Inspection on 06/06/06 for Fir Tree House

This inspection was carried out on 6th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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 Mary Williamson Key Unannounced Inspection 6th June 2006 10:00 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.V298777.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.V298777.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.V298777.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 1st September 2005 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 DS0000013321.V298777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was undertaken by Mary Williamson who is the Lead Inspector for the home. The registered Manager Maria Varnava was present for the duration of the inspection. There were thirty-two service users in the home during the inspection and the inspector had the opportunity to meet most of them. Some service users were able to contribute to the inspection in greater detail than others. There was also the opportunity to talk with five relatives who were visiting throughout the day. 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. Service users were sitting in both lounges and some were sitting in their rooms. There were several activities taking place for example a general sing along in the old lounge, some service users were watching television in the new lounge and others were reading books and newspapers. Lunch was s social event in the old lounge with several service users sitting and chatting at the table. The home was well managed and staff were undertaking their duties in a polite and respectful manner. The inspector would like to thank the service users, relatives and staff team for their input to the inspection process. What the service does well: The home provides good quality nursing care to service users by staff in a kind and caring manner. Privacy and dignity was observed to be respected and staff were observed to knock on service users doors prior to entering. The home encourages family links and relatives are encouraged to visit and attend various events for example parties. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 6 The catering arrangements in the home are satisfactory and several service spoke to the inspector regarding the quality and standard of the food offered. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3, and 6. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. Prospective service users have information available to help them make an appropriate choice. Pre admission needs assessments determine the suitability of the placement. EVIDENCE: The home has a statement of purpose and service user guide in place, which is available to all service users and their relatives on admission to the home. One relative stated that she had a copy of this at home. Individual contracts outlining the terms and conditions of occupancy and fees paid are in place. These contracts are signed by the service users, or a designated representative and a copy retained on file. Two contracts were seen. The manager stated that she undertakes pre admission needs assessments on all prospective service users before a place is offered. She also requests a health needs assessment in order to determine if the needs of the prospective service user can be met. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 9 Pre admission needs assessments were seen for GS, BM, and EC. Theses were comprehensive and confirmed that service users and their relatives had contributed to this process. Intermediate care is not provided, but respite care is available. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. Health care needs are well met and the medication administration safeguards service users living EVIDENCE: Care plans were sampled for GS, BM, and EC. These were well written based on the pre admission needs assessment, input from the service users and their family, and information from relevant health care professional’s reports. The manager stated that care plans are reviewed by the staff team regularly and there was evidence to support this in the plans. Arrangements to meet the health care needs of the service users are satisfactory. All service users are registered with a local GP who attends the home every Monday morning. He will also visit when required, and all service users are seen by him routinely every three to four months. Chiropody is available every six weeks either privately or by the NHS. There is access to dental treatment and an optician through home visits. Specialist support is available on referral by the GP for example physiotherapy and tissue viability nurse. Currently there are no service users in the home who have a pressure sore. Pressure relieving equipment available in the home included six ripple beds, and all beds are equipped with a spenco mattress. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 11 The home has a medication administration policy in place. The home should also have a copy of The NMC (Nursing and Midwifery Council) Code of Professional Conduct policy on medication administration in place. The medication is supplied by Rose Hill Pharmacy, which is owned by the provider. The medication recording charts were seen and these are well maintained. A record of medication entering and leaving the home is kept. Currently there are no service users in the home who self medicates. Facilities are available for the storage of controlled drugs when in use. The manager demonstrated that she has a contract with Spectrum Care for the disposal of medication under the new medication legislation. The inspector observed staff to knock on service users bedrooms prior to entering. There are currently five double bedrooms, which are all equipped with curtains or screens for privacy. Locks are provided on bathroom and toilet doors. Service users do not have a key to their bedroom but the manager stated that this facility would be provided on request. The service users who were asked stated that they did not wish to have keys. Staff were observed to be sensitive and respectful when undertaking care as outlined in care plans. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is good. Judgement was made using available evidence including a visit to the service. The activities provided meet individual and collective needs of service users. The nutritional needs of service users are met. EVIDENCE: Daily activities are outlined in individual care plans. Some service users choose to participate in communal activities others choose to spend leisure time alone. Some activities include music in the lounge, games in the lounge, old films, and exercise. Some service users have a daily newspaper delivered. Outings are arranged using the services of Dial-A-Ride to the local shops or Epsom Downs. Spiritual needs are supported and Holy Communion is arranged for service users who request this. Visits from various clergy are encouraged. Relatives and friends are welcome in the home at any reasonable time. Relatives visiting during the inspection confirmed that the home is very accommodating of them, and that the home manager is supportive, and keeps them informed of any changes to treatment and care. Relatives were observed help with feeding during the inspection. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 13 The kitchen was visited and was clean and orderly. The cook was having a day off as she was covering the weekend cook who is currently on sick leave. Arrangements had been put in place for a senior carer to undertake the cooking that day. The menus were seen and the food offered was wholesome and nutritious. Lunch was observed and consisted of liver and bacon, potatoes and vegetables, followed by artic roll. There was an alternative choice for service users who dislike liver. Special diets are catered for to include soft, puree, diabetic, low sodium, and cultural needs are also met. The last visit from Environmental Health Department was in December 2005, which was satisfactory. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 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 the following standard(s): 16, and 18. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. Service users are protected by the complaints and abuse awareness policies and procedures in the home. EVIDENCE: There is a complaints procedure in place, which is included in the service user guide. All service users and their relatives are given a copy of this when they are admitted to the home. There has been one complaint since the last inspection. This was resolved “in house”, by a meeting with the manager and the family. Service users and relatives stated that they felt confident with the complaints process. The home has a policy in place for abuse awareness and all staff have been trained in these procedures. Two members of staff questioned stated that they would feel confident reporting any incident of abuse. The home also has a copy of Surrey’s Multi Agencies Safeguarding Vulnerable Adults Policies and Procedures in place and these procedures were implemented since the last inspection to investigate an allegation of abuse in the home. This has now been resolved with a satisfactory outcome. As a requirement of this investigation the deputy manager has now undertaken training in Surrey’s procedures. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 21, 22, 24, and 26. Quality in this outcome area is adequate. Judgement has been made using available evidence including g a visit to the service. The general decoration in parts of the home does not meet the National Minimum Standards. The home is equipped to meet assessed mobility needs of service user. EVIDENCE: The general standard of decoration varies throughout the home. The new extension provides individual comfortable and a homely style of accommodation for service users to live in. In the original building several shortfalls were noted and the home would benefit from a routine programme of maintenance and redecoration. Room 8 had a broken window, which was unable to be opened. Room 5 had stains on the carpet, which required immediate attention. Room 19 requires the paper border to be replaced. The front entrance and hallway is in need of redecoration. The front stairway and upstairs corridor needs to be re-carpeted. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 16 There is general lack of storage space in the home and a storeroom is currently being constructed to address this issue. There are ample toilets and bathrooms provided throughout the home for service user use. Adaptations have been made to meet the mobility needs of the service users. Ramps are in place to access the courtyard gardens, grab rails have been fitted in convenient places, raised toilet seats and commodes are also in use. There is a call bell system in place and a shaft lift to access the first floor. Hoists are provided for moving and handling. The home was clean and tidy and free from offensive odour apart from one bedroom, which required immediate attention. The laundry facilities are adequate to meet the requirements of the home. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Quality in this outcome group is poor. Judgement has been made using available evidence including a visit to the service. The number of staff on duty was adequate to meet service users needs. The recruitment procedures do not protect the service users in the home. EVIDENCE: On the day of the inspection there were sufficient staff on duty to meet the assessed needs of the service users and included the manager, one qualified nurse, five carers, one cook, one kitchen assistant, one laundry assistant, and two cleaners. Two relatives stated that they felt more staff were required, however on discussion with the manager and in view of the occupancy rate and dependency of the service users, the number of staff on duty was adequate. All the staff undertake induction training, which is an eighteen-hour programme. The staff then work supervised until they are competent and safe. One staff member confirmed this and there were also certificates on file to confirm this. Two staff have NVQ Level 3 and four staff have NVQ Level 2 in care. There is also an ongoing programme of training in place for qualified staff to update their skills and personal development. Several staff were spoken to and they had a good understanding of service users needs as outlined in individual care plans. The registered manager is also qualified to undertake the manual training in the home. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 18 The recruitment procedures in the home are poor. Four employment files were sampled. File one had no references, no confirmation of a PIN number, and no photographic identification. File two had no references, no photographic identification, no contract of employment, and no national security number. File three had no references and a CRB disclosure dated May 2003. File four had no photographic identification and a CRB disclosure dated May 2003. A discussion took place between the inspector and the home manager regarding the importance of good recruitment practise and the safety implications to the service users. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, and 38. Quality in this outcome area is good. Judgement has been made using the information available including a visit to the service. The home is well managed and the health and safety of service users is promoted. EVIDENCE: The home manager is a qualified nurse with an RGN qualification. She has managed the home for several years and has a good understanding of the needs of older people and the service users in her care. A caring and trusting relationship was observed between the service users, relatives and the manager. Staff meetings are held every three months but there are formal handovers every day and any new policies and procedures are cascades through the staff team during these handovers. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 20 The provider invoices relatives or funding authorities direct. Additional charges for chiropody, and private therapists are included in these invoices. Small amounts of money are kept on behalf of service users for hairdressing, and newspapers. There is a manual of health and safety policies and procedures in the home and this is available in the office for staff to read and understand. The procedure for recording accidents and fire safety are satisfactory. COSHH training had been booked for the week following the inspection, which is undertaken by the company, which supplies the cleaning products to the home. Risk assessments are in place for safe working practice. Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 3 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 2 3 X X 3 Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 31/07/06 arrangements for the safe administration of medication and provide a current MNC code of conduct. A programme of routine 31/07/06 maintenance must be drawn up to include the renewal of fabric and decoration of the premises. The registered person must 31/07/06 ensure that all parts of the care home are kept reasonably decorated to include replacing carpets in, both lounge areas, the stairway and hallway. The registered person must 31/07/06 ensure that service users bedrooms are reasonably decorated. The registered person shall 31/07/06 ensure that all parts of the care home is kept free from offensive odours. The registered person shall 31/07/06 establish a system for reviewing quality of care in the home. Requirement 2. OP19 23(2)(d) 3. OP20 23(2)(b) 4 OP24 23(2)(c) 5 OP26 16(4)(a) 6 OP33 24(1)(a) Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fir Tree House DS0000013321.V298777.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Surrey Area Office 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. 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