registration. There are 19 single bedrooms and 1 shared bedroom. Communal facilities are located on the ground floor, consisting of a central lounge and diner, with adjacent kitchen and a smaller lounge at one end of the building. There is also a small designated smoking room. A shaft lift provides access to the bedrooms on the first floor and there is also a staircase. There are plans to build a to the property that will improve the provision of communal space and increased bedrooms. Plans are also in hand to provide an enclosed safe garden, which will improve the homes facilities, and be of special benefit to people during the summer months ahead. The fee chargeable for the service at The Farmhouse is from GPD322.00p to GPD400.00p per week. The fee information included in this report applied at the time of inspection, and the reader may wish to obtain more up to date information from the care service. Care Homes for Older People Page 5 of 33 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: We conducted this unannounced inspection with the Registered Care Manager, deputy manager, and care staff on duty, and an expert by experience, whose input contributed to this report. An expert by experience is a person who, because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in, or use the service. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 17 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to Care Homes for Older People Page 6 of 33 the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and seven survey forms returned that we sent out to people who use the service some weeks before the inspection. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Care Manager and deputy, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. What the care home does well: What has improved since the last inspection? We have recognised that resources have been allocated to upgrade facilities and services to create a more homely and pleasing environment for people to live in, although much remains to be done. There is recognition that a more person centred care approach has been generated, and a greater involvement by people who use the service and their relatives. We were informed that a greater emphasis in receiving peoples opinion has resulted in an awareness of the insufficiency in providing meaningful activities and social interaction, There is evidence of staff having taken on board the importance of socialisation, with two staff members being trained and recognised as activity instructors for the over fifties. There remains much to develop, especially in providing time and resources to people with dementia care needs. Care Homes for Older People Page 8 of 33 There has been significant progress made in staff training and supervision, with a result that care staff are more involved in promoting person centred care to a significant level. We were satisfied that the Registered Provider has complied with requirements, and have dealt with, or are in the process of dealing with, those recommendations made at the last key inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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 33 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 33 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. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services revised Statement of Purpose and Service User Guide, and found them to provide an informative description of The Farmhouses aims, objectives, and the way it operated. We acknowledged that the documents were presented to all enquirers, and that information concerning fees payable were included in the Service User Guide, and is produced in large print as and when necessary. We consider that an audio version would help people to make an informed choice. It is stated in the AQAA that the Statement of Purpose represents the basis on which the home operates upon, offering those people who may use the service, and their relatives, the opportunity to make an informed choice about where to live. It is also Care Homes for Older People Page 11 of 33 Evidence: stated in the Statement of Purpose that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people who use the service. Our examination of three peoples care records and plans, indicated that each person had an individualised pre admission assessment, carried out by the Provider/Care Manager or deputy. We found that the assessment appreciated any special needs of the individual, including cultural, social or personal needs, which are fully discussed and documented. This assessment initiates the process of care, each individual having a plan of care based on personal needs and a daily living process. We found through our discussions with relatives that their involvement was taken into account, and that they felt included. A relative we talked to informed us: To this family concerned, we are satisfied with the terms and conditions at this home, and our involvement. Comments received from surveys sent to people using the service some weeks before the inspection: My son looked around for me and said it was a good place. A friend recommended the home. From our examination of care files we found that the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. We are satisfied that people are informed of those facilities. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. We identified that within those peoples files we examined that contracts were in place, and specified the number or name of the room to be occupied. No intermediate care took place in the home. Care Homes for Older People Page 12 of 33 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. Peoples needs are addressed through the care planning process, meeting clear principles of respect, dignity and privacy. Medicine administration systems and practice are safe. Evidence: We found that care records, through case tracking, showed that this standard is met overall, whilst maintaining a good quality process of assessment and planning. The pre admission assessment represented the foundation for an organised care planning process, in association with Social Services reports if available. Each persons health, personal and social care needs were found to be assessed in an individual plan of care, including those peoples, and relatives views, to reflect their changing needs, reinforced through a thorough daily report. There is an inconsistency in the care plan review process, requiring the establishing of a monthly review of each issue of care. Three individuals care files were examined in detail, each demonstrated essential information on the individual, their life style and needs, events and contacts, Care Homes for Older People Page 13 of 33 Evidence: procedures and actions monitored on a daily basis and reviewed monthly. Effective risk assessments had been completed in areas such as manual handling, falls, nutrition, personal hygiene, and continence. The process has also established a social awareness for each person, which has proved to be useful in enhancing understanding of personal needs. We confirmed through our discussions with staff an effective understanding of need, enabling staff to identify risk areas, and put systems in place to reduce risks. We had evidence that physical, psychological and special needs are assessed and documented, along with a satisfactory monitoring process, such as nutritional screening, weighing, hearing and sight tests as appropriate. The General Practitioner (GP) of choice service is supportive; through which arrangements are made to provide professional support. Case tracking confirmed to us that specialist support and advice are sought as needed, with access to a local Doctor, Dentist, and Chiropodist. Comments we received from several people using the service during the course of inspection: Looks after my mum very well, and they always tell me about if they have had a doctor out for her. I have nothing but praise for them, and they also keep an eye on all the other residents. Extremely happy with the staff and home. Doctors are always called when my mother needs attention, sooner rather than later. Carers were seen by us to interact with people who use the service with understanding and friendly compassion. In the progress of meeting people who use the service we acknowledged that their general appearance indicated that their health and personal care was attentive and effective. Several relatives were visiting and we asked for their comments on the quality of the service and care given. There was a clear appreciation of the openness and opportunity to contribute. All comments were complimentary of standards, facilities and staff: Relaxed, friendly and homely atmosphere. Very welcoming to us and we are given refreshments. The expert by experience offered a comment from her discussions with people: All the residents I spoke with felt they were treated well. One lady stated that she could speak to staff at any time, even if they were busy, they would explain that and always return to her as soon as possible. We found the administration of medicines generally adhered to procedures to maximise protection to people who use the service. The medicines in use storage was secure, with good environmental controls, including a medicines fridge. Our Care Homes for Older People Page 14 of 33 Evidence: examination of the record of administration of medicines showed consistency, with no omissions observed, and staff signatures were up to date. Controlled drug arrangements and management are appropriate, and staff training continues to be pursued actively by the Care Manager. We found an effective and smooth process of ordering, receiving, storing, administering and disposing of medicines, although it was noted that medicines awaiting collection by the suppliers had been left in an insecure loft area, awaiting the senior carers attention. Records were seen to be complete and easy to follow through, with no observed breaches in the system. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. In our discussions with people who use the service and staff it was recognised that diverse needs were accommodated within the planning of care. Dietary, religious and personal matters were identified, along with the diverse physical needs. Our case tracking confirmed that the policies were implemented, with people we talked to, being complimentary of the degree of respect given, by each and every member of staff. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Our discussion with visitors on the day was a helpful exchange, with all being very complimentary of care: Its great having open visiting, and we are kept up to date on all matters that affected dads care. We come and go as we wish. An excellent daily report system chronicled events and issues as well as stability. Generally the arrangements for care planning are improved, and are being continually updated. Pre admission assessments were consistent in approach, and gathered the necessary information. Inconsistent standards of review needs to be addressed. Care Homes for Older People Page 15 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are central to the homes aims and objectives, and are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found the daily routine to be flexible and non institutionalised, offering choices for meal times, personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, clearly identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. We recognise the principle that activities are a key element in the socialisation approach to care, with visitors encouraged to be involved in a partnership style with care staff. The home does not have an activity coordinator, although on talking with the Care Manager it was apparent that the home is committed to enhance the socialization role. During the course of the inspection we saw staff interact with people in a positive and polite manner, with two carers having had specific training, who take responsibility for providing activities. An observation by the expert by experience Care Homes for Older People Page 16 of 33 Evidence: indicated: I did not see any specific activity taking place while I was there, but saw quite a lot of staff/resident interaction, and there was a busy and lively feel to the home. A schedule of regular activities was on the wall. I was not convinced that many regular structured activities actually take place as it would be difficult to engage with more than three or four residents at any one time due to the limited space available. None of the residents I spoke with said they were able to leave the home to go on visits or trips, which would be a welcome addition. It was felt that there was limited space to provide an area for sitting, receiving visitors and activities, although an extension to the building is planned. We were informed that the Home is planning extended activities to add to those already in place, with occasional trips to the locality. It was noted that significant progress had been made with the introduction of a small garden area available for peoples usage. This experience should be widened with the development of an enclosed rear garden area, to offer wider encouragement. Comments we received from surveys issued to people who use the service before the inspection: More activities for the residents, sometimes they get bored. It would be nice for mum to go out occasionally and meet different people. It was noted that significant progress had been made with the introduction of a small garden area available for peoples usage. This experience should be widened with the development of an enclosed rear garden area to offer wider encouragement. Concluding comments received from the expert by experience were: Some more careful activity planning and some additional simple resources would ensure that individual residents could engage in activities tailored to their needs. The home could make more effort to recognise and reflect that one size does not fit all, when it comes to individual preferences, hobbies, likes and dislikes etc., and consult the residents more about how they would like to spend their time. It is stated in the Statement of Purpose that personal choice and relative self determination are respected in policy and action. Throughout the inspection we found this to be true. Those individuals rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general decor. Our inspection of the Home demonstrated a degree of expressed individuality in most of Care Homes for Older People Page 17 of 33 Evidence: the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care. Comments received from people confirm their appreciation and involvement with the progress of their health and social status: Helps with personal hygiene and dressing, always dignified. Asked for preferences for meals. Looks after and gets on well with visitors, good interaction with family. We found that the standards of catering offered a satisfactory service, to which those people we spoke with were very complimentary of all aspects of quality. It was recognized that the kitchen was being shared with the catering staff from another home during an unavoidable temporary closure for a few weeks. A menu on a four weekly cycle offered a wholesome, varied and suitable choice. We observed a very pleasant lunch served during inspection, with choices available between braised steak. lobby and chicken salad. A menu for the day was inspected and seen to offer a wide choice of meals throughout the day, served in a comfortable and clean dining room. The quality and quantity of the food offered on the day was observed to be of a good standard. People interviewed confirmed that that the quantity and quality food provided was good: The food here is always good and tasty, always hot, and the staff are very helpful. Varied and well presented, good quality, and Very good standard of cooking and choice available. Its always set out so nice. We saw that staff offered discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of residents. Comments made by the expert by experience: I sampled the food on offer at lunch. There was a choice of lobby or steak with vegetables, but only one dessert on offer. The food was tasty and during the meal I spoke with several residents who told me that they enjoyed the food and it was always good. I was told that during the morning staff went round and asked people what they wanted, and I think that a fruit bowl or fruit salad should be available as an option every day. We found that a person who had a vegetarian diet was not offered a choice of prepared meals specifically for vegetarians, a point accepted by the cook and Care Manager for immediate action. Care Homes for Older People Page 18 of 33 Evidence: We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special needs at the time. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements with people using the service. Care Homes for Older People Page 19 of 33 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. The service has a meaningful complaints policy. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. All people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. There were a few minor concerns, which we feel would be better dealt with through a record of concerns, complaints and safeguarding, to record peoples concerns in a meaningful and effective manner. We identified that there had been no complaints received by us, and one complaint received and dealt with satisfactorily by the care manager. There have been no allegations made to us since the last inspection. a comment we received from a relative, through the surveys returned: I would make sure that any problems are relayed back to the staff. I know there is a structure, and the manager is very sensitive to her residents concerns, a good system. Care Homes for Older People Page 20 of 33 Evidence: Our discussion with the care manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on abuse at induction, this includes the right to whistle blowing, consistent with the Public Disclosure Act, 1998. Care Homes for Older People Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Farmhouse provides a clean and comfortable environment for the people who use the service. There is a need to maintain the fabric and furnishings of the home to a satisfactory standard to meet all peoples needs. Evidence: We found that the surrounding garden areas are much improved, with a partial clearance and cleaning up of the surrounding walkways and patio areas, with some work gone into improving the gardens and grounds for general use by people living in the home. We still consider that the perimeter fencing is in need of repair to ensure privacy and security, and to enclose the garden area for general use. The attached residency building, presently used as a store is poorly maintained, presently used by the caretaker, and will be included for renovation in the extension building plans. On admission the Care Manager or her deputy assesses each individual service users needs for equipment and necessary adaptations. A letter confirming those arrangements was seen in each case file. Our inspection of the Home verified that the internal premises were generally fit for purpose, clean warm and tidy, internal communal and personal rooms being satisfactorily maintained. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home, except Care Homes for Older People Page 22 of 33 Evidence: between the two lounges interlinked by quite a steep ramp. Although there were rails either side of the ramp, it still seems quite a hazard for a frail person to negotiate without help. We consider this to have been a high risk area over some time and acknowledge that people are risk assessed , however there is a pressing need to redesign this feature, although there is a plan accommodated in the building extension work. Whilst we recognise that efforts had been made to provide a homely atmosphere, and the decor in most areas of home was found to be of an adequate standard, there is evidence of some bedrooms, and communal areas looking tired and worn. The carpets in the communal areas were somewhat grubby (especially in the dining area), and in need of either a deep clean or replacement. We found those lounge areas to be pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests, albeit in shared space, limited by the lack of private areas elsewhere in the home to meet people. A compact, homely dining area was clean, and conducive to enjoy a good meal. Bedrooms were generally well maintained to peoples personal preferences. On inspection, most bedrooms were styled to individual preferences, with some displaying peoples own furniture, and most with personal belongings. Some of the homes original furniture is in continuing need of renewal. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the inspection. We found that this policy is inadequately addressed with the pending, promised extension, in which provisions for improvement in internal facilities is expected. We noted that there is little in the way of enhancing personal space for people with dementia, in identifying bedroom doors, fitting items of easy recognition and usage, and installing a sense of personal ownership to their rooms. Nevertheless people told us that they had a sense of belonging, and satisfaction in the quality and presentation of their living areas. An effective call system was tested; care staff reacted readily to tests. A locked facility and lockable bedroom doors are available on request in each bedroom. The Care Manager expressed a willingness to meet any reasonable demand for special needs. The kitchen was inspected, and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. It was advised that the medicines fridge is inappropriately placed in the kitchen. The kitchen was clean and considered secure. Access to the kitchen should be for catering staff only, with suitable over clothing for visitors. The laundry was well organised, equipped to a good standard, with red alginate laundry bags available to meet cross infection control procedures. There is a provision Care Homes for Older People Page 23 of 33 Evidence: of suitable skips to accommodate soiled linen. Alert notices regarding chemical handling are openly displayed. Peoples belongings were seen to be handled piecemeal, in an organised process, with no evidence of communal usage. Toilets were located on both floors and were in close proximity to bedrooms and communal areas. Aids, adaptations and equipment were available throughout the Home. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff. An attic space used for storage was examined; the access was secure, but the stairwell very risky, with a loose banister rail, and temporary lighting. The area, although used only by staff, is hazardous and poorly laid out, no smoke alarm, and one free standing extinguisher only. The expert by experience reported: The home was clean and pleasantly presented. The furnishings were adequate, with some basic items past their sell by date, and needed replacing with some more modern fittings (e.g. wardrobes in bedrooms, chairs, etc.). The bedrooms were pleasant if basic, with commodes and vanity units with inbuilt sinks also in need of modernisation. I understand improvements have been made to the home in terms of renovation and decoration, and that the management structure has greatly improved. Clearly more needs to be done to the fabric and decor of the home, both inside and outside. Care Homes for Older People Page 24 of 33 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. Staffing levels ensure that suitably qualified staff are provided to meet the needs of people who use the service. Recruitment processes are consistent and robust, protecting the people who use the service from harm and abuse. Evidence: We confirmed that there were 17 people using the service on the day of inspection. Three weeks of duty rotas were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of people are met. On the day of inspection the staffing levels were: Morning shift 1 Senior Carer and 2 carers (Plus care manager). Afternoon shift 1 Senior Carer and 2 carers Night duty 1 Senior Carer and 1 carer We recognised that the Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfall due to sickness and absence; agency staff are not employed. We acknowledged that there are adequate support staff for housekeeping, catering, and maintenance (caretaking). The care manager has the Registered Managers Award (RMA), and we were informed through the AQAA that 60 of all staff have National Vocational Qualification (NVQ) at Care Homes for Older People Page 25 of 33 Evidence: level II or at level III; and 30 of all staff are presently undertaking NVQ training. This was confirmed on examination of training records, and speaking with staff. It is recognised that staff received a meaningful training programme, to compliment an effective induction course, and to enhance staff supervision. The Provider and Care Manager have established, and continue to pursue satisfactory procedures for interview, selection and appointment of staff. The Care Manager was advised to establish the practice of confirming the outcome of interviews with a letter of appointment to successful interviewees. The thoroughness of staff selection has a significant effect upon the provision of care, to ensure protection of people. Three staff were interviewed and confirmed the policies in action. All new staff goes through a detailed induction process, that will ensure that they are going to be the right person for the home, and are familiar with essential procedures, code of conduct, and the environment. We advised that the staff record be reviewed in the way information is organised and presented. Discussion with staff demonstrated an on going process of supervised practice, six times a year Care Homes for Older People Page 26 of 33 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. The care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests, based on openness and respect. Evidence: We acknowledge that the Care Manager, Mandy Peever, has over the past year demonstrated effectiveness in establishing a solid management foundation, implemented to achieve a satisfactory standard of set aims, objectives and care. We recognise that she has been actively engaged in quality reviews and audits with the Registered Provider, following our last inspection, meeting compliance to requirements and addressing recommendations we made. She has achieved her Registered Managers Award qualification. We observed an openness, professional and pleasing confidence in the interactions of staff, relatives and people who use the service, based on mutual trust and respect. Comments from those people we met and surveyed Care Homes for Older People Page 27 of 33 Evidence: included: If there is anything you need to speak about you can see the manager, or another member of staff at any time. I find the staff welcoming and easy to talk to. The home is comfortable and warm, and visitors are made welcome. Extremely happy with the staff and the home, very relaxed, friendly, homely atmosphere. The expert by experience assessor stated: Improvements have been made to the home in terms of renovation and decoration, and that the management structure has greatly improved. Clearly more needs to be done to the fabric and decor of the home, inside and outside. From my observation, I thought staff showed both consideration and care in handling and talking to residents. One lady was assisted to walk from the lounge with great care and patience by a member of staff. Some more careful activity planning and some additional simple resources would ensure that individual residents could engage in activities tailored to their needs. The home could make more effort to recognise, and reflect that one size does not fit all when it comes to individual preferences, hobbies, likes and dislikes etc. and consult the residents more about how they would like to spend their time. Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning and monitoring, staff selection and of the general environment, these are up to date and accurate. An examination of administrative, monitoring, planning and care records showed to us a diligent attitude to effective record keeping, although needing review in the way they are organised and presented. We found them to be generally well maintained in ensuring that the peoples rights and best interests are safeguarded. Records we inspected included recent fire prevention, hoists, gas, and water inspections, each were examined and found to be up to date. The policy and procedure manual however, has not been reviewed for some time, and would be of greater help to staff to be updated to meet new situations, especially in light of changes in Mental Capacity and Safeguarding regulations. We found that staff supervision had been held on a frequent basis, were kept up to date for all staff, and was agreed that a cascaded staff supervision programme would be established to continue to meet a two monthly target. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. All were seen to be cross checked with care plans and logged into day report. We were informed through the AQAA, and by the manager that financial arrangements are supervised and administered by the Registered Provider and Care Manager in Care Homes for Older People Page 28 of 33 Evidence: respect of pocket money, comfort fund and petty cash management. The administration and management of the home has established an improved, and a satisfactory standard of care based on sound practice and efficient care planning. There are however areas of concern regarding the support arrangements for people with dementia, activities, and standards of the environment that need address. Care Homes for Older People Page 29 of 33 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 30 of 33 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 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 Procedures to undertake a formal monthly review of care plans is to be established, to ensure that peoples care is updated to reflect changing needs. To ensure at all times that medicines awaiting collection for disposal are kept secure, to ensure the safety of people using the service, and maintain medicine security within the home. Activities need to reflect the individual assessed needs of people in a more robust and regular manner. This would meet the declared objectives of improved internal and external activities for all people using the service. Consideration be given to providing a vegetarian diet with choices available to meet the dietary needs of people. The provision of a structured concerns, complaints and allegations log would complement satisfactory system of handling complaints, for and on behalf of the people using the service. To ensure that the general fabric and furnishings and decor standards are maintained, to provide people with a comfortable and safe living environment. 2 9 3 12 4 5 15 16 6 19 Care Homes for Older People Page 31 of 33 7 8 19 19 To make safe the high risk area of the attic store, to ensure the safety of people working in the home. To take steps to safeguard people who wish to use the garden and patio areas, in maintenance of gardens, fencing, pathways and appropriate disposal of unwanted equipment. To move the medicines fridge from the kitchen area to a more appropriately accessible area in the home, to limit access to the kitchen area of unauthorised staff. To replace the steep ramp in the connecting stair between lounge and dining area, to ensure safe passage at all times for people living in the home. To consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. To limit access to the kitchen to authorised catering staff, to maintain satisfactory standards of infection control and food hygiene. Update procedure manual to reflect changes and meet new regulation and legislation. This will offer staff a more relevant and up to date assistance in applying policy effectively. 9 22 10 22 11 24 12 26 13 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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