Inspection on 05/05/05 for Fir Tree House

This inspection was carried out on 5th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fir Tree House 31/01/08

Fir Tree House 14/08/07

Fir Tree House 06/06/06

Fir Tree House 01/09/05

Fir Tree House 16/11/04

Fir Tree House 01/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Fir Tree House 2 Fir Tree Road Banstead Surrey SM7 1NG Lead Inspector Mary Williamson Unannounced 05/05/05 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Salim Jiwa Maria Varnava CRH N 35 Category(ies) of OP - Old Age - 35 registration, with number of places Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Up to 2 beds may be used for Respite and Short Term Care Date of last inspection 16/11/04 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 service users who are old. Accommodation is arranged over two floors and there is a passenger lift in place to provide access to the first floor. Communal space includes two lounges incorporating dining areas in both. There is a conservatory which can also be used as a visiting area. The garden is mainly a patio area. Limited parking is available at the front of the home, and on the roadside. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and the first in the Commission for Social Care Inspection programme year 2005/2006. The inspection was undertaken over a period of five and a half hours. Mary Williamson the lead inspector for the home undertook the inspection with Gloria Mantana Staff Nurse as the representative for the service. The home manager was off duty during the inspection. Twenty service users, nine staff and three relatives were spoken to during the inspection. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. The home was functioning well during the inspection with several service users taking a keen interest in the general election progress on the television. There was a homely atmosphere in the home and all service users were relaxed and well cared for. What the service does well: What has improved since the last inspection? The home has provided covers for radiators in service users bedrooms. The inspector was informed that all staff now receives induction training. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 6 The cook has updated her food hygiene certificate. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,and 5 It was not possible to view the information provided to service users prior to admission. It was not possible to sample a written contract. Pre-admission needs assessments were in place. Service users and their families are able to visit the home prior to admission. EVIDENCE: The statement of purpose and service users guide was not available during the inspection. Therefore it was not possible to establish if the written information required by service users and relatives was adequate to help them make an informed choice about the home. Written contracts were not available for inspection. The home manager was off duty and these documents were unable to be located. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 9 Pre- admission needs assessments were seen and these form the basis of the homes care planning process. The home manager undertakes these assessments either in hospital or in the prospective service users own home. The nurse in charge stated that trial visits are encouraged. These visits can be for a meal or longer if required. There are occasions when prospective service users are unable to visit, and a relative or a designated representative will undertake a visit on their behalf. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and10 All service users have individual care plans in place, which outline their detailed care needs. However these must be signed and include social and emotional needs. Appropriate arrangements are in place to ensure that all care needs are being met. Service users privacy is protected and they are treated with respect. EVIDENCE: All the service users have an individual care plan in place, which contain comprehensive and detailed information regarding physical care needs. These plans are generated from the pre admission needs assessment, input from the service user and their relatives and medical reports available at the time of completion. The care plans need to be developed to also include social and emotional needs of service users. All care plans must be signed by the service user or their designated representative. There was evidence that risk assessments are also carried out, for example pressure sore risks, falls, and moving and handling risks, which are included in the care plans. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 11 The designated representative must sign risk assessments for the use of cot sides. These assessments need to be reviewed regularly as it was noted from the accident records that a service user had recently climbed over his cot sides resulting in an accident. Service users have access to appropriate health care services. A GP from the nearby practice visits the home weekly or more frequently if required. Chiropody treatment is available six weekly. There is also access to a dentist and optician on a regular basis. Physiotherapy can be arranged privately or on referral by the GP. There is currently one service user in the home with a pressure sore. Equipment necessary for the prevention and treatment of pressure sores is available in the home. There is also access to a tissue viability nurse. Staff were observed to interact with service users in a positive and respectful way during the inspection. They were seen to address service users politely and explain their actions when giving care. The staff were observed to knock on bedroom and bathroom doors prior to entry. The home has a policy in place with regard to the privacy and dignity of service users and one staff member stated that this was part of her induction-training programme. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,and 15 There was little evidence to suggest that service users social and recreational interests were being met. Service users are able to maintain contact with their family, and friends. Service users were not supported to make choices about their lives. Service users diet was appetising and appealing. EVIDENCE: On the day of the inspection service users were observed to be sitting in both lounges. Both television sets were switched on but only some of the service users were actually interested in this activity. Some service users were reading the daily newspapers. An activities programme was not available on the day of the inspection. Relatives and friends are encouraged into the home at any reasonable time. Three relatives spoken to during the inspection stated that they are well supported and kept informed by the manager, and are made welcome at any time. The day of the inspection was also polling day for the general and local elections. Four of the service users spoken to stated that they would have Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 13 liked to vote but were not given this opportunity. None of them could recall being approached about a postal vote either. The nurse in charge was unable to support the service users statements. The menus were not available for inspection as these were being updated and reviewed by the chef who was having a day off. The second chef prepared lunch. This consisted of sausages, mixed vegetables, potatoes and onion gravy, follower by pineapple sponge and custard. More than half of the service users were able to give complimentary comments about the choice, quantity, and standard of the food. One relative who visits daily to feed her husband also stated that the food was excellent. Special diets can be catered for. Sensitive support was observed being offered to service users who required help with feeding. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users and their relatives and friends cannot be confident that their complaints will be listened to, taken seriously, and acted upon. EVIDENCE: The complaints procedure was not available during the inspection. There was also no record of complaints made against the home. It was stated by the nurse in charge that this is kept locked when the manager was off duty. On discussion with several service users and relatives they reported that they had no concerns and complaints about the home. There has been one complaint made to The Commission for Social Care Inspection about the standard of care provided in the home since the last inspection. The lead inspector for the home is currently investigating this. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,24,25,and 26 The environmental standards of the home fall short of The National Minimum Environmental Standards. Bathrooms and bedrooms are used inappropriately to store equipment. Specialist equipment is in place to promote independence. The home was clean and there were no malodours. EVIDENCE: There should be a programme of routine maintenance and renewal of fabric and decoration to the premises. Room 8 is a shared room but the service users share a wardrobe and chest of drawers. This must be addressed immediately to supply individual wardrobes and chest of drawers. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 16 Room 3 had 3 wheelchairs being stored inappropriately and room 4 had 4 wheelchairs being stored inappropriately. Alternative storage areas must be found for this purpose. Rooms 14,15, and 20 need the floorboards repaired. The lounge carpet near the conservatory is badly stained and needs to be replaced. The window on the stairway needs the safety catch repaired. The shower next to room 29 needs attention to stop the flooding problem. The home was fitted through with the appropriate aids and adaptations. Grab rails are fitted in hallways and bathrooms and toilets. Call systems are available in service users bedrooms. There is a passenger lift in place, and ramps to access the patio garden. Bedrooms have been personalised to reflect individual personalities. The temperature in one bedroom was not adequate for the service user who was being nursed in bed. An immediate requirement was made. The home was clean and free from offensive odour. The home employs housekeepers for all cleaning duties. The laundry facilities are satisfactory to meet the homes needs. Arrangements are in place for the weekly collection of clinical waste. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The service users personal care needs are met by the number and skill mix of staff employed in the home. It was not possible to assess the recruitment procedures during inspection. Manual handling training was out of date and identified as a risk to staff and service users. EVIDENCE: The duty rota was samples and staff spoken to. There was a good mix of staff skills available on each shift. Service users and relatives supported this by stating that the care provided was of a good standard. The social and emotional needs of service users must be identified and supported by appropriate staff. The manager was off duty and therefore the recruitment and employment records could not be examined. Currently there are two staff undertaking NVQ level 3 and three staff undertaking NVQ level 2 at the local NESCOT College. Other members of staff stated that they had enrolled for this training and waiting for a commencement date. All staff undertake induction training. The manual handling training is out of date and needs to be updated as soon as possible. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health and welfare of the service users are not adequately protected. EVIDENCE: On the day of the inspection the home manager was off duty and there was a staff nurse in charge of the home. During a tour of the premises several health and safety issues were identified. • • • • Hazardous chemicals must be stored securely. The sluice room next to the office had four containers of cleaning chemicals unattended. The portable heater in room 14 must be removed. This is an outstanding requirement from the last inspection. The room temperature in room 11 must comply with The National Minimum Standards. Appropriate storage facilities must be found to prevent potential accidents in bathrooms, the shower room, and rooms 3, and 4, due to excessive equipment cluttering these areas. s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 19 Fir Tree House • • • • • Paper towels must be provided in sluice rooms to promote hand washing and good infection control practice. The window safety- catch on the stairs window must be repaired. All accidents to service users must be recorded in the accident book. There was one service user observed to have bruising to her face. This was recorded in the daily notes but not in the accident book. The fire log -book must be completed on a regular basis. The last entry was noted to be on 13/04/05. Manual Handling Training must be kept up to date. Staff stated that this training was undertaken in 2003. This must be arranged immediately to promote safe practice for service users and staff. Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION 2 2 2 3 x 2 2 3 STAFFING Standard No Score 27 3 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x 1 Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5(1)(a) Requirement Timescale for action 30/06/05 2. 2 3. 4. 7 12 5. 6. 14 and 17 16 7. 19 8. 20 Service users must be provided with a statemant of purpose and service users guide prior to admission to the home. 5(1)(b) All service users must be provided with terms and conditions of occupancy of the home and these must be available for inspection. 15(1) Each service user or their representative must sign their care plan. 16(2)(m) The home must arrange social and recreational activities specific to individual and collective needs of service users. 12(2) The registered person must maintain freedom of choice includung the right to vote. 17(2)Sche A record must be kept in the dule 2 home of all complaints made against the home including details of investigation and any action taken. 23(2)(d) A programme of routine maintenance must be drawn up to include the renewal of fabric and decoration of the premises. 23(2)(b) The Registered person must ensure that all parts of the care home are kept reasonably s13321 Fir Tree House v224355 050505 Un stage 4.doc 30/06/05 30/06/05 30/06/05 30/06/05 30/06/05 30/06/05 30/6/05 Fir Tree House Version 1.30 Page 22 9. 21 23(2)(n) 10. 24 23(2)(j) 11. 12. 13. 25 30 38 23(2)(p) 18(1) 17(1)(2) Schedule 3 (l) decorated wich shall include replacing the lounge carpet. The registered person must ensure that the shower room which floods is recommissioned and alternative storage facilities are found. Individual bedrooms must not be used as storage areas and suitable storage facilities are to be provided. Suitable heating must be provided in bedrooms and should not include portable heaters. All staff must be trained in manual handling to include the night staff. All accidents to service users must be recorded in the accident book. 30/6/05 30/6/05 30/6/05 30/6/05 30/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fir Tree House s13321 Fir Tree House v224355 050505 Un stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!