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Inspection on 23/06/05 for Fir Close Residential Home

Also see our care home review for Fir Close Residential Home for more information

This inspection was carried out on 23rd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides long-term care in an appropriate environment for older people. The care staff work well together and are committed to providing quality care. Activities are provided for service users within the home. The homes menu meets dietary needs of the service users. Service users are satisfied with the provisions provided by the care home.

What has improved since the last inspection?

The care plans are now filed in a consistent manner with an index at the front of each individual file. The recruitment policy of the company is now being followed consistently.

What the care home could do better:

The staff duty rota does not identify a member of the staff who assumes responsibility for the home in the absence of the registered manager. An agreement to identify a named member of staff in charge at the last inspection has yet to be met. Staff still see the home has two units rather than a single care home. Staff were giving bed baths to service users at 5.30am without obtaining their permission or giving choice. This is not acceptable care practice.

CARE HOMES FOR OLDER PEOPLE Fir Close Residential Home 2 Westgate Louth Lincs LN11 9YH Lead Inspector Ken Hague Unnannounced 23 June 2005 @05:00 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 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. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fir Close Residential Home Address 2 Westgate Louth Lincs LN11 9YH 01507 603882 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Prime Life Limited Mrs S Capes CRH - Care Home 36 Category(ies) of (DE) Dementia - 22 registration, with number (OP) Old Age - 14 of places Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7 February 2005 Brief Description of the Service: Fir Close Care centre is owned by Prime Life Limited who have 50 care homes throughout the country. The home is made up of two detached buildings, which are named Riverview and Fieldview both set in the same grounds. The home offers residential care for 36 older people over the age of 65, this includes 22 service users suffering with dementia. Fir Close offers both short-term and long-term care, nursing care is not provided. Fir Close Care Home has large extended private gardens and a large car park at the side of the care home. The home itself is set in the centre of Louth and, therefore, can be reached easily by local transport services. The service users staying in the home are provided with a minibus for transport to hospital appointments and for local shopping. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a six-hour period. It included investigating a complaint relating to service users being bathed early in the morning without their consent. The inspection started at 5am and was completed by 1.30pm. The Inspector interviewed four members of staff, inspected care records including the communication book and had a detailed discussion with the registered manager. A tour of the home was made and five service users were involved in discussions. What the service does well: 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. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3&5 Service users are provided with a full assessment before being admitted to the care home, however a risk assessment is not always included in the initial assessment. Service users are given a copy of their terms and conditions for their stay at the home. The home offers an opportunity for perspective service users to visit before making long-term decisions. EVIDENCE: A copy of the terms and conditions for service users was found to be on their individual file. A sample number of files was viewed as part of this inspection and they all contained an initial assessment signed by the assessor and service user or a member of the family. Not all individual care files contained a detailed risk assessment. One service user had bed rails fitted to their bed and no risk assessment was in place for this procedure. A form demonstrating that the service user or family had consented to bed rails being fitted, again was not in the file. Service users interviewed confirmed they had been invited to visit the home prior to making a long-term decision. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Not all individual service users files contained a full care plan and risk assessment identifying the total needs of the service users and stating how these needs would be met by the resources of the home. The poor care practice identified as a result of a complaint received by the Commission for Social Care Inspection demonstrates that the home is failing to treat the service users with respect and to ensure them appropriate privacy. EVIDENCE: There were four individuals service users files viewed as part of this inspection and they all contained details of the choices and wishes of service users in respect to activities, diet and the provision of personal care. All assessment records contained details of medical history, identified health care needs at the time of admission and how these were to be met. There were details of service users choices and wishes in respect of bathing, which included the type of cosmetics they liked to use. The files seen during this inspection did not provide evidence that reviews were being carried out appropriately. There was one individual file with two care plans completed at different times stating how the same identified need was to be met. There was no evidence of care plans being updated and a care plan dated 31st July 2002 was still being used as a current care plan. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 9 Discussions with staff and an interview with the registered manager confirmed that a complaint made to the Commission for Social Care Inspection was substantiated. The registered manager had issued an instruction in the homes communication book on 9th May 2005 stating please ensure that the following are cared for in the morning as follows - bed baths for five (named service users) these can be started at 5am. The registered manager confirmed that the service users named in this communication had not been consulted nor had their family regarding agreement to a bed bath at such an early time. The registered manager agreed that this practice had also taken place at the end of 2004 when there were staffing problems. The reason given for this poor care practice was that it was due to staffing difficulties. It was accepted by the registered manager that given a bed bath at this early hour had not been at the request or for the benefit of the individual service users. This practice was ended at the end of May 2005 on the instruction of another manager employed by Prime Life Ltd who was visiting the home. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Meals are well-managed and reflect service users likes and dislikes. EVIDENCE: All service users spoken to during this inspection expressed their satisfaction with the quality, quantity and menu offered by the care home. The inspection of a sample of individual service user’s files contains the likes and dislikes of the service user in relation to their menu and diet. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16&18 There are procedures in place for the handling of complaints and any allegations of adult abuse. Staff are clear on the actions to take in the event of any problem occurring ensuring that the service users are safe. EVIDENCE: The home has a complaints policy displayed in the reception area which states how service users and their relatives can make a complaint. There have been no complaints made to the care home since the last inspection. A copy of the Lincolnshire County Council’s Vulnerable Abuse Procedures is within the homes procedure manual. Prime Life has its own vulnerable abuse procedure which is known to all staff. The staff formally interviewed stated that they would report to the registered manager or their line manager immediately any concerns relating to a possible abuse situation. They had an understanding of the actions which would be taken by the Police, Social Services and the Commission for Social Care Inspection in the event of the vulnerable abuse inquiry. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) not inspected EVIDENCE: Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29&30 The home is experiencing some recruitment difficulties at present. There are still sufficient staff on duty to meet the needs of service users and there is a good staff training program to enable them to carry out their role effectively. The home is following prime life limited recruitment policy which meets the National Minimum Standards. EVIDENCE: Service users stated staff are very helpful and kind. The service users spoken to during this inspection stated there are always sufficient staff on duty to meet their care needs. The registered manager stated that the home was experiencing difficulties in recruiting staff. This is preventing the appointment of senior carers to be named as individuals in charge in the absence of the register manager. She agreed that staff were working under pressure but was confident that the service users needs were all being met. The home has a written training plan. The details of future training opportunities were found to be displayed in the staff room. This included the title of planned courses and the dates on which these courses will take place. The dates for future staff meetings which are held monthly were also displayed on the staff notice board. The inspection of a new member of staff’s personal file provided evidence that the recruitment policy of the company was being followed. All of the information required to be obtained before staff can be employed at the care home was found to be on this individual staff members file. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,&38 A written directive from the registered manager did result in poor care practice. Fire training and fire drills have not been completed by all care staff which could result in service users being placed at risk in the event of the fire. The staff have not been provided with supervision or appraisals in accordance with the National Minimum Standards. EVIDENCE: The instruction to staff to carry out bed baths at 5am in the morning was found in the homes communication book. The staff formally interviewed stated that they have not received supervision or appraisals as set out in the National Minimum Standards. Some staff stated they had not received fire training or taken part in fire drills. The registered manager confirmed the above information was correct and that not all staff had received supervision, appraisals, fire training and fire drills. Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 2 x x x 2 x 3 Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 16 no Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement The registered person must prepare a written care plan setting out the needs of the service user and this should include a full risk assessment. This care plan should be reviewed in accordance with the National Minimum Standards. The registered person must make arrangements to ensure that the care home is conducted in a manner which respect the privacy and dignity of service users Care staff must be provided with supervision in accordance with the national minimum standards Timescale for action August 05 2. 10&32 12-4 Immediate 3. 4. 36 September 05 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 none Good Practice Recommendations Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 17 Commission for Social Care Inspection Unity House The Point, Weaver Road Whisby Road, Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 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 Fir Close Residential Home C53 C04 S2358 Fir Close V234862 23-6-05 Stage 4.doc Version 1.30 Page 18 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!