CARE HOME ADULTS 18-65
Firgrove Hill (29) 29 Firgrove Hill Farnham Surrey GU9 8LN Lead Inspector
Marianne Barham Unannounced Inspection 26th January 2006 12:50 Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 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 Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 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 Adults 18-65. 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. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Firgrove Hill (29) Address 29 Firgrove Hill Farnham Surrey GU9 8LN 01252 721580 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) www.mencap.org.uk Royal Mencap Society Mrs Deborah Alison Skidmore Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Of the 5 residents accommodated 1 resident may fall within the category of LD(E), Learning Disabilities/Older Person The age/age range of the persons to be accommodated will be: 18 64 AND ONE PERSON AGED OVER 65 YEARS The named condition of registration in the CSCI letter dated 11th April 2005. 12th July 2005 Date of last inspection Brief Description of the Service: 29 Firgrove Hill is a detached Victorian house situated in the centre of Farnham, just off a busy road and within easy access of the town centre. The property is owned by New Era Ltd and managed by Mencap. The home provides accommodation and personal care to five adults with learning disabilities under the age of 65 years. Accommodation is provided in 5 large single occupancy rooms that are on the two upper floors. The home has two bathrooms available. There is a communal lounge, kitchen/diner and a large garden available for use by the service users. Some parking is available at the front of the house. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 12.20pm by Marianne Barham, regulation inspector on behalf of Vera Bulbeck, lead inspector for the service. The inspection was undertaken over a period of three hours and was the second inspection in the Commission for Social Care Inspection year April 2005 to March 2006. The registered manager of the home, Mrs Deborah Skidmore was not on duty however the member of staff in charge, Mr John Russell was able to facilitate this inspection. A tour of the premises was undertaken, records relating to care of service users and management of the home were examined and two staff members and two service users were spoken with. The inspector would like to thank the service users and members of staff on duty for their time and positive approach to this inspection. What the service does well:
The service is run as a family home and this is reflected in the involvement of service users in all aspects of the everyday running of the home. Service users are treated with respect and their rights and responsibilities as individuals are recognised and promoted by the home. Two service users were at home during this inspection and were happy to provide feedback on the care and services provided by the home to the inspector. Both service users are happy living in the home and praised the staff team as being caring and supportive. Both were able to give examples of their involvement in the daily routines of the home. Both service users expressed a desire to eventually move on to a supported living scheme and said that they were being assisted by the staff to learn the skills necessary to achieve this goal. Members of staff spoken with said that they enjoyed working in the home and received a good level of training, supervision and support to carry out their jobs. Service users attend a wide range of meaningful activities, including adult education and employment locally. Good use is made of the facilities in the nearby community and the service users had just returned from a trip into town for lunch at the start of this inspection. All other service users living in the home were out at planned activities. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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.
Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective service users are given enough information to make an informed choice about where they live. EVIDENCE: The home has a comprehensive statement of purpose that gives detailed information on all aspects of the care and services provided. There is also a clearly written service users guide given to each service user living in the home and also to any prospective service users on enquiry. A requirement was made at the last inspection on 12th July 2005 to place a copy of the local fire procedure in the statement of purpose and this has been done. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 The home supports and encourages service users to make decisions about their lives. EVIDENCE: The home is committed to supporting service users to be in control of their lives. Service users meetings are held monthly and any issues raised recorded. All service users have a copy of the complaints procedure that has been explained to them and all are involved as fully as possible in the planning of their care and activities. Two service users spoken with confirmed this and were able to tell the inspector in detail of their involvement in the running of the home and their engagement in meaningful activities. Both service users expressed a wish to move out of residential care into supported living and said that the staff team in the home were supporting them to achieve this. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The home offers service users a healthy, balanced diet that takes into account their individual needs and preferences. EVIDENCE: The home has a four weekly menu that is reviewed at the service users meeting each month and complied by the service users with minimal support from members of staff. There is a pictorial menu on the notice board in the dining room that is changed each day to further assist service users to make choices about what they eat. The kitchen is a good size and well equipped and food is stored appropriately. Records are maintained of fridge, freezer and food cooked temperatures and a cleaning schedule is in place. All members of staff have received food hygiene training and foods are purchased at the local supermarket. Service users spoken with said that the food they had was good and that they were able to make choices about the menus and what they ate. They also said that they take it in turns to cook the evening meal and enjoyed doing this.
Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The home’s policies and practices for dealing with medicines protect the service users. EVIDENCE: The medication in the home is stored appropriately and there are good systems in place for the receipt, return and disposal of medicines. The medication administration (MAR) charts were examined. These were completed accurately with no errors in the recording of medication administered. Medication is supplied by the local pharmacy that also provides training to staff members and medication audits. MENCAP also provide a training workbook on the administration of medication and the home manager assesses each staff members’ competence in this area. There is a policy and procedure for dealing with medicines and a list of staff members able to administer medication. The MAR charts do not have a photograph of the service user attached and there is no guidance in place for the use of an inhaler for one service user. Recommendations have been made to address these issues. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Service users’ concerns and complaints are listened to and acted upon by the home. EVIDENCE: The home has a complaints procedure in place that is made available to all service users and members of staff. Two service users spoken with were able to tell the inspector how they would raise any concerns and also of the procedure to follow. A requirement was made at the last inspection on 12th July 2005 that members of staff have the complaints procedure explained to them. The staff members spoken with had a good understanding of the procedure and were able to explain the process. They confirmed that they had received training in this area from the home manager. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The home is clean, pleasant and hygienic. The cause of the flooding to the front of the home needs to identified and rectified to ensure the safety of the service users, staff team and visitors. EVIDENCE: The home is pleasantly decorated and comfortably furnished. There is a cleaning schedule in place and service users are fully involved in the daily upkeep of the home and are responsible for keeping their own rooms clean and tidy. The home is clean and tidy throughout with no unpleasant odours. One service user spoken with brought to the inspector’s attention the fact that there is a problem with drainage to the front of the property resulting in heavy flooding to the path and drive area in front of the main door of the home. The service user is partially sighted and this poses a significant risk of tripping or slipping. Members of staff spoken with confirmed this was an ongoing problem and that several requests had been made to New Era Ltd for this to be attended to and following the last letter a date for works to commence was in 2007. Owing to the risk posed to the service users and the inconvenience to members of staff and visitors it is felt that this timescale is not acceptable.
Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 14 A requirement has been made that a risk assessment is carried out and interim safety measures be put into place and the works required to rectify the problem be carried out within four months of this inspection. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 From observations throughout this inspection and discussion with members of staff and service users it is apparent that the service users’ needs are being met by, an appropriately trained staff team, however it was not possible to see recorded evidence of this. EVIDENCE: It was not possible to view training records as these were locked away and the manager had the key, however the members of staff on duty told the inspector that there is a comprehensive induction and foundation training package that all staff have to complete and ongoing training thereafter. They also said that they receive regular supervision and appraisal from the manager and all staff members have completed NVQ training to level two or three and training in the administration of medication. Training records will be examined at the next inspection. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): N/A These standards were not assessed at this inspection. Please see report dated 12th July 2005 for detail on these standards. Requirements made at that inspection are detailed below. EVIDENCE: Standard 37 – A requirement was made that the manager must receive training in the management of finances. Standard 42 – A requirement was made that the manager must confirm with the fire officer that training the staff by a fire safety CD-Rom is acceptable. It was not possible to assess whether these requirements were met owing to the records being locked away and the manager having the only key. The inspector has asked that written confirmation be sent to the Commission that these requirements have been met. Standard 42 – A requirement was made that the fire risk assessment must be reviewed and a copy sent to the commission – this has been done. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X X X X X X X Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 18 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 24 Regulation 13 (4) (c) Requirement Timescale for action 02/02/06 2 24 23 (2) (b) The registered person must assess the risk posed to service users, staff members and visitors of the occurrence of heavy flooding to the front of the home when it rains, putting into place measures to minimise identified risks until works are carried out to rectify the cause of the flooding. The registered person must 26/04/06 ensure that any works required to rectify the problem of heavy flooding to the area at the front of the home is carried out without delay in order to ensure the safety and welfare of service users, staff members and any visitors to the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 19 1 20 It is recommended that a profile detailing the circumstances in which a service user’s inhaler should be administered and how often it should be administered is put into place and also that a photograph of each service user is attached to their individual MAR chart to prevent the risk of errors. Firgrove Hill (29) DS0000013479.V274831.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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