Care Home: Friarn House Residential Care Home

What the care home does well What has improved since the last inspection? The standard of the environment is good though decorating and refurbishment is on-going. Appropriate action had been taken to address the requirements of the last inspection relating to health and safety matters. Bedrails have been removed as appropriate, sash windows have been made safe, a loose handrail has been secured and a stair lift has been replaced. The home have also taken appropriate action to ensure that protocols are in place for the use of as required medication. What the care home could do better: The home needs to ensure that care plans are raised to address individuals` assessed needs. This was found to be lacking in the two care plans examined. It has also been recommended that individual records are maintained for people who require their fluid and diet to be monitored and for those who require regular staff assistance to turn in bed. In his completed AQAA, the registered manager acknowledged that the home further needed to improve with regard to its provision of activities. Comments from people who use the service and their relatives also expressed concerns about the provision of activities and lack of `mental stimulation`. Stimulation and meaningful activities were also noted to be lacking during the inspection. It is positive that the registered manager acknowledges the areas for improvement and that he appears very committed to addressing this. It has been strongly recommended that the home sources appropriate training for staff in the provision of activities for older people with dementia. Apart from the afore mentioned, Under the heading of `How do you think the care home can improve` the following comments were made by some relatives; `I don`t think that it can be improved, it has been turned around 100%` `This is a difficult question to answer` `They seem to be doing a reasonable job already` `If there were any problems with the care, my relative would not be there` Staff felt that staffing levels needed to be increased during the day and at night. No concerns were raised at this inspection about the home`s ability to meet the assessed needs of people living there with the current staffing levels, but it has been recommended that the home reviews dependency levels of people to ensure that staffing levels are adequate to fully meet their needs including psychological needs. CARE HOMES FOR OLDER PEOPLE Friarn House Residential Care Home 35 Friarn Street Bridgwater Somerset TA6 3LJ Lead Inspector Kathy McCluskey Unannounced Inspection 09:30 12 February 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Friarn House Residential Care Home Address 35 Friarn Street Bridgwater Somerset TA6 3LJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01278 445115 Westcare (Somerset) Ltd Alan Sandor Farkas Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 16 persons over the age of 65 years in categories DE(E) and OP. Date of last inspection Brief Description of the Service: Friarn House is a large terraced house situated in Bridgwater and is within easy access of the town centre and local facilities. The home has a good sized enclosed garden. Parking is limited to the surrounding streets. Friarn House is registered with the Commission for Social Care Inspection to provide personal care for up to 16 service users over the age of 65 years, who require care by means of old age or dementia. The home is not registered to provide nursing care. The registered provider is Westcare (Somerset) Ltd. The responsible individual is Mr J.Whitehouse. The Registered Manager is Mr Alan Farkas. The fees payable vary from £360 to £500. Additional charges are met by people using the service for chiropody treatment, hairdressing, newspapers and personal items. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This Key unannounced inspection was conducted over one day (6.5hrs) by CSCI regulation inspector Kathy McCluskey. As part of this inspection the registered manager completed an Annual Quality Assurance Assessment (AQAA) which was submitted to the Commission. Comment cards were sent to a random number of relatives, staff, people using the service and healthcare professionals. 9 comment cards were received from people living at the home, 8 from relatives and 6 from staff. No completed comment cards were received from healthcare professionals. Comments have been incorporated throughout this report. At the time of this inspection, 16 people were living at the home and this included 2 people who were currently in hospital. During this inspection the inspector met with the majority of people living at the home and staff on duty. The registered manager was available throughout the inspection. All communal areas of the home and a selection of bedrooms were viewed. Care records, staff records and records relating to health and safety were examined. The inspector would like to thank the people living at the home, staff and management for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 6 What the service does well: Friarn House provides a comfortable and very homely environment for the people that live there. The standard of décor and furnishings are good and the registered provider and manager are committed to maintaining and improving standards at the home. The standard of cleanliness is good and the home was free from malodours. Appropriate systems are in place to reduce the risk of the spread of infection. The home has a small and stable staff team. Staff turnover is low and the home does not use agency staff. The home make sure that they can meet peoples assessed needs before they are offered a placement. People are also encouraged to test drive the home before they move there. People who live at the home and relatives say that the staff are kind and helpful. Relatives say that they are always made to feel welcome and are always kept informed about important matters. Comments about the food were positive and the four week menu appeared wholesome and varied. These are some comments from relatives about what they felt Friarn House does well; ‘Friarn House is a lovely care home and the staff are all lovely, an extension of our own family’ ‘The staff seem very kind, friendly and caring and my relative says how good they are’ ‘The house is bright, warm, comfortable and clean’ ‘Staff always show a sense of humour and have caring natures’ ‘Friarn House provides all that my relative needs and provides a caring environment to enjoy’ ‘Individual needs are catered for on a personal level’ ‘Its good to see the same staff and they obviously know my relative well’ One relative described the home as follows; ‘Friarn House – the care home that cares’ Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The home needs to ensure that care plans are raised to address individuals’ assessed needs. This was found to be lacking in the two care plans examined. It has also been recommended that individual records are maintained for people who require their fluid and diet to be monitored and for those who require regular staff assistance to turn in bed. In his completed AQAA, the registered manager acknowledged that the home further needed to improve with regard to its provision of activities. Comments from people who use the service and their relatives also expressed concerns about the provision of activities and lack of ‘mental stimulation’. Stimulation and meaningful activities were also noted to be lacking during the inspection. It is positive that the registered manager acknowledges the areas for improvement and that he appears very committed to addressing this. It has been strongly recommended that the home sources appropriate training for staff in the provision of activities for older people with dementia. Apart from the afore mentioned, Under the heading of ‘How do you think the care home can improve’ the following comments were made by some relatives; ‘I don’t think that it can be improved, it has been turned around 100 ’ ‘This is a difficult question to answer’ ‘They seem to be doing a reasonable job already’ ‘If there were any problems with the care, my relative would not be there’ Staff felt that staffing levels needed to be increased during the day and at night. No concerns were raised at this inspection about the home’s ability to meet the assessed needs of people living there with the current staffing levels, but it has been recommended that the home reviews dependency levels of people to ensure that staffing levels are adequate to fully meet their needs including psychological needs. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People are provided with the information they need to enable them to make an informed decision about moving to the home. The home ensures that prospective service users are fully assessed before a placement is offered. Prospective service users are given the opportunity to test drive the home. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide. Both documents are available to service users, prospective service users and/or Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 11 their representatives and provide details of the services offered. There have not been any changes to these documents since the last inspection. Nine service users completed comment cards for the Commission and eight confirmed that they had received sufficient information about the home before they decided to move there. The home ensures that prospective service users are fully assessed before a placement is offered. Documented evidence of this was available in care records relating to two people who had recently moved to the home. Assessments from other healthcare professionals are obtained where available. Prospective service users and/or their representatives are invited to visit the home to meet staff and other service users. Day visits are also offered. The first four weeks of admission is considered a trial period. The home avoids emergency admissions and will only consider if they are able to conduct a pre-admission assessment first. This is felt to be positive. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans identify individuals preferences and care staff have a good knowledge of individuals needs but care plans are not fully reflective of a persons assessed needs. People using the service have access to appropriate healthcare professionals but the home’s recording systems could be improved. The home follows the correct procedures for the management and administration of peoples medication. People using the service are treated with respect. EVIDENCE: The care records relating to two people who had recently moved to the home were examined at this inspection. Care plans contained good information Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 13 regarding individuals preferences but information regarding care needs were lacking. One person was poorly in bed, required hourly turns and was only taking sips of fluids. This person was also on a pressure relieving mattress. Whilst care staff confirmed that they were aware of this persons needs the care plan was not reflective of the current needs. The registered manager stated that records of fluids taken were recorded within daily records. It has been recommended that separate charts are maintained for fluid input/output, diet intake and turns. A care plan must be established to reflect the individuals assessed needs and this must contain detailed instructions for staff on how needs should be met. This was also the case in the second care plan examined and related to periods of challenging behaviour. No care plan was in place and there were no instructions for staff as to how the individuals assessed needs should be met. These findings were discussed in detail with the registered manager at the time of the inspection. The registered manager confirmed that the home had excellent links and support from appropriate healthcare professionals. It has been recommended that the home develops a recording system for each individual which details their contact with healthcare professionals as this information was not available in the care plans examined. The home ensures that service users are weighed on a monthly basis. Records relating to two people were examined at this inspection. It was noted that one person had lost a significant amount of weight and there was no evidence in the care records of any action taken by the home. This was discussed with the registered manager who stated that this occurred during the time the person was in hospital and acknowledged that records should have been maintained. In comment cards completed for the Commission, 5 relatives stated that the home ‘Always’ met the needs of their relative, 3 responded ‘Usually’. Additional comments made included; ‘Every comfort and assistance with personal and medical issues are met and catered for’ Some relatives indicated that ‘mental stimulation was rather poor’. 6 relatives indicated that they were ‘Always’ kept up to date with important issues and 2 responded ‘Usually’. ‘I was informed immediately what was going on’, ‘They always tell me by phone or when I visit’. Nine people living at the home completed comment cards for the Commission and 3 stated that they ‘Always’ received the care and support they needed. 5 responded ‘Usually’ and 1 ‘Sometimes’. The home’s procedures for the management and administration of medication were examined at this inspection and were found to be satisfactory. Medicines were securely stored and no excess stocks were apparent. Medication Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 14 administration records (MAR), had been appropriately completed. Staff spoken with stated that they had received appropriate training. Staff interactions with people using the service were noted to be kind and respectful. People who were able to express a view did not express any concerns. In response to the question, ‘Do the staff listen and act on what you say’, all 9 people using the service responded ‘Yes’. One person made the following comment, ‘They are busy people but they will do and act with any help that is needed’. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home employs an activities person but the provision of activities available could be improved. The home welcomes visitors in line with the preferences of people living there. People living at the home are offered a varied and wholesome diet and individual preferences are recorded. EVIDENCE: Prior to this inspection the home completed an Annual Quality Assurance Assessment (AQAA) for the Commission which identified areas for improvement in the homes provision of activities. Relatives who completed comment cards for the Commission also identified some concerns in this area. Relatives indicated that mental stimulation was ‘rather poor’ and that there should be ‘more activities and outings for people to join in with’, ‘I feel that people are left to get bored and there appears to be little conversation’. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 16 Nine people living at the home completed comment cards for the Commission and in response to the question; ‘Are there activities arranged by the home that you can take part in’, 2 responded ‘Always’, 3 ‘Usually’, 3 ‘Sometimes’ and 1 no response. Some people spoken with during the inspection stated ‘It is boring’ and ‘There is not much going on’ The registered manager stated that they were currently ‘struggling’ to provide suitable and stimulating activities for some people but indicated his commitment to improving this. The home employs an activities person who works 1000-1200hrs & 14001600hrs weekdays. The home does not have a set activities programme at this time. The registered manager advised that an outside entertainer visits the home approximately every two months. The home has a mini-bus which is shared with its sister home. This is not currently wheelchair accessible but the inspector was informed that there are plans to install this provision. During the afternoon of this inspection the inspector spent time sitting with people in the lounge area. Music was playing and three gentlemen were chatting amongst themselves in the conservatory. One was reading a newspaper. The activities person spoke to each person briefly and then took two people into the dining area to complete some puzzles. There was little stimulation for people who were unable to join in with this activity. The home do try and offer people trips into town and examples were given to support this. The registered manager stated that, weather permitting, more trips out would be offered this year. The home maintains records of activities that have taken place and of the people who took part but it has been recommended that records are developed for each individual which will also identify the outcome of the activity. This was discussed with the registered manager at the time. It has been strongly recommended that appropriate training is sought in the provision of activities for older people with dementia. The registered manager indicated his commitment to addressing this. No relatives were available for this inspection but 8 completed comment cards for the Commission. Relatives were positive about the visiting arrangements at the home; ‘The staff are very patient and friendly and make visitors welcome’, ‘Always friendly, welcoming and informative’. People can choose where to see their visitors. Apart from the main communal areas the home has a small quiet room which people can use or they can see their visitors in the privacy of their bedroom if they choose. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 17 All meals are prepared and cooked at the home. The home employs catering staff who cover 7 days a week. A four week menu was made available to the inspector and this appeared wholesome and varied. The registered manager stated that the home’s menu had also been looked at and approved by a nutritionalist. Dietary preferences of individuals had been recorded in their plan of care. People spoken with during the inspection were positive about the food available and stated that there was ‘plenty to eat’. Nine people using the service completed comment cards for the Commission and 6 indicated that they ‘Always’ liked the meals at the home and 3 ‘Usually’ An inspection of the home’s kitchen was carried out by Environmental Health Department on 28/06/07. No concerns were raised and it was noted that all staff had received appropriate training in food hygiene. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Appropriate complaints procedures are in place and people feel confident that their concerns will be acted on. The home has procedures in place to reduce the risk of harm or abuse to people using the service. EVIDENCE: An appropriate complaints procedure is displayed in the reception area of the home. Relatives who completed comment cards for the Commission indicated that they knew how to make a complaint. The home have not received any complaints since the last inspection. The home have procedures in place to reduce the risk of harm or abuse to people using the service. The registered manager agreed to download a revised copy of Somersets Policy on Safeguarding Adults (May 2007). All staff receive training on the prevention of abuse. The home has appropriate policies for staff on the acceptance of gifts. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 19 Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People living at Friarn House benefit from a comfortable homely environment which is well maintained. People are offered comfortable bedrooms which they are encouraged to personalise. Standards of cleanliness are good and appropriate steps are taken to reduce the risk of the spread of infection. EVIDENCE: The home has an on-going programme of redecoration and refurbishment and it was apparent at this inspection that the registered person and registered Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 21 manager remain committed to maintaining and improving the home’s environment. During this inspection all communal areas and a selection of bedrooms were viewed. Standards of décor, furnishings and cleanliness were very good. Positive comments were raised by relatives in completed comment cards; ‘The house is bright, warm and comfortable’, ‘Friarn House is a small family unit which creates more family intimate living’, ‘The home is always clean’. People living at the home also expressed their satisfaction; ‘My room is always clean and I have my personal things around me’. At the last inspection some concerns were raised regarding some of the sash windows. The registered manager stated that as the home is a Grade II listed building, applications to replace windows were made to the heritage committee over a year ago. The registered manager gave his assurances that windows had been made safe and that further enquiries would be made to establish the status of the home’s application. At the time of this inspection all areas of the home viewed were warm, clean and free from malodours. The home employs designated cleaning staff. Appropriate procedures are followed to reduce the risk of the spread of infection. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People benefit from a stable staff team. The home needs to be sure that staffing levels are adequate to meet the current needs of people living at the home. The home’s staff recruitment procedures are generally good though would benefit from further improvements. Newly appointed staff follow an appropriate induction programme. EVIDENCE: At the time of this inspection 16 people were living at the home although 2 people were currently in hospital. The registered manager advised that current care staffing levels were as follows: AM – 0800-1400 = 2 care staff PM – 1400 – 2200 = 2 care staff Night – 2200 – 0800 = 1 waking and 1 sleep-in care staff. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 23 The registered manager is on duty in addition to the above from 0800-1600hrs weekdays and also provides on-call cover. In addition to care staff, the home employs an activities person, catering staff and cleaners. Six care staff completed comment cards for the Commission and in response to the question; ‘Are there enough staff to meet the individual needs of people’, 5 responded ‘Always’ and 1 ‘Sometimes’. Staff indicated that there should be two waking staff at night and that it was difficult to spend quality time with people during the day with just two care staff. Nine people using the service completed comment cards for the Commission and in response to the question; ‘Are the staff available when you need them’ 4 responded ‘Always’ and 5 ‘Usually’. No concerns were raised by relatives in completed comment cards. There was no evidence at this inspection to indicated that individual’s assessed needs were not being met by the numbers of staff on duty but it has been recommended that the home reviews dependency levels of the people living there to ensure that current staffing levels during the day and night remain adequate. Staff turnover is low and the home does not use agency staff. The home provided information which indicated that of the 12 care staff employed, 5 have achieved a minimum of an NVQ level 2 in care and 5 were currently working towards this award. This equates to 42 of care staff who have achieved this award which falls just short of the recommended 50 of the National Minimum Standards. Progress will be followed up at the next inspection. Two staff recruitment files were examined at this inspection relating to recently appointed staff. Both files contained all required information including Criminal record checks (CRB) and checks against the vulnerable adults register (POVA). It has been recommended that the application form requests employment history for the past 10 years as this was not available in one of the files examined. The home should also ensure that applicants provide full dates of employment as this will allow for any gaps in employment to be identified and explored. To ensure that people using the service are protected from the risk of abuse, the home need to ensure that risk assessments are completed for any staff member who commences employment pending a full CRB check. This will be in extreme circumstances where the home need to commence an employee on receipt of a POVAfirst check. In these cases the employee needs to be aware of Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 24 and confirm the restrictions imposed on them during this period. The home also need to maintain records as to who will be responsible for supervising the employee during this period. Newly appointed staff follow an appropriate induction programme which also includes mandatory training. Six staff completed comment cards for the Commission and in response to the question; ‘Did your induction cover everything you needed to do the job’, 5 responded, ‘very well’ and 1 ‘mostly’. All indicated that they had received the training they needed. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 – Standard 35 is N/A. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Effective management systems are in place and people benefit from an open and inclusive style of management. Quality assurance procedures are in place and are followed. The home’s arrangements relating to health and safety are good. EVIDENCE: Mr Alan Farkas remains as the registered manager and he is currently working towards an NVQ level 4 in management. Mr Farkas stated that he promoted an ‘open’ style of management. Comments received from relatives were positive Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 26 about the management of the home stating that; ‘I can always talk to the manager’. The registered manager is supported by a deputy manager. The registered manager ensures that the home’s quality assurance policies are followed and that views about the service are sought on a regular basis. The home sends questionnaires to people using the service and relatives every 6 months. Results of questionnaires returned in July 2007 were seen and comments were positive. The home should consider also seeking the views of appropriate healthcare professionals. Formal meetings for people currently living at the home are not felt to be appropriate. Views are sought on a daily basis. Staff meetings take place every three months. Minutes are maintained. The last meeting took place on 23/01/08. As required under the Care Home Regulations 2001, monthly visits to the home are carried out by the responsible individual. Reports are kept at the home and were made available for this inspection. The home does not manage money on behalf of people using the service. There was evidence that staff receive one to one supervision sessions and annual appraisals. The registered manager informed the inspector that supervision records were being replaced with a template which will enable more detailed recording. This is felt to be positive and progress will be followed up at the next inspection. The home’s procedures relating to health and safety were examined at this inspection and the findings were as follows: FIRE SAFETY - The registered manager stated that the home has produced a fire risk assessment which had been seen by the local fire officer. This was not examined at this inspection. Fire fighting equipment and detection systems were serviced by an external contractor on 07/02/08. The home carries out weekly checks on the fire alarm systems and monthly checks on the emergency lighting. At the time of this inspection, all checks were up to date. The registered manager stated that all staff receive fire training four times a year and that fire drills are conducted every 6 months. ELECTRICAL SAFETY – Annual testing on portable appliances is due to take place this week and it was agreed that confirmation that this had been completed would be forwarded to the Commission. This was also the case for the home’s electrical hardwiring certificate. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 27 GAS SAFETY – The home has an up to date annual Landlords Gas safety Certificate dated 29/01/08. EQUIPMENT SERVICING – 6 monthly servicing in accordance with LOLER regulations were found to be up to date. The home has three stair lifts – 1 newly installed on 09/09/07 and due to be serviced March ’08. The two existing stair lifts are due to be serviced this month and it was agreed that confirmation would be forwarded to the Commission. The home has two bath hoists and one mobile hoist which are due to be serviced June 2008. HOT WATER/SURFACES – To reduce the risk of injury to service users, radiators are fitted with a guard and bath hot water outlets are fitted with thermostatic controls. The home checks hot water outlets each month to ensure that temperatures do not exceed recommended Health & Safety Executive safe upper limits. The home maintains appropriate records relating to accidents. These are analysed monthly by the registered manager to enable any traits to be identified. Results examined were found to be unremarkable. As required under the Care Homes Regulations 2001, the registered manager has informed the Commission of events/deaths listed under this regulation. To ensure the safety of service users, upstairs windows have restricted openings and free standing wardrobes are secured to the wall. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A 3 x 3 Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered person must ensure that detailed care plans are developed for each assessed need. Clear instructions for staff as to how needs should be met must also be available. Timescale for action 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The registered person should ensure that separate charts are maintained for people who require their fluid intake/output and dietary input to be monitored. Charts should also be maintained for people who require regular turns in bed. The registered person should develop recording systems for each individual which detail their contact with any healthcare professional. This should be maintained in the individuals care plan. It is strongly recommended that the home sources appropriate training for staff in the provision of activities DS0000050730.V360109.R01.S.doc Version 5.2 Page 30 2. OP8 3. OP12 Friarn House Residential Care Home 4. OP12 5. OP27 6. OP29 7. OP18 OP29 for older people with dementia.. The registered person should further develop recording systems relating to activities so that information is recorded for each individual which includes the outcome of each activity. The registered person should undertake a review of the dependency levels of individuals living at the home to ensure that current staffing levels are sufficient to meet their assessed needs including psychological needs. The registered person should ensure that applicants provide a 10 year employment history as appropriate. Full dates of employment should be obtained to enable any gaps in employment to be identified and explored. To reduce the risk of abuse, the registered person should complete risk assessments for any staff commencing employment on a POVAfirst pending a full CRB. This should be signed by the employee. Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Friarn House Residential Care Home DS0000050730.V360109.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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