Inspection on 01/09/05 for Fir Tree House

This inspection was carried out on 1st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fir Tree House 31/01/08

Fir Tree House 14/08/07

Fir Tree House 06/06/06

Fir Tree House 05/05/05

Fir Tree House 16/11/04

Fir Tree House 01/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fir Tree House 2 Fir Tree Road Banstead Surrey SM7 1NG Lead Inspector Mary Williamson Announced 1 September 2005 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 Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fir Tree House Address Fir Tree House 2 Fir Tree Road, Banstead, Surrey, SM7 1NG 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) 01737 350854 Mr Salim Jiwa Maria Varnava Care home with nursing (N) 35 Category(ies) of Old age, (OP) - 35 registration, with number of places Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1: Up to 2 beds may be used for Respite and Short Term Care Date of last inspection 5TH May 2005 Brief Description of the Service: Fir Tree house is a large detached property situated off the A217. It is close to the community amenities of Banstead village. The home is registered to provide nursing care for up to thirty five service users who are old. Accommodation is arranged over two floors and there is a passenger lift in place to provide access to the first floor. Communal space includes two lounges incorporating dining areas in both. There is a conservatory which can also be used as a visiting area. The garden is mainly a patio area. Limited parking is available at the front of the home, and on the roadside. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and the second in The Commission for Social Care Inspection programme year 2005/2006. Mary Williamson the lead inspector for the service undertook the inspection. Maria Varnava the registered home manager was present throughout the inspection. There were twenty- nine service users in the home on the day of the inspection. Most of them were spoken to some in more detail than others. There were two relatives visiting and the inspector had the opportunity to talk with them also. Twelve service user comment cards, seven relative/visitor comment cards and one GP comment cards were received prior to the inspection. They contained mainly positive feedback with two comments about the choice of food and one comment about staffing levels at weekends. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. Some of the service users were watching television, some were reading newspapers and others were engaged in a hand- ball game/ gentle exercise with staff in the main lounge. The home is well managed with staff interacting with service users and each other in a caring and professional manner. All the service users are well cared for and there was a relaxed and homely atmosphere in the home. What the service does well: The home provides good quality nursing care to service users by staff in a kind and caring manner. Privacy and dignity was observed to be respected and staff were observed to knock on service users doors prior to entering. The home encourages family links and there were various photographs on display around the home of various events organised by the manager which included family and friends for example garden parties, Christmas parties and Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 6 birthday parties. Two relatives spoken to stated that they can visit any time and are kept informed by the manager of any changes which effects the well being of the service users. The catering arrangements are satisfactory. The food offered on the day of the inspection was wholesome, appetising, and well presented. Several service users gave positive feedback on the quality of the meals served. Some comment cards suggested more choice was required. What has improved since the last inspection? What they could do better: The standard of decoration in the home varies greatly between the new building and the original house. The provider must draw up a programme of redecoration to include repainting the stairway, hallway and landing in the original building. Several carpets need to be replaced as identified in the main report. There is limited storage space available for equipment for example hoists and wheelchairs. These are being inappropriately stored in bathrooms and present as a health and safety risk. Suitable storage space must be provided. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 7 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 Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 8 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 Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 9 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) 1, 2, 3, and 5. Prospective service users and their relative have access to the information required to enable them to make an informed decision about living at Fir Tree House. Contracts and assessments demonstrate that the wellbeing of service users is being safeguarded. EVIDENCE: There is a statement of purpose and service user guide in place. All prospective service users and their designated representative have a copy of this prior to admission to the home. Individual contracts of occupancy are in place. The contracts seen outline the room to be occupied, the fees payable, and any additional charges if applicable. One signed copy is given to the service user and a second copy is retained on individual files. The manager stated that she undertakes a full pre admission needs assessment on all prospective service users. A random selection of these Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 10 assessments were seen throughout the day. One relative confirmed this. Prospective service users are invited to visit the home whenever possible, but it is usually the relatives undertake this due to capacity. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 11 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, and 9. Appropriate arrangements are in place to ensure that service users health care needs are being met. These are outlined in well- documented care plans. The homes medication policy is satisfactory; however there must also be a copy of the NMC code of conduct on medication administration available in the home. EVIDENCE: Individual care plans are in place for all service users. The majority of these have been updated and signed since the last inspection. There are however some service users without capacity to sign these and do not have regular contact with family. The manager has included a supporting statement in these plans to support this. These plans also include a plan of individual daily activities. All the service users are registered with a local GP who visits the home on a regular basis. It was encouraging to receive the positive feedback form from the surgery. Chiropody is available six weekly by the NHS or privately. Arrangements are also in place for dental and optician visits. Physiotherapy can be arranged on referral by the GP. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 12 There is currently one service user in the home with a superficial sore on the heel. The manager stated that the home had six ripple beds in place and all beds had a spenco mattress in place to aid skin care. There are also pressurerelieving cushions available. There is a policy in place for the administration of medication. Medication is supplied by Rose Hill Pharmacy, which is owned by the provider. The medication recording charts are well maintained. The controlled medication is stored and recorded correctly. The manager demonstrated that an application has been to Spectrum Care for a contract to dispose of medication under the new medication legislation. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 13 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) 12, 13, and 15. The lifestyle experienced in the home generally meets the expectations of the service users. Community and family links are supported. The catering arrangements are adequate to meet the service users needs. EVIDENCE: Activities are arranged both on an individual and group basis. Individual daily activity programmes have been included in individual care plans since the last inspection. A list of events taking place was displayed on the notice board. During the inspection some service users were sitting in the conservatory lounge watching television, some were reading their daily newspaper. In the main lounge staff were encaged in a game of ball with some service users, and some chose not to participate. Two service users stated that some of the musicians arranged provided good entertainment. Relatives and friends are encouraged into the home at any reasonable time. One relative stated that he was made to feel welcome and felt well supported by the staff team. Spiritual needs are supported and the local clergy visit the home regularly. The menus are planned over a four- week cycle. The cook plans these with input from the manager and service users. Lunch on the day of the inspection was ham salad with boiled new potatoes, followed by chocolate sponge and Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 14 custard. An alternative choice was offered to anyone who disliked or was not able to eat salad. The food offered was wholesome, nutritious and appetising. All service users spoken to were very complimentary about the food in general. Arrangements can be made for relatives to dine with service users. The kitchen was visited and was clean and orderly. All fridge and freezer temperatures are being recorded at least once a day, and records are kept of this. The last EHO visit was 30/04/04 and all any requirements have been actioned. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 15 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, and 18 Service users are protected by the complaints and abuse awareness policies in place. EVIDENCE: There is a complaints procedure in place and all service users and their relatives have access to a copy of this. It is also included in the service users guide. Two relatives and two service users stated that they had no concerns or complaints about the home and felt satisfied that their concerns would be listened to by the manager. The home has an abuse awareness policy in place and the manager stated that all staff receive training in this during induction training. One member of staff confirmed this. The home also has a copy of Surreys Multi Agency’s Protection of Vulnerable Adults procedures in place. The manager has attended training in these procedures. It is recommended that the deputy manager also attend training in these procedures. There are currently two VAP proceedings ongoing relating to separate incidences in the home. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 16 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) 19, 20, 21, 22, 24, and 26. The environmental standards fall short of The National Minimum Environmental Standards. Bathrooms are used inappropriately to store equipment. The standard of cleanliness is good with mal odour being present in one bedroom. EVIDENCE: The general standard of decoration varies greatly throughout the home. The new extension provides individual comfortable and homely accommodation for service users to live in. The lounge carpet in this area needs to be replaced as it is badly stained and cleaning has not been successful. The hallway, stairs and landing in the original building need to be redecorated and a new stair carpet provided. The carpet in the main lounge also badly Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 17 stained and this is a requirement carried over from the inspection in April of this year. The chest of drawers in bedroom 3 needs to be repaired. Room 8 is a shared room and only has one wardrobe, a second wardrobe need to be provided. Room 29 has mal odour and needs to be addressed. Room 16 has a frayed carpet between the en-suite bathroom and bedroom, which is a potential trip hazard and needs urgent attention. Room 10 requires redecorating. The shower room and bathroom on the ground floor and the bathroom on the first floor are being used inappropriately to store several hoists and other equipment. Alternative storage arrangements must be provided. The bath panel in bathroom 34 needs to be replaced as this is damaged by water. The home is fitted throughout with appropriate aids and adaptations. Grab rails are situated in hallways, bathrooms and toilet areas. A nurse call system is available in individual bedrooms. There is a passenger lift to access the first floor, and ramps to access the patio garden areas. The home was clean and tidy and free from offensive with the exception of one bedroom. There were three cleaners on duty on the day of the inspection. The manager stated that there is also a cleaner employed at the weekends. The laundry facilities are satisfactory and the home also employs a laundry assistant. Arrangements are also in place for the weekly collection of clinical waste. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 18 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, and 30. The duty rota indicated the number and skill mix of staff on duty was adequate to meet the assessed needs of the current service users. Service users are protected by the homes recruitment policy. EVIDENCE: There was sufficient staff on duty during the inspection to meet the assessed needs of the current service users. In addition to the care team the home also employs two cooks, three cleaners, one laundry assistant, and a maintenance person. Several service users stated that they were satisfied with the level of care provided and felt well supported by staff. The recruitment procedure was discussed with the manager and three stall employment files were sampled. All the required documentation was in place. Staff spoke of the training they had undertaken. Two carers have completed NVQ level 3, and four carers are undertaking NVQ level 2 at NESCOT College. Two staff have completed medication administration, and all staff undertake induction training. The home manager has successfully completed a course to become a manual handling trainer. All the staff have now received moving and handling training, which was a requirement at the last inspection. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 19 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, 35, and 38. The service users live in a home, which is run and managed by a person fit to be in charge. An open and inclusive atmosphere was observed. EVIDENCE: The home manager is an RGN and has been in post for several years. She has a good understanding of the needs of the elderly and the service users in her care. Two relatives and three service users were very complimentary about the level of support she provides. Staff meetings are held every three months but there are formal handovers every day and any new policies and procedures are cascaded through the staff team during these handovers. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 20 The provider invoices relatives or funding authorities direct. Additional charges for chiropody or private therapists are included in these invoices. Small amounts of money are kept on behalf of service users for hairdressing, and newspapers. There is a manual of health and safety policies and procedures in the home and this is available in the office for staff to read and understand. The procedure for recording accidents and fire safety are satisfactory. Risk assessments are in place for safe working practice. The potential trip hazard from the frayed carpet in room 16 must be repaired immediately. Appropriate storage facilities must be provided to prevent potential accidents in the bathrooms. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 21 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 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 3 x 2 x 2 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 3 x x 3 x x 2 Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 22 yes 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 9 Regulation 13(2) Timescale for action The registered person shall make 31/10/05 arrangements for the safe administration of medication and provide a current MNC code of conduct. A programme of routine 31/10/05 maintenance must be drawn up to include the renewal of fabric and decoration of the premises. The registered person must 1/12/05 ensure that all parts of the care home are kept reasonably decorated to include replacing carpets in both lounge areas and the stairway. The registered persom must 31/10/05 make proper provision for the storage of equipment in the care home and keep the bathrooms free of clutter. The registered person shall 31/10/05 provide adequate furniture in service users bedrooms to include a wardrobe. The registered person shall 31/10/05 ensure that equipment provide in the care home is maintained to include the chest of drawers. he registered person shall ensure 31/10/05 that the care home is kept free from offensive odours. Version 1.40 Page 23 Requirement 2. 19 23(2)(d) 3. 20 23(2)(b) 4. 21 23(2)(l) 5. 24 16(2)(c 6. 24 23(2)(c 7. 26 16(2)(k) Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc 8. 38 13(4)(a) The registered person shall ensure that all parts of the care home to which the service users have access to are kept free from hazards to their safety to include room 16 and the over cluttered bathrooms. 31/10/50 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 18 Good Practice Recommendations It is recommended that the deputy manager attends training in Surrey Multi Agency Protection of Vulnerablle Adults procedures. Fir Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 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 © 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 Tree House H58 - H09 s13321 Fir Tree Hse v240461 010905 Stage 4.doc Version 1.40 Page 25 - 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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