Inspection on 31/01/08 for Fir Tree House

This inspection was carried out on 31st January 2008.

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 14/08/07

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 Jane Jewell Unannounced Inspection 31st January 2008 11:00 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.V352785.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.V352785.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 Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Fir Tree House DS0000013321.V352785.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 14th August 2007 Brief Description of the Service: Fir Tree House is a large detached converted domestic property situated on the main 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 with access to the first floor via a passenger lift. Resident’s accommodation consists of twenty-five single and five shared bedrooms. Eight bedrooms have en-suite facilities. 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. The fees for residential care are currently £450 to £700 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport , toiletries are additional costs. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been comprised from an unannounced inspection undertaken over seven and half hours and information gathered about the home prior to the inspection. This includes discussions with relatives and stakeholders involved in resident’s care and eight survey questionnaires. The manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection of the home. Information obtained from an unannounced random inspection of the home undertaken on the 13th September 2007 has also been used in this inspection. The reason for the previous visit was to undertake a specialist pharmacist inspection following concerns regarding the handling of medication in the home, which had been brought to the attention of The Commission for Social Care Inspection. The inspection was facilitated by Mr Maria Varnava (Registered Manager). There were thirty residents living at the home at the home at the time of the inspection. The focus of this inspection was to identify whether all the areas of previous shortfall have now been addressed as well by looking at experiences of life at the home for people living there. This involved observing residents and their interactions with staff and examination of the homes facilities and documentation. Discussion with staff residents and visitors. Signs of residents well-being/ill-being (terminology used for observing behaviour for people with dementia) were observed and are also included in this report. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspectors would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Residents live in a clean and homely environment, which is decorated to a good standard. Resident’s private accommodation is personalised, safe and comfortable. A relative commented: “Keep everyone exceptionally clean and comfortable no smell of incontinence”. A resident commented: “Its nice as there are two lounges one which is quiet one which is noisy” Resident’s are supported to maintain relationships with their families and friends with a relative commenting: “Able to pop in at any time”. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 6 Residents receive regular input from health care professionals to help meet their health care needs. The home is able to meet most needs of residents a sample of their comments about their experiences at the home included: “I’m Happy”; “Its ok here they do there very best to look after us”; “comfortable” and “Very happy”. A relative commented “staff are very kind and caring and my mum is very happy there”. Staff do try and accommodate resident’s personal wishes with regard to going to bed, rising and bathing. A resident commented: “I go to bed when I want all you have to do is ask one of the staff”. Resident’s benefit from a staff team that are enthusiastic, A sample of comments made about staff included: “Nice girls”; “sometimes difficult to get across what you want but usually get the point”. What has improved since the last inspection? What they could do better: All residents or their representatives need to have a terms and conditions of residency with the home so they are aware of their rights, responsibilities and of any additional charges while residing at the home. Staff need to have the competencies and be appropriately supervised to be able to follow residents care plans and follow good practices in the care of Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 7 older people. This is necessary to ensure that resident’s individual needs and preferences are met in a safe way and that promotes choice and individuality. A relative commented: “The matron and her top staff under her certainly have the right skills and experience to look after people properly. They are brilliant. The other staff do not have these skills and experience”. Resident’s lives need to be further enhanced by the increased opportunities for suitable occupation and stimulation. Comments included “don’t do very much just sit here really” and “staff don’t really know what to do to occupy residents”. The provision of meals must improve, as there was little evidence that residents are offered either quality meals or choice. A sample of comments included; “if scream loud enough I dare say they would give you something else”; “cold”; “mostly its ok”; “food could do with improving haven’t had a trained cook for two years”; “nothing is fresh” and “not all of the food is appropriate for people with dentures”. Residents must be protected from potential harm or abuse by ensuring that staff have the knowledge and the correct guidance to follow should they suspect abuse. Not all of the training that staff have received is translated into good care practices. 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.V352785.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.V352785.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): 1 2 3 4 and 5 People who use the service experience adequate 1quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with information to enable them to help make an informed choice about whether to move to the home. The admission procedures ensure residents are assessed prior to an admission being agreed. Staff need to have the competencies to ensure that the range of residents needs can be met at the home. All residents or their representatives need to have a terms and conditions with the home so they are aware of their rights, responsibilities and any additional charges. EVIDENCE: Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 10 There is information available about the home and the services it provides, this includes a statement of purpose and service user guide, which are available at the home, and given to prospective residents, representatives and other interested parties. It was previously required that these documents be updated to include the range of needs that the home intends to accommodate. The manager reported that this information is being hand written onto these documents at the moment until the printed copies have been returned from the provider. Residents who are privately funded had received a contract with the home, stating the terms and conditions at the home. However, residents who are funded by social services do not have a contract directly with the home. This has been required in order to ensure that residents and their representatives are aware of the placement arrangements and to clarify mutual expectations around rights and responsibilities and all additional charges. A relative commented: that “the contract is not transparent over the matter of having to pay an extra seven days upon the death of a resident”. Pre-admission documentation was viewed for recent admissions this showed that the needs assessment completed by social services combined with an assessment undertaken by the home provided sufficient information upon which the manager is able to base their decision that needs could be safety met at the home. There is a wide range of residents needs being accommodated, which includes residents who live independent lives and residents who have dementia, physical needs, visual impairments and mental health needs. The evidence seen indicates that although most needs of residents are being met, further work is needed to staff training/supervision in order to ensure staff are competent to be able to identify and meet residents needs and aspirations. This is discussed further on in this report. Residents spoke in the main positively about their experiences at the home and a sample of their comments include: “I’m Happy”; “Its ok here they do there very best to look after us”; “comfortable” and “Very happy”. A sample of comments made by relatives include; “we are very pleased with the care mum has”; “they look after my mum well she is always clean and tidy and they are always kind to our family and make us welcome when we visit” and “staff are very kind and caring and my mum is very happy there”. The home had received many letters of thanks and complements from relatives and friends of deceased residents. A sample of themes from the most recent ones received spoke of the kindness of staff and of the good level of care undertaken. Residents and their representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Most residents consulted said that it was their families that looked around the home on their behalf. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 11 The first six weeks of occupancy is looked upon as trail occupancy. Where social services are the placement authority it is usual practice that within this period a review be undertaken to determine whether the residents wishes to stay permanently or not. Intermediate care is not offered at the home therefore this standard is not assessed. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 12 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): 7 8 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans recorded the agreed action to meet most assessed needs of residents, however these were not always being followed by staff in their practices which placed residents at risk. Significant improvements have been made to medication systems this now ensures that resident’s medication needs are met. Residents receive input from health care professionals to help meet their health care needs. EVIDENCE: Five plans of care were looked at in detail. These comprised of many documents including risk and needs assessments, basic information, daily notes and a plan of care. Further minor work is needed to care plans to ensure that residents social needs and preferences are also identified. Care plans Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 13 evidenced that they were being reviewed regularly and that changes in needs had been promptly identified. The standard of daily recording was noted to be good with a clear account of actions and events that had occurred. Residents consulted with expressed little or no interest in the development and review of their care plans, but felt that they could ask to see what is recorded about them. Many of the care plans seen had been signed by residents or their representative to indicate that they agreed with its contents. Risk assessments had been completed on most risks residents faced and posed, this included pressure sores and manual handling. However an example was noted whereby the manual handling risk assessment did not accurately reflect the practices at the home and the manager agreed to update this as a matter of priority. Although staff were able to describe most resident’s needs they were not always clear on the agreed actions on how to meet them. This is with particular reference to staff not following agreed continence plans and manual handling risk assessments. This was evident in the practices observed during the inspection and feedback from residents and relatives. This placed residents at risk through incorrect manual handling manoeuvres and did not always promote residents individuality. Records of medical intervention showed that residents receive input from a range of health care professionals including GP’s, chiropodist, speech therapists, district and specialist nurses. All residents and relatives consulted with felt that when they have requested to see a doctor this has been obtained promptly. The Nurse on duty said that they had undertaken further specialist training in tissue viability which they had lead responsibility for. They spoke of the measures undertaken and equipment they have available to them to be able to maintain good standards of skin care and reported that only one resident is currently receiving treatment for a skin breakdown. A random inspection was undertaken in September 2007 by a Commissions pharmacy inspector following concerns raised to the Commission regarding poor medication practices at the home. The random inspection identified many areas of shortfall, which the home was required to address in order to improve residents safety. Examination of the medication practices on this occasion showed that practices have significantly improved with evidence seen that action has been taken, or sufficient positives steps taken to address all of the previous shortfall. During the inspection staff were seen to be respectful and considerate towards residents and visitors. Staff were observed using residents preferred forms of address and a resident commented “The girls are always very polite and knock on my door before they come in”. Several examples of personal care notices displayed in resident’s bedrooms did not promote residents privacy. The Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 14 manager agreed to review this and ensure that staff are provided with this information through the care plans. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 15 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): 12 13 14 and 15 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. Although residents are able to exercise some control other their lives with regard to going to bed and rising, not all care practices promoted choice for residents, which impacted on their health and welfare. Links with families are valued and supported by the home. Residents lives need to be further enhanced thought increased opportunities for suitable occupation and stimulation. The provision of meals is poor with little evidence that residents are offered either quality meals or choice. EVIDENCE: Variable feedback was received on the opportunities for social engagement and occupation. Several residents spoke of going out independently to local shops and social clubs. A sample of comments received included: “don’t do very much just sit here really”; “Its nice as there are two lounges one which is Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 16 quiet one which is noisy”; “staff don’t really know what to do to occupy residents”; some staff do sit and have a chat with residents but this does not happen very often” and “ I would like to see more activities organised”. As previously mentioned care plans must record resident’s social needs and preferences and opportunities for social engagement and activities be developed based on these in order to enrich residents lives. The manager also spoke of bingo and musical entertainers being made available. Visitors commented upon being made to feel welcomed during their stay, this included being offered beverages or meals and staff being friendly and approachable. A relative said: “Able to pop in at any time”. There were a group of visitors on the day of the inspection that visit on a daily basis and are able to met with their relatives in one of the lounges and have formed a close group. Observation of the daily routines and discussion with residents confirm that staff do try and accommodate resident’s personal wishes with regard to going to bed, rising and bathing. A resident commented: “I go to bed when I want all you have to do is ask one of the staff”. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy. For a few people living at the home, being able to exercising their choice was difficult due to their level of dementia. Staff were seen to use their acquired knowledge of a person to help them make choices, however not all staff showed an understanding of how to present relevant choices to people who have dementia. Consistent feedback was received from residents and relatives regarding the sometimes lack of autonomy and choice residents have in the support they receive to manage continence. Individual continence programmes are recorded in care plans but these were not always being followed by staff. Instead examples of inflexible support was feedback to the inspector. Comments received included: “although they have certain toilet times I think residents should be able to go when they want to”; and “I don’t want them to tell me when to open my bowels”. The home has been required to ensure that care practices are conducted so as to enable residents to make decisions in respect of their care. This was feedback to the manager who agreed to ensure that some care staff undergo an intense period of supervision and re-training in order to improve practices. This is discussed further under standard 27 of this report. Considerable feedback was received regard poor standards of meals and can be summarised into three main areas, lack of choice, inappropriate and poor quality meals and meals not being hot enough. A sample of comments included; “if scream loud enough I dare say they would give you something else”; “cold”; “mostly its ok”; “food could do with improving haven’t had a trained cook for two years”; “nothing is fresh”; “I would like to see more choice in meals, if there is a meal not up to standard you can only have a Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 17 sandwich, which they get every evening anyway, the meals are never hot, never a warm pudding every meal time it is either yoghurt or tinned fruit” and “not all of the food is appropriate for people with dentures”. The meal served at inspection confirmed the three main areas of criticism, but was relaxed and staff were observed providing discrete attentiveness to those residents who needed assistance. Residents are weighed monthly and where that has been significant weight loss evidence was seen of prompt intervention to supplement meals. Following a recent consultation the Manager was aware of problems with food and in line with the previous requirement had recently purchased a hot food trolley. The manager agreed to ensure that staff were fully aware of how to use this. The manager reported that the cook is imminently about to commence further training in cooking. It has been required that meals are provided in adequate quantities, suitable, wholesome and nutritious and which are varied and properly prepared. Good practice recommendations have also been made in relation to providing a suitable alternative meals and obtaining professional advice from relevant health care professionals on creating and cooking a balanced menu. It was observed that only three residents sat at a dinning room table to eat the meal served at inspection. Instead residents sat in lounge chairs with lap tables provided. Although it was clear that some residents preferred this it was not always clear that residents who are not able to communicate their choices would choose this as it did not promote good posture when eating or socialisation. It has been recommended that this situation be reviewed to ensure that all residents are provided with a choice of eating at a dining room table and their preferences recorded. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 18 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): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents felt that their concerns were listened to and acted upon, however not all relatives felt that their concerns were addressed satisfactorily. Residents must be protected from potential harm or abuse by ensuring that staff have the knowledge and the correct guidance to follow should they suspect abuse. EVIDENCE: There is a written accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. The manager reported that there have been no formal complaints made since the previous inspection. All residents and relatives consulted with said that they were aware of how to raise any concerns and felt comfortable to do so. A resident spoke of a minor issue that they had raised with the manager and this had been addressed promptly another resident feedback that the home “Have always heard anything I’ve said”. Not all relatives consulted with felt that when they have raised issues that these are addressed to their satisfaction and a relative commented “I always mention things to the matron because if you mention anything to the owner he passes if off by saying tell the matron”. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 19 It was previously required that the home review and revise their safeguarding adults procedure in line with local authority multi-agency guidelines. Although the manager had sought further guidance on this issue they had not yet obtained a copy of the local authority multi-agency guidelines. The manager agreed to obtain a copy in order to update the procedure further. The manager demonstrated an understanding of her roles and responsibilities under safeguarding adult’s procedures. Not all of the staff consulted with had yet undertaken comprehensive safeguarding adults training as they were still in their induction period. This topic had briefly been discussed in their local induction. Not all staff interviewed could demonstrate how they safeguard adults in their daily work, as they could not understand the questions posed by the inspector. The manager reported that they would arrange for all staff to have completed this in the next three months. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 20 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): 19 20 21 22 24 25 and 26 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment, which is undergoing gradual redecorated to ensure a consistently well-decorated environment throughout. Resident’s private accommodation is personalised, safe and comfortable. EVIDENCE: The home is located on the outskirts of Barnstead village within walking distance of some local shops. In line with previous requirements a plan of routine maintenance has been developed and the home is gradually undergoing redecoration. Since the previous inspection several more bedrooms have been redecorated, some new furnishing provided, new carpets fitted throughout and a large patio area created in the garden. A resident spoke of being involved in choosing the colours for her bedroom when it is redecorated. Where redecoration has occurred this has been undertaken to a good standard Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 21 and creates a pleasant environment in which to live. Much effort is made throughout the home to promote a domestic and homely feel. Much feedback was received regarding the impact on resident’s lives when the lift breaks down, which prevents residents from going out or socialising downstairs. The manager stated that this has been a significant problem in the past due to the lifts frequent breakdown. In order to address this they have recently changed service contracts in order to obtain a better service and standard of repair. The manager reported that since this change the lift has not broken down so often and when it last breakdown, engineers had repaired it within two hours. Some minor issues of repair were feedback to the inspector who in term passed them onto the manager who agreed to ensure that the homes maintenance staff address them immediately. Communal space consists of a large combined lounge dinning room and two conservatories one of which is a lounge and another used as a meeting or dining area. There is a rear secure garden with seats for residents to use in warmer weather. Two bedrooms lead out onto their own small patio. Many residents spoke of purchasing their own electronic reclining lounge chairs, which are located in the conservatory lounge. The manager said that this situation has evolved and it is not an expectation that residents purchase their own furniture. There are a few none individualised chairs in this lounge to enable those residents who do not have their own to be able to also use this communal area if they wanted. All residents consulted said that they liked their bedroom and that they provided everything they needed. Bedrooms were observed to have been individualised with resident’s personal effects and residents spoke of being able to bring to the home small items of furniture. Adjustable height beds have been obtained for ease of use by residents and staff. None of the bedrooms have door locks fitted and the manager stated that if necessary one could be installed upon the request of a resident. There are sufficient number of toilets and bathrooms located around the building this includes assisted baths and showers. Eight bedrooms were reported to have their own ensuite facilities with commodes provided in the rest. Suitable sluicing facilities are available to ensure hygiene standards can be maintained. There was a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, hoists, walking aids, and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. A resident who said that they have used this felt that staff usually responded quickly. Feedback was received that there is only one call bell in the conservatory lounge located at the entrance, which means that residents cannot call for assistance quickly in an emergency. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 22 This was feedback to the manager who felt that further call bells in this area was not currently necessary as there is always staff present. Many positive comments were received regarding a good standard of cleanliness and hygiene. Comments included: : “Keep everyone exceptionaly clean and comfortable no smell of incontinence”; “very clean”; “its always kept very clean” and “always very clean and smells clean”. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 23 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): 27 28 29 and 30 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. Residents benefit from a staff team that are enthusiastic, however not all staff are fully competent to work with residents safety and to be able to meet the range of residents needs accommodated at the home. Not all of the training that staff have received is translated into good care practices. EVIDENCE: At inspection there were four care assistance and one nurse on duty plus three ancillary staff. Although this should be sufficient to meet the assessed needs of residents, concern was noted regarding the overall competences of the majority of the staff on duty. This is in reference to their lack of experience, training and understanding of English. As previously noted this has lead to some poor care practices, agreed care plans not being followed, lack of choices for residents and inflexible care routines. Most staff on duty had some rapport with residents, which helped to promote a relaxed atmosphere in the home. Residents were observed showed signs of recognition towards staff and being relaxed and comforted by their presence. However not all staff showed an understanding of the needs of people who Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 24 have dementia. This is with particular reference to staff’s understanding of the ill-being and well-being signs of people who are not able to clearly verbally communicate. Consistent feedback was received that groups of staff often have breaks together leaving few staff on the floor available for care duties. The manager stated that this was not the case but would ensure closer supervision of breaks. A sample of comments made about staff included: “Nice girls”;“sometimes difficult to get across what you want but usually get the point”; “The matron and her top staff under her certainly have the right skills and experience to look after people properly. They are brilliant. The other staff do not have these skills and experience”; “constant changes of staff who tend to work long hours” “staff are very kind and caring and my mum is very happy there” and “staff always cheerful even when residents show mood swings someone always available”. The manager reported that staff who have previously obtained a National Vocational Qualification (NVQ) have subsequently left and that in order to redress this they have arranged for a least ten staff to commence this training in the immediate future. In response to concerns raised regarding the skills and experiences of the staff on duty the manger said that they try to balance the skill mix of staff on each shift. They acknowledged however that this was difficult at the moment with an influx of new staff who do not have previous care experience or relevant qualifications. The personal files of newly appointed staff were inspected and these showed that a recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. Four full time staff have recently been employed via an overseas agency. Concern was however expressed regarding the recruitment of staff with a poor command of English and lack of experience. In line with previous requirements the recording of training has improved and most staff have now received or are in the process of receiving the mandatory training in order to enable them to work safely with residents. New staff were reported to be in the process of completing an induction booklet in line with the recommended care industry minimum standards. No completed induction booklets could be viewed as staff regularly take them away in order to complete. For new staff who are currently undergoing an induction it was clear that although they had received basic training this had not always been translated into good or safe care practices. For example in manual handling techniques. In order to address the concerns regarding some staffs competencies the manager agreed to provide an intensive period of close supervision of Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 25 individuals and additional training. Furthermore it has been required that at all times there are suitable qualified competent and experienced person working at the home. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 26 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): 31 33 35 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefited from a manager who is motivated to continue to improve standards at the home. Staff are not always being appropriately supervised and this must be actioned as a matter of priority to ensure that standards are improved across the home. Generally the health, safety and welfare of residents and staff are being promoted and protected, however further work must be undertaken to ensure safe manual handling techniques are used at all times. EVIDENCE: Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 27 The manager is a qualified nurse and has completed the registered managers award and an NVQ level 4. They have been in post since 2000. It was clear that they remain motivated towards improving standards at the home and most areas of shortfall noted in this inspection they had identified and were taking positive steps to address. A sample of comments made regarding the manager included: “when Maria around it’s a happy atmosphere” and “Matron and staff nurses great help at raising low spirits”. Concern was however expressed regarding some discrepancies in information supplied to the commission in the AQAA against the actual practices at the home. It was established that the provider had completed the AQAA. The manager agreed that in future they must take a more active role in its completion in order to accurately reflect services, facilities and practices in order to avoid prosecution by the Commission for inaccurate or misleading information being supplied. In line with previous requirements the manager reported that feedback questionnaires were sent to residents and relatives and their results analysed and steps taken to address any areas noted for improvement. The manager was unable to locate the results of the surveys but said that menus had been changed and a heated food trolley purchased in response to feedback. Relatives spoke of a recent meeting where they had the opportunity to feedback any areas for future service improvement. The manager spoke of their plans to ensure that regular surveys are sent out in the future. Staff are in the main supervised by the nursing staff working along side them each shift. Nursing staff spoke of receiving formal supervision with the manager and felt well supported by her to be able to undertake their role. As previous mentioned concern was expressed regarding the poor competencies of some newly recruited staff and in order to improve standards of care practices and residents safety the manager stated that they would be providing a period of intense supervision of these staff. Furthermore it has been required that all persons working at the home are appropriately supervised at all times to ensure that residents are safe and their wellbeing is promoted. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. The manager stated that they do not manage the personal finances for any current residents. Written guidance is available for staff on issues related to health and safety. As previously noted however feedback was received regarding poor manual handling techniques, which did not promote residents safety. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 28 Records submitted by the provider prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken or due to be serviced. The manager reported that a fire safety officer has undertaken a fire risk assessment of the home, which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. Since the previous inspection all bedroom doors have been fitted with automatic door closures, which will automatically close in the even of the fire alarm sounding. Fir Tree House DS0000013321.V352785.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 3 2 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 3 X 3 x STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Fir Tree House DS0000013321.V352785.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 OP2 Regulation 5(1)(b) Requirement That all service users or their representatives are provided with a copy of the terms and conditions of residency, in order that they are aware of the charges including all additional charges and their rights and responsibilities whilst residing at the home. That personal risk assessments include accurate and up to date information on the safe manual handling techniques to be used by staff which are reviewed regularly and followed by staff. That service users social needs and preferences are identified and recorded on individual care plans and opportunities for social engagement and meaningful activities are provided based on these identified needs. That care practices are conducted so as to enable service users to make decisions in respect of their care, with particular reference to the support provided to manage continence. DS0000013321.V352785.R01.S.doc Timescale for action 30/04/08 2 OP7 13(4)(c) 30/03/08 3 OP12 16(2)(m) 30/04/08 4 OP14 12(3) 30/03/08 Fir Tree House Version 5.2 Page 31 5 OP15 16(2)(i) 6 OP18 13(6) That meals are provided in adequate quantities, suitable, wholesome, nutritious and which are varied and properly prepared and available at such times as may reasonable be required by service users. 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. (timescales of 31/10/07 not met) That at all times there are suitable qualified competent and experienced person working at the home in sufficient numbers as is necessary to ensure the health and welfare of service users. That all persons working at the home are appropriately supervised at all times to ensure that service users are safe and their wellbeing is promoted. That at all times staff follow the assessed and safe manual handling techniques as recorded in individual care plans in order to ensure service users and staff safety. 30/03/08 30/04/08 7 OP27 18(1)(a) 30/03/08 8 OP36 18(2) 30/03/08 9 OP38 13(4)(c) 30/03/08 Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 32 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. 2. 3 Refer to Standard OP15 OP15 OP15 Good Practice Recommendations That suitable alternative meals are made available for service users. That professional advice is sought from relevant health care professionals on creating and cooking a balanced menu. That Service users preferred options for the location of eating their meals is identified and recorded to ensure that those residents who wish to eat their meals at a dining room table are supported to do so. Fir Tree House DS0000013321.V352785.R01.S.doc Version 5.2 Page 33 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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