Care Home: Farrant House Nursing Home

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What the care home does well The manager ensures that people admitted to the home have an assessment of their needs to make sure the home can meet all of their needs. The manager ensures that people are satisfied with the health and personal care provided and accessed through Farrant House. And there was evidence that peoples health needs were met effectively and people are supported to achieve a good level of personal hygiene. We were told: `Illnesses are dealt with very quickly.` The manager ensures that staff treat people with dignity and respect, and people like the staff who support them. We were told: `The staff are very good.`; `It`s nice- it`s very friendly.` The manager ensures that people maintain good family and community contact, and people are encouraged to maintain religious observation if they choose. Cultural choices are respected. The manager ensures that complaints and concerns are dealt with fairly. The manager ensures that people are protected from exploitation and abuse through providing staff with relevant training, guidance and support. The manager ensures that people only work at Farrant House following completion of robust recruitment and selection process, as this promotes employment of suitable people. The manager ensures that the home is clean, tidy and pleasantly decorated and furnished. The manager ensures that staff are encouraged and supported to undertake training to ensure they have the necessary skills to meet the needs of the residents living at the home. The manager has employed an activity coordinator with a good understanding of resident`s and a variety of activities are available from one to one activities to outside entertainers. What has improved since the last inspection? Since the previous inspection inspection the manager has commenced an audit of the quality of assessments and care plans developed for people living at Farrant House and so recent care plans and assessments are detailed and reflect the care and support that people should be offered. What the care home could do better: The registered person must ensure that risk assessments and the mitigation plan concerning self-medication, addresses all risks concerning, recording, handling, safekeeping, safe administration and disposal of medication. This is so that staff and the service user know precisely what action must be taken to ensure that the process is handled safely.The registered person should continue the process of auditing and updating the careplans and assessments to ensure that all the information, including that for established service users, provides all the information that is expected. The registered person should ensure that all information concerning medical and health care provided is recorded in full so that it can be easily demonstrated that this is provided and the effectiveness monitored when relevant. The registered person should make sure that it can be shown that service users are offered a variety of meals, drinks and snacks throughout the day, and that the presentation of meals and the general dining experience is improved. Key inspection report Care homes for older people Name: Address: Farrant House Nursing Home 44 Farrant Road Longsight Manchester M12 4PF     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: Michelle Haller     Date: 1 4 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 31 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 31 Information about the care home Name of care home: Address: Farrant House Nursing Home 44 Farrant Road Longsight Manchester M12 4PF 01612573323 01612259920 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.schealthcare.co.uk Southern Cross Healthcare Services Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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. The maximum number of service users who can be accommodated is: 44. Date of last inspection Brief description of the care home Farrant House Nursing Home provides accommodation with nursing care for up to 44 older people. The home is situated in the Longsight area of Manchester close to a main public transport route, a local market, shops and a supermarket, public houses and other social facilities and amenities. The home is a purpose built, two-storey home set in its own small and accessible grounds. The home offers accommodation in 40 single and 2 double bedrooms. 18 bedrooms, including both double bedrooms, have en-suite facilities. Access to the home is at ground level. A passenger lift is provided. The front door is digitally locked for security reasons and exit could be achieved by pressing a switch at the side of the door. CCTV covers the homes entrances and Care Homes for Older People Page 4 of 31 0 8 1 2 2 0 0 8 0 Over 65 44 Brief description of the care home grounds. The home provides smoking and non-smoking areas for the residents. The homes hairdressing salon and the administrators office are situated in the reception area. The most up to date inspection report is made available in the main reception for people to access. The fees at the time of this visit were from 383.88 to 599.80 pounds. Additional charges are also be made for hairdressing, chiropody and other personal requirements. Care Homes for Older People Page 5 of 31 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 inspection by visiting the home without informing the manager before hand, and we looked at all of the most important or key Care Homes for Older People National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the home. This included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We also considered the outcome of the previous key inspection we conducted in 2008. We received ten completed Care Quality Commission (CQC) surveys from staff and nine surveys completed by people living at Farrant House. We visited Farrant House, we looked around the home and checked through written Care Homes for Older People Page 6 of 31 information, including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the home. We also talked to residents, their relatives and staff working at the home. We also interviewed a health care professional who was visiting the home at the time of the inspection. We observed the interactions between service users, staff and others at the home. We interviewed manager and talked to one of the registered providers. The manager returned to us the CQC Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and compliance with health and safety checks when applicable. The information also influenced the outcome of the inspection. An expert by experience inspection was also completed and this information has been used to inform the findings of this inspection. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The registered person must ensure that risk assessments and the mitigation plan concerning self-medication, addresses all risks concerning, recording, handling, safekeeping, safe administration and disposal of medication. This is so that staff and the service user know precisely what action must be taken to ensure that the process is handled safely. Care Homes for Older People Page 8 of 31 The registered person should continue the process of auditing and updating the careplans and assessments to ensure that all the information, including that for established service users, provides all the information that is expected. The registered person should ensure that all information concerning medical and health care provided is recorded in full so that it can be easily demonstrated that this is provided and the effectiveness monitored when relevant. The registered person should make sure that it can be shown that service users are offered a variety of meals, drinks and snacks throughout the day, and that the presentation of meals and the general dining experience is improved. 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 31 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 31 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. People at Farrant House benefit from having their needs assessed before they move into the service. Evidence: We looked at the care file for the most recent admission to Farrant House and found that this persons needs had been fully assessed prior to them moving into the home. We saw that this had been completed by the registered manager who is skilled and experienced in undertaking assessments. The information in the initial assessment clearly involved the individual and their family. In the information returned to us the manager confirmed that Southern Cross audits are in place to monitor all aspects of assessments, home management and client care. Despite this we found that some information gleaned through the assessment was not always used to trigger additional assessment or development of a care plan which Care Homes for Older People Page 11 of 31 Evidence: would be expected by the system in place. Care Homes for Older People Page 12 of 31 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. People at Farrant House have their health and personal care needs met in timely manner, they were kept physically well, illnesses are treated and action is taken to promote and maintain good health. Evidence: We found that care plans had been developed from the assessments completed, and that, in most cases, these provided staff with information about how peoples needs should be met. And also, in some cases, how people wanted to be supported. We also found, however, that detailed care plans were not always developed to deal with matters that could have been considered a priority in relation to health and personal care, for example, continence needs, diabetic care, and matters concerned with self medication. We noted that not all care plans had been reviewed monthly. This is important because it helps those concerned to identify peoples progress and areas of care that may need more attention. Care Homes for Older People Page 13 of 31 Evidence: We did see, however, that since admission, some peoples needs had been fully reassessed and this process involved the person, their relatives and relevant health and social care professionals and so the process was thorough. We consider that the process of updating and auditing of the care plans and files must continue until each provides the information necessary and the pattern for monthly reviews is fully established. We consider that care plans and assessments would improve if those completing the assessments and care plans fully understood and used more diligently the scoring systems that are in place. This will help to ensure that priority and appropriate attention is given to areas that score as a moderate or high concern. This will help to safeguard against important needs, that may eventually have a negative effect, been overlooked by staff. And will also promote peoples well being and comfort in these areas. We found, through reading the daily and weekly reports, that people received health care from doctors, specialist nurses, speech and language care and other health and social care professionals. It was difficult to confirm, however, that people were receiving regular routine treatment such as dental checks, optical checks, influenza injections or podiatry. We discussed this with the manager who agreed that she would ensure that staff recorded all health care visits and their purpose on the professionals visit form provided by Southern Cross. This will make it possible for her to determine whether people have had all their routine health care checks, and these are at the recommended intervals. We discussed health care matters with a health professional visiting Farrant House at the time of the inspection. Their comments indicated that staff cooperated in full with health care advice, and that additional intervention was sought in a timely manner so that treatment is provided quickly in order to prevent unnecessary deterioration in a persons condition. We observed the interaction between staff and residents and noted that staff were always pleasant and attentive. They called people by their preferred terms of address and promoted peoples dignity and privacy by ensuring that all procedures were carried out in private. Staff are encouraged to use communication or choice cards so that people can indicate their preference for example with new clothes, outings, items from the shop or, preferred gender of staff for person care. Care Homes for Older People Page 14 of 31 Evidence: People were in the main clean and well-groomed, and it was noted that some wore aids to communication such as glasses and hearing aids. The expert by experience observed that: Residents appeared well groomed and clean and tidy and those I spoke to said that they were well looked after by the carers. The expert by experience also observed that some staff spoke with heavy accents and also quietly, however, no one spoken to during the period of the inspection identified this as a problem to them receiving appropriate and effective health and personal care. We noted that one toilet door could not be secured. This is unacceptable and was brought to the attention of the registered manager and it was agreed that this matter would be addressed as soon as possible. We observed a medication round, looked at the way in which medication was managed in the home. We found that the medication policy was readily available and easy to understand. We saw that it was possible to identify who had administered medication because sample signatures of permitted staff was held in the medication admission record (MAR) file. We looked through a sample of MAR sheets and noted that there were no unaccounted for gaps and that people had received their medication as requested on their prescriptions. We saw that a body chart is now in place for people who have creams applied. This is so that staff can see precisely where each cream must be put. We noted that medication which is handwritten onto a MAR sheet needs two members of staff checking it in, this will make help to ensure that information on the prescription has been written in accurately. We also noted that risk assessment and care plans concerning people who self medicate needs to be detailed enough to mitigate the identified risks, and staff must follow any guidelines that have been developed. Overall we found that peoples health needs were been met in timely manner, that they were kept physically well and that illnesses were treated and action taken to promote and maintain good health. The manager confirmed that she was in the process of updating and reassessing people in the home and it was noted that the care plans for people more recently admitted provided better information. Comments from relatives included: She is well looked after and illnesses are dealt Care Homes for Older People Page 15 of 31 Evidence: with very quickly. Care Homes for Older People Page 16 of 31 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. People at Farrant House benefit from been supported to maintain effective family, community and cultural contacts, and efforts continue to be made to improve and increase activities. Evidence: We found that in the main people felt that activities available in the home had improved, however more outings would be appreciated. The records indicated and people told us that activities at Farrant House included games, arts and crafts, one-toone discussion, monthly entertainers, one to one outings, parties and BBQs (weather permitting). The activities calender suggested a daily change, however the activities record did not reflect this. We assess that this area will be improved when manager is able to demonstrate that people are offered a variety of stimulating activities on a daily basis, as this will help to confirm that emotional well being is promoted. We found that people are given a choice about the lifestyle they lead and comments about activities included: The activities coordinator is very good- theyve bought a lot of new equipment recently, people arent pushed but its there if they want it. Care Homes for Older People Page 17 of 31 Evidence: The expert by experience found that people enjoyed the games that were organised and he wrote: Residents I spoke to seemed very happy and I was able to observe them playing hoop la with rings being tossed on to pegs and the activities coordinator was very enthusiastic in encouraging them to enjoy the game. And people are supported to maintain religious observance. The expert-by experience (Ex-by-Ex) found that: Regarding religious activities, a Catholic Priest visited the home each week for prayers and to give out the Sacraments to those who wanted them and the Manager said the Priest was always on hand at times when residents were in the last stages of life. He was also informed when new residents wanted to see him. A Church of England representative visited quite regularly on Sundays and played the piano and residents joined in with the hymns. One resident went out each Sunday to his local Church and friends from that Church visited him during the week and took him out on trips. The ex-by ex also interviewed a relative, and their observations identified possible improvements as been More outings arranged for the residents as well as much larger T.Vs as the ones in use at present were awkward to view due to them not being large screens. This relative was also a member of the relatives committee which held regular meetings with the management. We found that people who returned surveys also identified that they would like the opportunity to go on more outings. We found that peoples family contact and continued community presence was encouraged and supported. We saw that family contact was assessed in detail and peoples wishes respected. Records indicated that people went out with their families and friends and that people were able to visit when they liked. We also observed that visitors came to the home throughout the day. Comments included: They are very welcoming, we come when we want and help with her meals sometimes-its a friendly place theres no doubt about it. On the day of inspection the expert by experience (ex-by-ex) was asked to look at the quality of meals and dining. He found that there was insufficient choice at breakfast time in that a cooked breakfast was not offered. The lunchtime meal was fish and chips with gravy, no starter or dessert was offered, however the ex-by-ex enjoyed what was provided. He also noted the effect of people not been provided with serviettes. Care Homes for Older People Page 18 of 31 Evidence: The ex-by-ex wrote: I had lunch with some of the residents and it was enjoyable but I was offered no dessert and only water to drink, no hot beverage or fruit drinks. There was no fresh fruit available, also there were no napkins on the table and I observed one diner wiping her fingers on her dress. We also made additional observations during lunch and tea time at Farrant House. We found that the dining experience could be improved in that people remained seated in their wheelchairs over lunch and food presentation was not particularly appetising. People told us that they had a choice of cereals for breakfast. We were also told that there was always two choices at lunchtime. Menus were not prominently displayed and and when asked care staff did not know what was on the menu for the day of inspection. In the dining area that was observed at lunchtime, the television was left on for a substantial period of time resulting in staff shouting above it to make themselves heard. We found that the soft diet looked unappetising on the plate, however, the person who ate it said that they enjoyed it and commented: The meals are very very nice I think everything is first class. Most people who were observed at lunch time finished their meals. However no dessert was offered, and hot drinks were not provided. At tea time people were served stew with chips, meaning that people were offered chips twice in one day, followed by fruit crumble. The meal presentation was unappetising, everyone was given very large portions with no consideration to peoples appetites, furthermore the food was at times spilling over the side of the plate or bowls. Southern Cross use a nutritional management system which is monitored to ensure that people receive the nutritional support they require however the application of the system is determined in each home. We discussed the meals and dining experience observed on the day of the inspection with the manager- she observed that the meals and drinks were in keeping with the system in place, but agreed that people should be given a choice in relation to breakfast and drinks, and that more care must be taken in relation to the presentation of meals. We saw that staff supported people who required assistance discreetly and with patience. We saw that nutritional assessments were completed for service users. We saw from the sample we looked at that weight was not always recorded in a way that made it possible to quickly identify weight fluctuation, however, it could be seen that one person had experienced unexplained weight lost since moving into the home and additional monitoring had not been introduced. We accept that this person, on paper, Care Homes for Older People Page 19 of 31 Evidence: appeared to be of substantial weight, however this weight loss was not planned and therefore should be monitored. Care Homes for Older People Page 20 of 31 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. People at Farrant House benefit from having access to senior staff a clear complaints procedure, and they are protected from harm through a detailed adult safeguarding policy which is understood and adhered to by staff. Evidence: We noted that the complaints procedure is readily available, is clear and easy to use. The information includes the different stages of a complaint and the timescales for the process. We looked at the complaints record and found that the information was clearly documented, and that action was taken to resolve any issues. We assessed that complaints are dealt with fairly and openly. The recording of complaints needs to be improved as at the time of the inspection complaints from different people were recorded on the same sheets of paper, meaning that it was impossible to look at information for only one person. Furthermore it would be good practise if a copy of the complaint and the outcome were kept in the persons personal file. People said that there were no issues with making complaints and that they felt that they were listened to. Comments included: We have no complaints about the nursing home, if there are any concerns we follow the chain of command. We go to the person in charge who is usually able to sort things out without going to the manager. Care Homes for Older People Page 21 of 31 Evidence: We also found that everyone who returned surveys confirmed that they knew who to speak to if they were unhappy and the majority felt that they were listened to all of the time. We found that, according to the training calender, all staff have received protection of vulnerable adults training. Staff who were spoken to were clear about the actions that could be seen as abuse and also the actions they must take. We discussed incidents of physical violence, in-particular, between residents with the manager. There was clear understanding that these must be treated as potential abuse and so a referral made to Manchester Local Authority as well as inform the Care Quality Commission (CQC) under the Regulation 37 of the Care Standards Act 2000. The manager has completed Mental Capacity Training and Deprivation of Liberty safeguard training. We discussed how this was to be managed at Farrant House. We also discussed the principal of Best Interest which is an element of the response to this legislation in Manchester. This includes calling a multidisciplinary meeting to discuss the issue before beginning the Mental Capacity and DoLs process. The manager stated that there were no adult protection issues been investigated, and neither was there anyone subject to Dols at the time of the inspection. Care Homes for Older People Page 22 of 31 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. We found that people at Farrant House benefited from an environment that was was homely, clean and met their needs. Evidence: We found, through conducting a tour of the building that it was free from unpleasant odours, and fixtures, fittings and equipment was well maintained, clean and safe to use. There are several communal and dining areas which were well used by the resident and their visitors. It was noted that people mobilised around the home independently. We saw that bedrooms had been decorated and furnished to meet individual taste. We were told by the people who returned surveys that the home was always clean and fresh. The ex-by-ex also looked at this area and he found that for the most part the environment at Farrant House was good and met the needs of people living. He did note however that an ventilation cover in one of toilets was clogged with dirt. We also found that one of the toilets downstairs could not be locked. Both of these matters were discussed with the manager and it was agreed that the vent would be cleaned and a safety lock fitted as quickly as possible. Care Homes for Older People Page 23 of 31 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 living at Farrant House benefit from a staff team who are well trained, employed using a robust recruitment and selection process and deployed in sufficient numbers to meet their needs. Evidence: We found that the staff compliment met the needs of the people living at Farrant House. On the morning of the inspection there were 18 residents on the nursing unit been supported by one qualified nurse and two carers. On the residential unit the staffing was one senior carer and two carers to 20 residents. In addition domestic staff were working on both units, a handyman was on-site, the activities coordinator was working and the manager was also on duty in the home. Staff and residents who commented confirmed that there was almost always sufficient staff to meet their needs. Records confirmed that staff are recruited using a robust vetting system. This included an in-depth application form and interview notes were retained. We also saw that Criminal Record Bureau (CRB) checks, verification of identity, verification of professional qualifications and references from previous employers were also completed before the person took up a post at Farrant House. Care Homes for Older People Page 24 of 31 Evidence: We found that there is an extensive training programme offered to staff through the Southern Cross Training unit. This means that staff are well informed about how to do their jobs and kept up to date with new ways of working. This includes a detailed induction program that meets the Skills for Care core requirements. Training offered at Farrant House in December included: protection of vulnerable adults, infection control, Dementia Awareness, moving and handling, nutrition, health and safety, challenging behaviour, medication updates and Control of Substances Hazardous to Health. (COSHH). And the training statistics provided confirmed that the majority of staff had also received fire safety training, writing care plans updates and bed rails training. In the information she returned to us the manager confirmed that 18 out of 21 care staff had achieved the National Vocational Qualification in care level 2 or above. We were told by staff that they had checks completed before they started to work at Farrant House. All the staff who returned surveys also indicated that there was an effective and comprehensive training program that helped to prepare them to do their jobs and also kept them up to date. They also confirmed that management or senior staff were readily available to offer guidance and advice. Care Homes for Older People Page 25 of 31 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. Farrant House is managed by a manager who is intent on running the home in the best interest of the people who live there. Evidence: We found that Farrant House is managed by a person who is qualified and competent to run the home successfully and in the best interest of the people who live there. She keeps herself up-to-date with new idea and regulations concerned with the care of older people. In the past year she has completed the following training: Protection of Vulnerable Adults, dementia awareness, first aid, Mental Capacity Act, Deprivation of Liberty safeguards, Advanced Health and Safety and Gold Standard framework. We found that Southern Cross quality assurance procedure is operated at the home. There are questionnaires about all aspects of living at Farrant House and people can complete when they want. These are sent to head quarters and correlated on a yearly basis. Comments about the service for 2008 included: The family are very pleased with the way he is looked after. Care Homes for Older People Page 26 of 31 Evidence: The home hosts a residents and relatives meeting where issues are discussed and plans made for the coming months. Service users are protected from financial exploitation by the accounting systems used at Southern Cross. The finances of each person is automated and receipts and invoices are used to record all transactions. The system used is called Cold Harbour. The finances are also audited from head office which so that anomalies can be discovered and dealt with. We saw that all fire safety checks had been carried out and recorded. As well as qualified nurses there are also first aiders on duty at each shift. The majority of staff have completed infection training and senior staff and kitchen staff have completed food hygiene training. Staff have received health and safety training including Control of substances hazardous to health (COSHH) and moving and handling training. We were informed by the manager, in the information that she returned to us, that lifts, hoists and other appliances had been maintained and serviced in accordance with the manufactures recommendations. It was also confirmed to us that all the relevant gas and electrical safety checks and required maintenance had been completed and were up-to-date. We assess that the conduct of the manager and organisation of Farrant House should promote the health and safety of people living and working there. Care Homes for Older People Page 27 of 31 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 28 of 31 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 9 13 The registered person must 26/02/2010 ensure that risk assessments concerning people who self medicate identify all the potential risks concerned with receipt, recording, storage, handling, administration and disposal of the medication, and provide the service user and staff with detailed information about how these will be mitigated while promoting the persons wishes and independence. This is so the manager can be certain that medication is only taken by the person for whom it is prescribed in accordance to their prescription. Care Homes for Older People Page 29 of 31 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 The registered person should ensure that the process of updating and auditing of the care plans and files continues and made a priority until each provides the information necessary, and the pattern for monthly review fully established. This is so service users are assured that their current and changing needs will be met, and staff are provided with detailed information about how this will be achieved. The registered person should ensure that medication that is handwritten onto the MAR sheet is checked by two members of staff, this will make help to ensure that information on the prescription has been transferred across accurately. The registered person should make sure that people are provided with more information about the food and drink available so that people are fully aware of the choices that they have. The registered person should make sure that weights are recorded in a manner that makes it easy to identify weight loss or gain. This will mean that monitoring or other appropriate action taken quickly to deal with the issue. 2 9 3 15 4 15 Care Homes for Older People Page 30 of 31 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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