Farnworth Care Home

Farnworth Care Home is a care home registered to provide care to 120 people. At the time of the inspection 101 people were receiving care across three floors. The Firwood unit on the second floor provides support for people living with dementia. The Burnden unit on the first floor provides support for people with nursing needs and the Belmont unit on the ground floor provides support for people who need assistance with their care.

People’s experience of using this service and what we found

People were kept safe from the risk of abuse and safeguarding concerns were reported appropriately. Care plans were personalised, identified risks for people and how these should be managed. Medicines were managed safely and we were assured there were effective infection control practices in place. Staffing levels were sufficient to meet people’s needs and regular analysis of staffing ratios was carried out.

Staff felt well supported and received ongoing training. The management team received praise from staff for the support they provided. One staff member said, “They’re really supportive, they really want to help you progress. They are very hands on.” Auditing systems were robust and transparent. The management team worked holistically with professionals from other agencies and bodies, ensuring people received the care and treatment they required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 27 November 2019) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, management of dietary needs, medication administration, staff support systems, reporting of incidents, pressure care support and infection control practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Farnworth Care Home on our website at www.cqc.org.uk.

Farnworth Care Home is a care home providing personal and nursing care to 104 people at the time of the inspection. The service accommodates up to 120 people in one building split over three units.

People’s experience of using this service and what we found

The service had made improvements to the medicine’s issues raised at the last inspection. However, we found other areas of concerns in relation to medicines.

People’s pressure care was managed well, and no-one had developed a pressure ulcer whilst living in service. However, airflow mattress settings were not checked on a daily basis and we have made a recommendation about the provider seeking best practice guidance on pressure care.

People with modified diets had assessments from speech and language therapist (SALT) to specify the type of diet they needed to consume. However, some people on modified diets did not have any documentation to evidence what foods they had consumed. Training was not directly provided to the chef or the kitchen assistants who had the responsibility of modifying people’s foods. We have made a recommendation about the provider seeking best practice guidance on modified diets.

Governance systems had improved however we still noted room for further improvement. We have made a recommendation about the provider reviewing their approach to quality assurance processes.

People told us they felt safe and staff had a good understanding of how to safeguard people from abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Person-centred assessments and care plans had been completed which reflected people’s needs, wishes and preferences and staff knew people well. People told us staff were kind and sensitive. One visiting relative told us, “I feel very satisfied with all the staff who are kind and caring. They always show compassion and are wonderful when moving and handling [name of person]. Staff treat me like family and I feel part of a family here, I couldn’t be happier with the place.”

Staff said they were happy working at the service and spoke positively about the management team. Staff told us they would recommend the service to their own relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 February 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was in continued breach of one of these regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one continuing breach in relation to regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was no proper and safe management of medicines in particular in the Firwood unit.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Farnworth Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. In some services this may also include people who receive funding from both the local authority and the local care commissioning group (CCG).

The home is a purpose-built home and is situated off the main road leading in to Farnworth town centre. There is adequate car parking at the front of the home. Farnworth Care Home is registered to provide accommodation for up to 120 older people who require nursing and personal care. There were 103 people using the service at the time of the inspection. On Belmont unit 34 people were receiving nursing care. On Firwood unit 30 people were also receiving nursing care. Burden unit provided residential care for 39 people.

We last inspected Farnworth care on 21 October 2015 and the service was rated as good.

A new manager was in post and was in the process of registering with the Care Quality Commission (CQC) to become the registered manager. The manager was on annual leave and was unable to facilitate the inspection on the first inspection day. We were assisted by the deputy manager and the Regional Operations Support Manager. The manager was available on the second inspection day.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment and governance. You can see what action we told the provider to take at the back of the full version of this report.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. Staffing levels were sufficient on both days of the inspection. Staff rotas looked at confirmed the number of staff on both days of the inspection to be correct.

The administration of medicines was not consistently safe despite training records showing that staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and fresh. The environment was well maintained. However, we found some safety concerns in some bedrooms. For example, wardrobes were not secured to the wall.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP). A PEEP informs the fire service what room people live in and what assistance they require to evacuate them safely.

People were offered a well-balanced and nutritional diet and encouraged to eat and drink to ensure they were hydrated and well fed.

There were some activities and social interactions however these were limited especially for those people who were confined to their room.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions offer staff the opportunity to discuss their work and ask for any training they felt necessary.

Quality assurance systems were in place. However, some of the checks had failed to identify important issues. For example, shortfalls in the safe handling of medicines and environmental issues.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

There were dining rooms on each floor and people were encouraged to eat there if possible to engage with others in the home. Relative and visitors were welcome at all times and were observed to be made welcome. One relative told us they regularly came and had a meal with their X.

We found staff had a pleasant manner and spoke to people in a way that maintained people's dignity and self-respect.

We found staff had access to policies and guidance to support the safe running of the service.

We found that staff had a good awareness of safeguarding issues and could explain how they would raise any concerns.

We sampled nine care records during our inspection, three from each area of the home, all of which all contained photographs of the person using the service. Records were paper based; they were accurate and well maintained. All entries and care plans were signed by the person receiving the care to demonstrate involvement and agreement.

People told us: "I like it here, the staff are always cheerful, this is not just for your benefit they are always this happy". "The girls and lads are always busy but not too busy to stop and make sure you don't want anything. They smile all the time and are polite to everyone". "I ask and I get you cannot fault it here".

Each floor was independently staffed but staff had rotated between the floors to share good practice. Staff we spoke with had found this to be a positive experience. Staff told us that the staggered meal times that had been trailed was proving to be effective.

People we spoke to told us: "I am happy here the food is good" "I didn't want breakfast today so will have some fruit"

Staff told us: "Some people do not want to eat breakfast so we will offer them something later in the morning". "X usually has something at this time but not today but I will try him again and he will have something later". "We have had some extra training and it has helped us". "We have tried to use the feedback from the last CQC visit as a positive way of making changes to our practice".

All floors were laid out in the same way, this assisted people who moved floors for reason of dependence to have an understanding of the layout and not become disorientated.

Each floor was staffed independently and staff numbers were appropriate to the levels of dependency observed.

Rooms on the second floor had been decorated in line with guidance from the Dementia Awareness Society with familiar items and artifacts to help the person with their memory.

Relatives told us: "My X has been here a while he is well looked after and I think he likes it here". "My X is happy here, we couldn't give her the care she needed, it was a big decision for us but it was the right one". "I came here first then my X came 3 months later we are settled now and well cared for, the girls will do anything for you".

People told us: "It's a good as being at home but you have support if you need it". "Nursing care here is second to none". "They know what I need and always come when I buzz for them, I am very happy here". "If you have to be in a home then here is great".