Inspection on 14/08/07 for Fir Tree House

This inspection was carried out on 14th August 2007.

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 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 06/06/06

Fir Tree House 01/09/05

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 Susan McBriarty Unannounced Inspection 09:00 14 August 2007 th X10015.doc Version 1.40 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 Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 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 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 DS0000013321.V347261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fir Tree House Address 2 Fir Tree Road Banstead Surrey SM7 1NG 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) 01737 350584 Mr Salim Jiwa Maria Varnava To be confirmed Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 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 6th June 2006 Brief Description of the Service: Fir Tree House is a large detached property situated off the A 217. It is close to the community amenities of Banstead Village. The home is registered to provide nursing care for up to thirty-five older people. 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. Fees for 2007 ranged from £450 per week to £700. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the 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 09:30 am and was in the service for six and a half hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The information received included the Annual Quality Assurance Audit required by the commission and six surveys received from people who use the service and their relatives. What the service does well: What has improved since the last inspection? Most of the requirements made following the inspection of the June 2006 had been met including some areas of carpeting. New furniture had also been provided to a number of bedrooms and the manager said the home would be replacing other bedroom furniture shortly. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 6 What they could do better: A number of requirements and recommendations were made during this visit by the commission. These included requirements: To discuss with the commission’s registration team the need for a variation in registration to include people with dementia and mental health needs and update the statement of purpose and service user guide. This will make sure the home does not admit people whose needs they cannot meet. To improve care planning and risk assessment arrangements to make sure residents needs were documented and recorded accurately and ensure they could be met. Significant improvement was needed to make sure the policy and practice of the home when giving medication and medical supported and protected the people who use the service. To review how meals are served. This will make sure meals remain hot, are served in good time and take into account the dignity of the residents. Improvement is needed to ensure policies and procedures about protecting adults (safeguarding) including whistle blowing and restraint are reviewed to make the link to adult protection clear and make sure members of staff know what to do if an allegation is made. A matter raised during the visit was referred for consideration under the local authority safeguarding procedures. Maintenance of the home needed attention to make sure the home is well maintained and comfortable for the people who live there. Work was needed to make sure all the members of staff who worked at the home had the training they needed to meet the needs of the people who use the service. The recruitment practice of the home needed some work to make sure they supported and protected the residents. The quality assurance process used by the home was recommended to be collated and the outcomes made known to residents and their family to confirm the home is run in the best interests of the people who live there. Polices and procedures used by the home needed review and revision on a regular basis to make sure they were up to date and accurate and took into account the training needs of members of staff. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Significant improvement is needed to make sure the home does not admit any one whose needs they cannot meet and ensure pre-admission information including the statement of purpose and service user guide are accurate. This will make sure that any prospective resident and their family can make a decision about whether the home can meet their needs EVIDENCE: The home had a pre-admission assessment document that was completed before any one moved into the home. One of the pre-admission assessments sampled did not have all the information completed. Additional information had been supplied to the home by the local authority. It is recommended that the home complete the pre-admission assessment document in full to make sure they are able to meet the needs of new residents. Six surveys were received Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 10 from people who use the service and relatives. All said they had received enough information about the home before they moved in. A number of resident files were sample. The commission found that the home had admitted a person with confusion/mental health needs. The registration of the home at the time of this visit was for older people only. The manager said she and the provider were aware and had considered making application for a variation in registration. At the time of publication of this report the person was no longer a resident at the home. The AQAA received from the home states under ‘what they could do better’ the statement of purpose and service user guide needs reviewing to ensure they reflect the current service accurately. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. People who use the service experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Improvement is needed to make sure care planning and risk assessments arrangements make clear the needs of the people who use the service and how those needs are to be met in a way they prefer and maintains their dignity. Significant improvement is needed when dealing with medication to make sure the policy and practice of the home supports and protects residents. EVIDENCE: A number of care plans were sampled as part of the visit. Risk assessments, daily records, the completed AQAA, observations made during the visit by the commission and discussion with the manager confirmed that further work was needed to make sure all the records kept by the home were accurate. The care plans seen had all been completed on the day of admission and reviews stated that there had been no changes in assessed needs. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 12 The commission received six surveys. Two (2) said they always receive the care and support they need, two (2) said usually. Four (4) said staff listen and act on what they say, one 1 said staff do not. Three (3) said members of staff were usually available when needed and two (2) said members of staff were always available. Three (3) said they usually receive the medical support they need and two (2) said always receive the medical support they need. One resident’s file looked at by the commission did not make clear that a thickener was in use, this was found as part of the daily records made. The manager said the person had been using the thickener since their admission. The pre-admission information, care plans and risk assessment made no mention of this. The risk assessment identified a choking risk but not why there was a choking risk and the outcome was to inform everybody and record if there was an incident. A record had been made of care plan reviews taking place the record consisted of a date, the number of the care plan a comment as to whether there had been any change and the signature of the person completing. The reviews did not show who else was involved or whether the people who use the service had been included. One person spoken with said the home was alright and members of staff do the best they can but was not the same as being in their own home another said they did not think anyone could be ‘as fussy’ as they were when younger and could do everything for themselves. Some of the people spoken with were not able to make a response and tell the commission their view of the service. The care plans sampled had a record of any visit made by a General Practitioner including the date and any medication prescribed. The daily notes identified visits to the dentist and visits to or from a chiropodist. The people who use the service may attend either a National Health Service chiropodist or receive assistance from a private chiropodist who visits the home. Where the private chiropodist visits a record is kept as the home invoices for the service as part of the fee invoice. One file seen identified in large red writing that an NHS chiropodist was used. The care plans seen did not identify dental or chiropody needs. One survey received by the commission said they felt chiropody charges were high at £25 per visit thought they could be cheaper as all the people living at the home received the same service. A recommendation is made for the provision of chiropody to be reviewed to confirm that all those entitled to National Health Service care receive the appropriate service and to consider if an alternative service for less cost was Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 13 available and inform residents and their families of the outcome in order that a clear choice if available. A requirement is made for the home to review all care plans and risk assessments to make sure the detail needed including health care needs are up to date accurate and clear. Care plans, risk assessments and reviews must include where possible the people who use the service or their relatives and their inclusion or otherwise be recorded. This will make sure members of staff know what to do and why and ensures that residents needs are fully met. The commission looked at how medication was dealt with by the home. A number of medication charts were sampled and issues were raised with the manager about how the home makes sure people are given the medication they are prescribed. All the records were hand written; the manager said the home was due to change to pre-printed records soon. The record seen showed what medication had been received into the home and when and a further record made setting out what each individual should be given and the time of day. There were several gaps over a period of just over two months where no signature had been made to show the medication had been given. The home was advised to make sure that any medication given was signed for by a member of staff to confirm the resident had taken the medication prescribed. One record seen could not confirm that the medication prescribed had been given to the resident. The amount of medication coming in was twice that recorded as needing to be given. On further checking it was found the hand written record was incorrect and members of staff had continued to sign as given against the wrong amount. The manager changed the amount on the record in the presence of the commission, previous records were also looked at and showed that changes had been made to hand written records. An immediate requirement was made for the home to investigate what had happened and whether the resident had received the medication they had been prescribed. See also the complaints and protection section of this report as the commission suggested to the home that this matter be reported to other agencies. On the 15th August 2007 the manager confirmed by telephone that the relevant agencies had been contacted and informed of what had been found. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 14 The medication policy we saw during the inspection did not have a section on receiving medication into the home and how staff should record what has been received. The AQAA received from the home said they had robust policies and procedures in place. The requirement made during the inspection of 6th June 2006 for the home to have a copy of The NMC (Nursing and Midwifery Council) Code of Professional Conduct policy on medication administration in place had been met. A copy had been placed in the home’s policy and procedure manual. The manager confirmed to the commission that one member of staff giving medication had not been on a training course about administering medication and added that the member of staff only does so when supervised. Please also see the staffing section of this report. A number of further requirements and recommendations are made. • A requirement is made for the home to review the hand written medication information to make sure it is correct. • A requirement is made for the home to review the policy and procedure for dealing with medication to make sure it includes all the information needed for members of staff including receipt, storage, recording and handling of medication. • A requirement was made for only trained members of staff to give medication. • A recommendation is made to make sure that changes are not made to hand written records unless they are signed, dated and a reason for the change given. Where an error has been made it is also recommended the error be crossed out and error written and a new record made. • It is recommended that two members of staff sign for the receipt of medication and information on the medication record to reduce the risk of error. A number of documents were seen showing the home had asked people about resuscitation a number had been signed by relatives and made clear about whether resuscitation was wanted or not wanted. A recommendation is made for the home to make sure that relatives can make such decisions and to revise the information kept based on the outcome. Most of the members of staff working at the home had English as a second language and a number of the residents had communication difficulties. The commission made observations during the visit and reported the outcome to Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 15 the manager. Members of staff were observed moving and handling people who use the service appropriately but without explaining to the person what was happening. For example one person was seen to be made comfortable in their wheelchair and moved out of the room by two staff neither of whom spoke to the resident while doing this. This action did not confirm care staff treat people with dignity. The manager confirmed that she did not consider this good practice and discussed some difficulty in communication. Please also see daily life and social activity and the staffing section of this report. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The residents’ expectations where possible regarding their leisure, social, cultural and recreational needs are met and family relationships are supported and encouraged by the home. Further work was needed to make sure meals and mealtimes are provided and supported in a way that respects the dignity of the people who use the service. EVIDENCE: One resident spoken with said the home did provide activities and talked about a man playing the piano and sing a long sessions but could not remember everything. Others spoken with were not able to confirm what activities were provided. During the visit a sing-a-long session was heard and a number of people were heard singing to the music provided. The AQAA stated that some care staff time was dedicated to providing activities and are offered according to the wishes of the residents. The AQAA also said that some residents like to watch television. However one of the sitting areas is in a long room with the television at one end. Those Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 17 sitting at the other end may have difficulty seeing or hearing the television particularly if they have a visual or hearing impairment. The television was on in the same area from 9am and remained on throughout lunchtime. A recommendation is made to review the placing of this television taking into account the needs of the people who use the service and consider alternative options to make sure that all those who wish to see and hear the television can do so. The AQAA stated that three people had a visual impairment and nine had a hearing impairment and two had specialist communication needs. Family members were seen to be visiting during the day and some had lunch at the home, one family member told the commission they were very happy with the service provided and had no concerns. The daily notes sampled recorded when family members made visits to the home and care plans identified next of kin and contact names and addresses. The AQAA also said that the home seeks to meet residents spiritual needs by providing regular services within the home for those who wish to attend. The information provided said that of the thirty one residents thirty were Christian and one of another religion. The commission received six surveys. Three (3) said activities were sometimes arranged, one (1) said it was not applicable and one (1) said activities were arranged but not joined in with. A recommendation is made for the activity services provided to be reviewed to make sure the activities can be used by as many people who wish to do so taking into account the needs of the people living at the home. The manager told the commission that resident meetings are not held as most would not be able to take part. The commission observed what happened during lunch. The home has a small dining area at the end of one of the sitting rooms and two dining tables were available for use. The majority of residents ate in an armchair using a small table placed by each chair. A small group of people used one of the dining tables the other was not used. Other residents ate their meal in the conservatory again in armchairs and using a small table. The meals had been plated, including the pudding and put onto trolleys to take to the two areas where people ate. In the area observed it took five minutes for all the residents to receive their meal. The meals and puddings were cooling while members of staff served lunch and cut up food where help was needed. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 18 The commission saw one person who did not want to eat much of the main meal but was eating pudding, the person was taking their time eating, a member of staff went to the resident and fed the person the remaining food without telling them what they were going to do or why. This was brought to the attention of the manager during the visit and the manager confirmed that it was not considered good practice as residents can take the time they need to eat. A similar observation had been made at breakfast time when a member of staff was seen standing when assisting a resident to eat. Please also see the staffing section of this report. Pureed food was provided where needed and the manager confirmed the cook decided the menu and was aware of the likes and dislikes of the people who use the service. A list was kept in the kitchen to assist; one person was seen to have a different pudding at lunchtime due to their health needs. A requirement is made for the home to review how food is served at meal times to make sure food is provided at a reasonable temperature and in a way that maintains the dignity and respect of the people who use the service. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. People who use the service experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents’ views are listened to and acted upon regarding complaints. Improvement is needed to make sure the policy and practice of the home is able to support and protect people who use the service from abuse. EVIDENCE: The commission saw two complaint policies and procedures during the visit, one in the statement of purpose that needed updating and one in the home’s policy manual also needing some updating. The manager said she was aware an update was needed to show the address of the commission and was going to use sticky notes to cover the previous information and show the new contact number and address. The commission received six surveys. Four (4) always knew who to speak to if unhappy and one 1 sometimes knew. Five (5) knew how to make a complaint, 1 did not (1 added that had never needed to). The AQAA completed by the home said that two complaints had been received in the last twelve months both had been resolved within twenty eight days and none were upheld. The commission had received no complaints. The AQAA Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 20 noted compliments received by the home; these were not seen during the visit due to time. The home had a copy of the 2001 local authority multi-agency guidelines for safeguarding adults (adult protection). The AQAA stated the home had a policy and procedure for safeguarding adults with no review date given. The policy set out abuse as defined by the Department of Health and said the home must maintain best practice regarding challenging behaviour, control and restraint and care staff rights if the abuse allegation is against them in a criminal or disciplinary context. The policy does not support the local multi-agency guidelines. A requirement is made for the home to develop and implement a policy and procedure to protect residents from abuse that supports the local authority safeguarding procedures. As noted in the personal and health care section a matter was raised during the commission’s visit to the home and a safeguarding the local authority is considering the referral. The AQAA informed the commission that in the last twelve months no safeguarding matters had been raised by the home. The commission had received no safeguarding referrals prior to this visit. The manager said most of the members of staff had received training in 2006 about safeguarding awareness and read names from a list available. Please also see the staffing section of this report. The commission looked at three other policies and procedures, these were whistle blowing, restraint and dealing with aggression. The whistle blowing policy set out the expectations of the act and did not provide a procedure for members of staff to follow. A requirement is made to review the policy and to develop and implement a procedure for staff to follow including any link to safeguarding matters. This will ensure that members of staff know what to do and what to expect if they whistle blow. A restraint policy and procedure was in place. In addition the policy and procedure for dealing with aggression stated the home provides restraint. The manager confirmed that no member of staff had received training to carry out restraints. A requirement is made for the home to review the policies and procedures and if they wish to provide any restraint to ensure appropriate documents are in place to record any restraint in detail. Members of staff must also receive accredited training to make sure they are able to safely carry out any restraint. Please also see the staffing section of this report. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Further work is needed to make sure the home is well maintained and provides a comfortable pleasant environment for residents. EVIDENCE: A full tour of the home did not take place as a number of people who use the service stay in the bedrooms due to their ill health and a number were resting. • In one bedroom the carpet had rippled by the bed and wall the manager said the provider was planning to replace a number of carpets. • Another bedroom seen was bare of any personal items or items provided by the provider to assist in personalising the bedroom. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 22 • • The drawer handles of a bedside table in one bedroom were coming away. A vanity unit had the covering coming away on the door. Others seen had been personalised and had family pictures and photographs. All the communal areas were seen. The carpet in the sitting room was stained and had two burn marks caused by an iron. The manager told the commission a contractor had been due the day before this visit to replace that part of the carpet but had cancelled the appointment. The carpet in the hallway of the newer build was stained where wheelchairs had travelled. The manager said not all the cleaning staff were available for duty and the home had not been able to clean the carpets. A requirement to replace carpets in other areas of the home had been made following the inspection of 6th June 2006 and a further requirements to clean, repair or replace the carpets mentioned in this report is made. The commission received six surveys all said the home was always fresh and clean, one added the home was spotless. The requirement for the home to develop a programme of routine maintenance to include the renewal of fabric and decoration of the building made during the inspection of the 6th June had not been met. A maintenance book had been implemented which showed repairs or replacements needed, when they were reported and when completed. The AQAA confirmed the provision of a maintenance book and said this was how the fabric of the building was kept in good order and noted that upkeep ‘is always ongoing’ and wardrobes are being replaced. Access to the laundry room was outside the home. The laundry provided a washing machine with a sluice facility and a dryer. There was a large hole in the floor between the washing machine and dryer and an area of floor had been cut out and replaced leaving edges where dirt could collect. Part of the floor was very flexible when walking into the laundry area. The manager said the boiler was behind the wall and that was why a board was in position on the wall to assist access. A requirement is made for the laundry area to receive attention and repair to ensure the area can be cleaned and kept clean and is safe for members of staff to use. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 23 A further requirement is made for a programme of maintenance to include the renewal of fabric and decoration of the building to be developed and implemented to make sure action was taken by the home to ensure people who use the service live in a well maintained home. The remaining areas of the home seen were clean and hygienic and no unpleasant smells were present. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 24 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. People who use the service experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Improvement is needed to make sure the people who use the service are supported and protected by the home’s recruitment practice and members of staff who are trained to provide the care and support needed. EVIDENCE: The commission saw five members of care or nurse qualified staff on duty during the visit excluding the manager, a member of the domestic staff and the cook and her assistant. A number of staff files were sampled. Those seen had two references, application form, confirmation of a PIN number for qualified nurse staff and photographic identification. The requirement from the inspection of the 6th June 2006 had not been met. The application form needed minor revision to request a full employment history forms seen asked for previous employment with most recent first. One file did not confirm a right to work in the United Kingdom and another did not confirm Home Office agreement for a change of work place. The Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 25 commission noted the start dates of members of staff against the dates Criminal Record Bureau (CRB); the manager confirmed that members of staff began work before a PoVA first check or receipt of a CRB check. The AQAA received said the home had a robust recruitment procedure with PoVa and CRB checks completed and two references requested before members of staff are employed at the home. This was not correct. A requirement is made to make sure the home in future follows The Care Home Regulations 2001. The regulations state no member of staff may begin work before a satisfactory CRB check is received or satisfactory PoVA first check received and supervision provided until a CRB is received. A further requirement is made for the information about members of staff from other countries to be checked to make sure the home has confirmed their right to work. The AQAA received by the commission said all members of staff undergo a planned induction programme and are encouraged to undertake a National Vocational Qualification (NVQ). In ‘what we could do better’ section the home said they could further increase the number of staff with an NVQ and establish a development programme for staff. The files sampled held copies of training completed by members of staff. The induction programme was a tick list of areas to be covered within a short time of starting work at the home. One induction programme lasted two days one of twelve hours and one of six hours. The manager confirmed that a formal induction programme that supported Skills for Care was not in place. Manual handling training did take place and was provided by the manager who had received training to provide the course. As noted in the personal and health care section most members of staff did not have English as a first language and some residents had communication difficulties. In addition issues were raised with the manager about how one resident was fed and another resident moved without members of staff speaking to them identified further training needs. Communication has been included in the requirement to review training to assist in improving practice and maintain the dignity of people who use the service. It was not possible to confirm that all members of staff had received the training necessary including qualifying training to make sure people who use the service were supported and protected by members of staff who had been Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 26 trained. The manager told the commission that the home did not have a list of what training had been completed, when and by whom. Evidence was seen of one member of staff completing awareness training in dementia and none in mental health. One policy and procedure seen about visual and hearing impairments said staff would receive training to make sure they could meet their needs. The manager confirmed that was not the case and such training was not provided. A requirement is made for the home to review the training provided, when and to whom, including the registered manager to identify what training is out of date and what new or refresher training is needed including a formal induction programme, communication, first aid, fire safety, risk assessment, mental health, dementia, qualifying training and any other mandatory training needed and confirm in writing to the commission the outcome including dates training is planned and for which members of staff. This will make sure the members of staff working at the home have the skills and knowledge they need to work to provide care and support to the residents. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 27 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were assessed. People who use the service experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Significant improvement is needed to make sure the health, welfare and safety of people who use the service is promoted and protected by the policy and practice of the home. EVIDENCE: The manager confirmed the information provided by the AQAA that she was nurse qualified and had completed the registered managers award and an NVQ level 4. The manager had been in post since 2000. Quality assurance questionnaires had been sent out during 2006 as part of the requirement made and the manager confirmed that the information had not Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 28 been collated and feedback given to the residents and their relatives. The AQAA did not set out the homes quality assurance procedure but did state they plan to use the AQAA as a quality tool to audit all areas, assess their performance and reflect and learn from their experiences and then to plan. The home planned to share the completed AQAA with the staff team. The requirement to establish a system of quality assurance had not been met. A requirement is made for the home to develop and implement a quality assurance system and ensure the outcomes are made known to residents and their relatives. The manager told the commission the home does not assist any resident with their finances and relatives deal with all money. The commission looked at a number of policies and procedures as part of this visit and found the procedure manual contained old and new policies and others previously mentioned that required revision. The AQAA received confirmed that of forty three policies and procedures provided by the home only eleven had a review date. A requirement is made to ensure that all the home’s policies and procedures are reviewed and the home take any action necessary to make sure the practice of the home meets the policy and procedure set out. The AQAA stated that electrical circuits were tested at the home in January 2007, as were portable electric items. The lift, hoists, fire detection equipment, emergency call equipments and heating system were all tested during 2007. Matters raised in personal and health care, concerns and complaints and staffing indicate the home was not promoting and protecting the health, safety and welfare of the people who use the service. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement All care plans and risk assessments must be reviewed and updated. Where possible residents and or their relatives should participate to make sure they contain all the information needed including health care needs. This will ensure members of staff know how those needs must be met and reduce any risk to the residents that have been assessed. The issues noted in this report to be included. An investigation must take place into the medication error found during the inspection and the outcome made known in writing to the commission. The policy and procedure for dealing with medication must be reviewed and revised and followed by members of staff at all times including the receipt of medication. Only members of staff who have been trained must give Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 31 Timescale for action 31/10/07 2. OP9 13(2) 14/08/07 3. OP9 13(2) 07/09/07 medication. A record of medicine given or refused for any reason must be made on every occasion. The handwritten medication charts must be reviewed to make sure they are all correct and residents are receiving the medication they have been prescribed. This will make sure the people who use the service are supported and protected by the practice of the home. 4. OP15 16(g) To review the provision of meals to make sure they can be served hot in good time and in a way that promotes the dignity of the people who use the service. The safeguarding (adult protection) and whistle blowing policy and procedure of the home must be reviewed and revised to support the local authority multi-agency guidelines. This will make sure members of staff know what to do if an allegation is made and residents can be protected from abuse. The policy and procedure for dealing with aggression and restraint must be reviewed and updated to make sure the home is able to comply with the procedure they have laid down including the provision of accredited training to provide restraint and supporting documents and records. This will make sure residents are supported and protected by the Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 32 28/09/07 5. OP18 13(6) 31/10/07 6. OP18 13(6)(7) (8) 31/10/07 7. OP19 23(2)(d) policy and practice of the home regarding the use of restraint. A programme of routine maintenance must be drawn up to include the renewal of fabric and decoration of the premises. This will make sure people who use the service live in a well maintained home. Timescale from the inspection of the 6th June 2006 not met. The registered person must ensure that all parts of the care home are kept reasonably decorated to include replacing carpets in, both lounge areas and the hallway. This will make sure people who use the service live in a well maintained home. Timescale from the inspection of the 6th June not met. The laundry floor must be repaired and made good to ensure it is clean and safe and be kept clean and safe for members of staff to be able to use safely. The home must ensure that no future member of staff begins working at the home without a satisfactory PoVA first check being completed or the receipt of a satisfactory Criminal Record Bureau (CRB) check. This will make sure residents are supported by a robust recruitment procedure. The application employment form requires minor change to make sure a full employment DS0000013321.V347261.R01.S.doc 28/09/07 8. OP20 23(2)(b) 28/09/07 9. OP26 23(2)(b) 31/10/07 10. OP29 19 (9)(10) (11) 31/08/07 11. OP29 19(1)(b) Schedule 2 28/09/07 Fir Tree House Version 5.2 Page 33 history is gained from all prospective applicants. This will assist the home to provide robust recruitment procedures to support and protect residents. A review of training must take place to make sure all members of staff including the registered manager staff must have received the training necessary including; specialist training to meet the needs of the residents. These include : a formal induction programme, first aid, dementia, mental health, communication, fire safety, risk assessment, sensory impairment, qualifying training and any other mandatory training necessary. An appropriate recording of training must be established to set out what training had been provided, when, to whom and when any refresher training is due and action taken to provide any outstanding training. This will make sure residents are supported and protected by trained members of staff. The registered person shall establish a system for reviewing quality of care in the home. Timescale from the inspection of the 6th June 2006 not met. The policies and procedures of the home must be reviewed and updated as necessary taking into account any legislative changes. This will make sure people who use the service and members of staff are supported and Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 34 12. OP28 OP30 10(1)(3) 18(1)(a) (c)(i)(ii) 28/09/07 13. OP33 24(1)(a) 28/09/07 14. OP38 38 30/11/07 protected by the policy and practice of 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. 1. Refer to Standard OP3 Good Practice Recommendations It is recommended the home complete all of the preadmission assessment information for all prospective residents. This will make sure the home has the information necessary to meet the needs of the new residents. It is recommended that a review of the provision of chiropody take place to make sure residents and or their relatives are advised of the choices available to them including alternative chiropodist if preferred. It is recommended that a review take place of agreements regarding resuscitation take place to make sure the home is able to meet those needs and the agreements are within any existing legislation. It is recommended that two members of staff sign to say the information on the medication records is correct. This will assist in making sure residents receive the medication they have been prescribed. It is recommended the list of signatures of members of staff be updated to make sure it is correct and identifies those members of staff trained to give medication. It is recommended that changes are not made to the medication chart unless signed, dated and the reason why given. Where an error is made it is also recommended that a new record be made to further reduce the risk of an error being made. It is recommended the placement of the television in the sitting room be reviewed taking into account the sensory impairments of residents and the placing of the chairs. This will make sure that those who wish to watch the television will be able to see and hear programmes. It is recommended the home review the provision of activities within the home to make sure that all residents who wish to take part have an activity available they can enjoy and take part in. DS0000013321.V347261.R01.S.doc Version 5.2 Page 35 2. OP8 3. OP8 4. OP9 5. 6. OP9 OP9 7. OP12 8. OP12 Fir Tree House 9. OP29 It is recommended the home make sure documents and records are provided to confirm members of staff right to work and/or right to work at the home from the Home Office. This will make sure residents are supported by robust recruitment practices within the home. Fir Tree House DS0000013321.V347261.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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