Inspection on 26/08/08 for 40 Fir Tree Road

This inspection was carried out on 26th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

40 Fir Tree Road 16/07/07

40 Fir Tree Road 16/10/06

40 Fir Tree Road 01/11/05

40 Fir Tree Road 05/04/05

40 Fir Tree Road 20/09/04

40 Fir Tree Road 24/05/04

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Insight - Eastchurch

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: 40 Fir Tree Road Banstead Surrey SM7 1NG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Burnham     Date: 2 6 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: 40 Fir Tree Road Banstead Surrey SM7 1NG 01737 379242 Telephone number: Fax number: Email address: Provider web address: firtreeroad@c-i-c.co.uk Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Community Integrated Care Ms Karen Hopkins care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 8. The registered person may provide the following category/ies of service only: Care home only- (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). 0 Over 65 0 Date of last inspection Brief description of the care home 40 Fir Tree Road is a care home providing personal care and support for eight adults with learning disabilities of mixed gender. Some of the people using services may be over 65 years of age and/or may have physical disabilities as secondary conditions. The building is a large, detached, two - storey house situated in a residential area, on a busy main road. A parade of local shops is within walking distance of the home. All community amenities are within close proximity in Banstead village and in nearby towns. All bedrooms are single occupancy and arranged on the ground and first floor, Care Homes for Older People Page 4 of 28 accessible by passenger lift. One bedroom has an en suite bathroom. Bathrooms and toilets are located on both floors and have suitable adaptations and aids to meet the specialist needs of the people accommodated. Communal areas are on the ground floor. These include a large combined lounge/dining room, a separate small lounge, a spacious fitted kitchen, separate utility room and an office. Car parking facilities are at the front of the home and to the rear is an attractive, enclosed garden. The building is wheelchair accessible and service provision includes a wheelchair accessible vehicle. Fee charges range from #1192.91 to #1365.60 per week. Care Homes for Older People Page 5 of 28 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: one star adequate 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: The Commission has since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the Service was an unannounced Key Inspection. The Inspector arrived at the Service at 08:00 and was in the Service for 5 hours. It was a thorough look at how well the Service is doing. It took into account information provided by the Services owner or manager and any information that CSCI has received about the Service since the last inspection. We spoke to the manager, 3 staff members, 2 visitors and a Local Authority care manager. The people who live in the home have learning disabilities and limited verbal communication skills, they were unable to answer our questions. Judgements about their experience of life in the home were made through observation during the visit. We observed interaction and care practices and looked at records and documents, including 3 peoples care plans and Care Homes for Older People Page 6 of 28 personal records. There are 5 Required Developments at the end of this Report. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We would like to thank the residents, relatives, manager and staff for their hospitality, assistance and co-operation with this inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 28 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 9 of 28 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 who are thinking about moving into the home are given helpful information about what life is like there to help them decide if the home will be suitable for them. They can be confident their needs will be thoroughly assessed before a place is offered. Evidence: People who are considering moving into the home are given detailed information about what life is like there. The information is contained in the Statement of Purpose and Service User Guide. These documents have both been updated to include information about the new manager, they are presented in a user friendly format with pictures to help people understand them. Copies of the service user guide are placed in each residents personal file. Care Homes for Older People Page 10 of 28 People who are thinking about moving into the home can be confident their needs will be thoroughly assessed to ensure the home will be able to provide appropriate care and support for them. No new people have moved into the home since the last inspection. Admission procedures and other records show the home carries out a thorough assessment of need before anyone moves into the home to ensure their needs can be met. People are encouraged to visit the home wherever possible to meet staff and other residents so they can experience what life is like there before deciding to move in. Care Homes for Older People Page 11 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident their healthcare needs will be met in a way which promotes their privacy and dignity and protects them from harm. People who live in the home are not always supported in a way which promotes their dignity or wellbeing. They are not always adequately supervised. Risks management processes are inadequate and do not protect people from risk of harm. Evidence: People who live in the home can be confident their personal and healthcare needs are understood. Three care plans were examined, the format has been recently updated and includes pictures to help people understand them. Residents are involved in drawing up and reviewing these plans according to their individual abilities. A Local Authority care manager was visiting the home to carry out a formal review of her clients care during our visit. She said she was very happy with the way her client was being cared for. Two relatives were also present in the home to attend the review. Care Homes for Older People Page 12 of 28 They also said they were very happy with their relatives care. Care plans contain detailed information about individual needs, some discussion took place about how to expand information to include more detailed guidance for staff about how to provide care in line with the individual wishes of each person. Care plans and personal records are stored securely,they are accessible for staff whilst protecting peoples privacy. Care records include some risk assessments, these focus on particular risks such as scalding, hot water and kitchen activities. It was of serious concern that no risk assessments had been drawn up about the building repair work being carried out at the time of our visit. Builders were on site and had propped open the gate to the front of the property and main road. They were using scaffolding at the back of the building to repair a leak. One service user was observed wandering in and out of the garden under the scaffolding, there were no staff supervising as they were all busy with other residents. We told the manager of our concerns and she advised the resident not to go outside again. The manager was advised that all risks should be identified and clear individual risk assessments drawn up to indicate action staff need to take to protect people from harm. People can be confident their healthcare needs will be met. Records show people are supported with hospital and doctors appointments. Health professionals visit the home when needed, for example the GPs and district nurses. The home works closely with continence services to ensure people are correctly assessed and supported in this area. People are protected from harm through the safe handling of medication. There is secure storage for medication. Records seen were well maintained and up to date. Staff who administer medication have received training. People can be confident their privacy and dignity will be respected. Personal information is stored securely and is available solely to authorised and appropriate people. A number of people who live in the home home have severe physical disabilities in addition to their learning disability. Staff were very busy caring for peoples physical needs, getting people up, moving them around and giving them breakfast. The quality of the some staff interaction was excellent however poor practice was also seen during our visit with staff standing over people whilst feeding them; moving them around without explaining first what was going to happen;carrying out other tasks without explanation or eye contact. One person was moved without warning whilst he was drinking causing him to spill the drink.These observations were drawn to the attention of the manager. Care Homes for Older People Page 13 of 28 Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and encouraged to choose how they want to spend their time. They have opportunity to take part in a range of activities. However insufficient numbers of staff mean there is little time to engage in social interaction or promote choice of activity for people who live in the home. Evidence: People who live in the home are able to choose how to live their lives to extent allowed by their disabilities and dependency levels. During the visit one person went out with a member of staff. Others were taken to the activities room to listen to music, two visitors also spent time there with their relative. Two people declined this activity and chose to remain in the lounge. There were three staff on duty in addition to the manager. Four out of the seven people who live in the home have severe mobility difficulties, three people are confined to wheelchairs. Staff had very little time to do anything other than attend to basic physical needs, they also had to prepare meals and clean. As people were got up they were brought to the lounge or sat at the Care Homes for Older People Page 15 of 28 table, staff then left them there to get the next person up. One person was left at the table with his back to the TV and the rest of the room for over an hour before breakfast without any attention or interaction. One person who was wandering around was clearly agitated but was left largely unsupervised. Staff have little time to spend chatting to people. People who live in the home benefit from the policy of open visiting times. People are supported to maintain contact with family and friends. People are supported and encouraged to maintain their independence and to exercise choice and control over their lives as far as they are able within the limitations of staffing levels. They are encouraged to personalise their bedrooms. Meals are provided in the lounge/dining room, spade in the dining area. Space is limited given the very large electric chairs three people use. There are not enough chairs for staff to be able to sit and feed people in a relaxed and dignified way. Breakfast was chaotic with staff rushing in and out of the kitchen, trying to feed people who need help, prepare food and drinks, serve, supervise and administer medication, all at the same time. There was no time to present choice of food to people in accordance with their abilities. Care Homes for Older People Page 16 of 28 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 who live in the home are listened to and protected from abuse. Evidence: The majority of people who live in the home are unable to communicate verbally however staff know them well and recognise when they are unhappy. Visitors who were spoken to said they would know how to make a complaint if they ever needed to. There is a complaints procedure, a user-friendly version has been provided with pictures to help people understand. Each resident is provided with a copy in their personal file and a copy is displayed in the entrance hall. People who live in the home are protected from abuse. There is an policy for the protection of vulnerable adults and staff have had training on this issue. All staff are checked through the Criminal Records Bureau before they start working in the home. There is also a whistle blowing procedure for staff. Currently there is a safeguarding adults investigation in progress and the manager has suspended a member of staff pending the outcome of the investigation to ensure people who live int he home are protected. Care Homes for Older People Page 17 of 28 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. People who live in the home benefit from the comfortable, clean, attractive and well maintained premises. Evidence: People who live in the home benefit from the accessible layout of the building. The premises are generally well decorated and maintained. A handyman is employed to take care of decorating and general maintenance. All areas are pleasantly furnished and attractive. There is a lounge and dining area and an activities room. There is a large well cared for garden with a large patio and seating areas. Everyone has their own room. All bedrooms are sizable and have hand basins, one bedroom has an ensuite toilet. All areas of the home seen during the visit were clean and fresh, there were no unpleasant odours. Bathrooms and toilets were all well equipped, clean and tidy. There is a passenger lift between floors and the premises are accessible for people in wheelchairs. People can be confident their clothes and linens will be laundered with care. The laundry is well equipped, well organised, clean and tidy. Each resident’s laundry is sorted into individual baskets before return. Care Homes for Older People Page 18 of 28 Care Homes for Older People Page 19 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident staff are on duty at all times who have been trained to understand their physical care needs and provide appropriate support. However there are not enough staff to meet peoples emotional and social needs or supervise them effectively. Evidence: People who live in the home benefit from the support of the committed and well trained staff team. However On the day of our visit there were not enough staff to supervise everyone or be able to spend time chatting or meeting peoples emotional and social needs. The majority of people who live in the home have complex physical needs in addition to their profound learning disabilities. In addition to caring for residents, staff also have to clean, (the cleaner of currently off sick) do laundry, prepare, cook and serve food. There were 3 members of staff on duty, one of whom was agency. The manager was helping get people up, washed and dressed in the morning but later was involved in conducting reviews. One member of staff took a resident out leaving only 2 care staff in the home. This is not enough given that 3 residents need 2 staff to carry out Care Homes for Older People Page 20 of 28 physical care tasks and one of the staff had to prepare lunch. People can be confident staff are well trained. Staff are encouraged and supported to undertake relevant National Vocational Qualifications. Additional training has been provided since the last inspection to help staff understand how to support people with diabetes. People are protected through robust recruitment policies, which include checks through the criminal records bureau for all staff and taking up 2 references prior to appointment. Recruitment files were examined at the last inspection when they were found to be well maintained and up to date. All new staff undergo induction training. Care Homes for Older People Page 21 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident the manager has their best interests at heart however lack of management support from the organisation and the current safeguarding investigation has had a negative impact on outcomes for people who live in the home. Peoples health and safety is promoted through safe working practices. Evidence: People can be confident the manager has their best interests at heart. A new manager has been appointed and registered with the Commission since the last inspection. It is unfortunate that the current safeguarding investigation has put pressure on staffing levels the manager is struggling to cope with having to work on shift and carrying out Care Homes for Older People Page 22 of 28 her management responsibilities. She has not felt adequately supported by the organisation. The complex needs and communication difficulties of people who live in the home make it difficult for them to be involved in decisions about how the home is run. However the manager clearly know people well and understands their needs and aspirations. She has put in place a keyworker system so each resident has a designated member of staff to advocate for them. Positive comments about how the home is run were made by a Local authority care manager and relatives of people who live in the home during our visit. People can be confident their health and safety is promoted. Staff receive appropriate training in safe working practices. The manager conducts regular health and safety audits as part of the homes internal quality assurance system. Regular safety checks are carried out on all equipment and installations. Care Homes for Older People Page 23 of 28 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 24 of 28 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 7 13 The registered person shall ensure risks to the health and welfare of service users are identified and as far as possible eliminated. In that risks associated with maintenance and building work must be assessed and action taken to protect people from risk of harm. 26/09/2008 2 10 12 The registered person shall 26/09/2008 ensure the home is conducted so as to make proper provision for the health and welfare of service users. In that there should be sufficient staff on duty at all times who understand how to care for people in way that upholds their dignity and promotes their well being. 3 12 12 The registered person shall ensure the home is conducted so as to make 26/09/2008 Care Homes for Older People Page 25 of 28 proper provision for the health and welfare of service users. In that there should be sufficient staff on duty to ensure they have time to spend with people in order to meet their social needs and offer choice of activities. 4 15 12 The registered person shall 26/09/2008 ensure the home is conducted so as to make proper provision for the health and welfare of service users. Their should be sufficient staff on duty to ensure mealtimes are unhurried. 5 27 18 The registered person shall 26/09/2008 ensure there are sufficient numbers of suitably qualified and competent staff on duty at all times to meet the needs of service users. In that staffing levels should be reviewed to ensure peoples social and emotional needs are met. 6 31 12 The registered person shall 26/09/2008 ensure the home is conducted so as to make proper provision for the health and welfare of service users. In that the manager should be given sufficient time and management support to be able to manage the home in a way which promotes the Care Homes for Older People Page 26 of 28 wellbeing and protects people who live there. 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 Care Homes for Older People Page 27 of 28 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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