Inspection on 17/10/07 for Fir Trees

This inspection was carried out on 17th October 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fir Trees 29/08/06

Fir Trees 28/11/05

Fir Trees 14/06/05

Fir Trees 12/01/05

Fir Trees 29/06/04

Fir Trees 18/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Fir Trees Gorse Hall Road Dukinfield Tameside SK16 5HN Lead Inspector Steve O`Connor Unannounced Inspection 17 October 2007 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 Trees DS0000005591.V342460.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 Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fir Trees Address Gorse Hall Road Dukinfield Tameside SK16 5HN 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) 0161 338 2977 0161 304 8384 firtrees@tamesidecg.co.uk Meridian Healthcare Ltd Anne Robertson Boyd Dobson Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (45) Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 45 service users to include: *up to 45 service users in the category of DE(E) (Dementia over 65 years of age). *up to 45 service users in the category of PD(E) (Physical disability over 65 years of age). *up to 45 service users in the category of OP (Old age not falling within any other category). 29th August 2006 Date of last inspection Brief Description of the Service: Fir Trees is a large, purpose built care home providing 24-hour care and accommodation. The care home is owned and managed by Meridian Healthcare Ltd. The home has been extended and developed over the years to provide care for up to 45 elderly people, some of whom may have dementia or a physical disability. A day care unit is also located within the building but is not subject to regulation. Single room accommodation is provided over two floors. Fortyone bedrooms also benefit from en-suite facilities. Lounge and dining areas are located on both floors and each dining area has its own domestic kitchen. Five of the bedrooms at the home had been pre-booked to offer a transition service between people leaving hospital and either going back to their own homes or onto a care home. There are aids and adaptations to meet the assessed needs of the service users, in addition to passenger lifts. A landscaped garden is situated in the centre of the building and is fully accessible from the home. Fir Trees is located within a residential area of Dukinfield, close to the market town of Ashton-under-Lyne, with all the associated local facilities. Fees for accommodation and care at the home range from £368 for a single room to £386.70 for a single room with en-suite facilities. Additional charges are also made for hairdressing, private chiropody services, newspapers, personal toiletries and access to some social activities in the community. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the home was last inspected in August 2006. This information included the home completing a self-assessment form (called an Annual Quality Assessment Audit or AQAA) describing how they feel they have supported people in meeting the National Minimum Standards. Additional information included incidents notified to the CSCI and information provided through other people and agencies, including concerns and complaints. People who live at the home were sent questionnaires asking them about their views of the service they received. In total 8 people returned questionnaires. During the inspection site visit time was spent talking with people who live at the home, observing how staff work with people and talking to management and staff on duty. Documents and files relating to people and how the home is run was also seen and a tour of the building was made. The inspection report of August 2006 highlighted areas that the home needed to work on and improve. The home had addressed all the changes. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the home and to decide how much work the CSCI needs to do with the home. What the service does well: People live in a home that benefits from being very well decorated, clean, wellmaintained and has furniture and fixtures of a good quality. The atmosphere and feel of the home was welcoming, friendly, busy but also calm without to many distracting and conflicting noises. The building also offers people a flexibility and choice of where they want to spend their time and who with. This may be in one of the comfortable communal lounges, dining areas or in the privacy of their own rooms. Comments from people living at the home were all positive in terms of the care and support that they received from staff and that they were listened to. The son of one person commented that, ‘since my mother went to live there she has been very happy’. Staff were seen spending time with people, sitting and talking with them which created a very calm and welcoming atmosphere. Another comment from a Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 6 person’s relative stated that, ‘the staff are a caring staff and try to make the residents as comfortable’. Comments made by people and staff were also very positive about the management team. They were described as open, willing to listen and provide support when needed. A comment from a relative stated that,’ the team leader usually acts on problems raised in a professional manner’. People were generally satisfied with the quality and choice of meals and that there were opportunities to participate in social activities within the home. Staff had access to a varied Induction and training programme that provides the knowledge and skills they need to support people’s needs. The organisation that owns the home (Meridian Healthcare Ltd) have an ongoing structured training programme and the manager can also use other training providers to offer training in areas such as dementia. People, their families and other relevant people were able to express their views on the quality of the service in several ways. Each month a manager from Meridian Healthcare Ltd visits the home to speak to people, staff and to look at the quality of the service. These visits are recorded and provided to the CSCI. In addition, each year a survey is carried out where people were asked about the service they receive. This quality assurance system identifies areas that the home is doing well and where they may need to improve. What has improved since the last inspection? What they could do better: People can, at times, show behaviour that is challenging to staff and could cause themselves or others harm. To make sure that staff know to support people safely in those situations any such behaviour must be clearly identified and recorded in the persons care plan and a risk assessment must provide clear guidance on how to prevent and/or cope with that behaviour. The inspection report has made a number of recommendations for the home to consider as ways that could improve the service people receive. Two issues, which were raised in the last inspection report, which had been commented by people completing the CSCI surveys, include the provision of Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 7 more social activities outside the home in the community and the level of staffing during the night. The issue of activities was raised by the daughter of a person who stated that, ‘there are activities in the home but it would be much better if more took place outside.’ Several people also commented on whether the staffing levels during the night were enough. The manager stated clearly that staffing levels were regular reviewed and that extra staff would be used if people’s needs warranted it. Recommendations have been made for the home to look at these issues to make sure that people’s needs were being met. 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 Trees DS0000005591.V342460.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 Trees DS0000005591.V342460.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs were assessed and identified prior to them coming to live at the home. EVIDENCE: A sample of people’s files were looked at and found that they all contained an assessment of need from the relevant purchasing local authority prior to them coming to live at the home. In addition, the manager, or another senior worker, would visit the person, their family and/or any other relevant person to make sure that they have enough information about a person’s needs. It is recommended that any pre-admission information gained through the referral process and assessments by the staff team be clearly recorded. Once it had been decided that a person’s needs could be supported an initial assessment was undertaken by a senior member of staff when the person was Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 10 admitted. This uses information from the care management assessment and further information from the person and/or their family. A member of staff who was going to be the named keyworker was also involved at this stage to make sure that the person and family have a known, named person who they can relate to. The initial assessment documentation was signed by the person where possible. Five of the bedrooms at the home had been pre-booked by the local Primary care Trust to offer a transition service between people leaving hospital and either going back to their own homes or onto a care home. The manager stated that this was not an intermediate care service. However, the Statement of Purpose had not been updated to reflect this new aspect to the service offered by the home. It is recommended that the Statement of Purpose be reviewed and updated to reflect the aims and objectives of the services offered by the home. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs and support have been identified and support was being provided to keep people well. EVIDENCE: A sample of people’s care plans were viewed and found that these were initially completed on a person’s admission to the home and sign (where possible) by the person. In addition, the purchasing local authority would provide a care plan prior to the person’s arrival. The care plans sampled covered a wide range of people’s needs and included basic information around personal information such as daily routines, cultural and spiritual needs, communication, likes and dislikes and activities/interests they enjoy. The information recorded was accurate but basic and contained little actual detail showing how people were support to meet their needs. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 12 The issue of making the care plans more person centred and relevant to people’s actual lives was discussed with the manager. They recognised that she and the staff team held much more information about people but that this was not recorded in any way. It is recommended that the care planning process be more person centred focused on clearly identifying and recording people’s needs and life stories and the actual support provided to meet those needs. The management and staff were very knowledgeable of people’s needs and behaviours and how they work with them when a person feels distressed or anxious that enables them to keep them safe. However, people’s emotional/behavioural needs and support was not always identified through the care planning process. Evidence was seen that care plans were reviewed every month. However, an example was found where a person’s improving health and reduced support had not been reflected in the care plan reviews even though this was recognised by the staff. It is recommended that care plan reviews clearly demonstrate the changes in people’s needs and support. Visits from the district nursing service, chiropodist, physiotherapist, general practitioner and opticians were all noted within the individual care file. People’s health needs were clearly reflected in their assessment and care planning documentation. Examples of nutritional, moving and handling and other risk associated health assessments were also seen. Throughout the site visit staff were seen to work with and speak to people in a very positive and respectful way. Core values of working with vulnerable people were developed during the induction process and staff provided support that maintained people’s dignity. The medication administration system records were sampled and found that they were accurate with deliveries and returns, medication administration records and audits all recorded accurately. The controlled drugs records were also being accurately maintained. Examples were found where people had been administered with a medication ‘as required’ (PRN) and it was almost being used as a regular prescribed medication. It is recommended that people’s use of PRN medication be reviewed and guidance sought from the relevant G.P as to the correct use of such medication. In addition, there was no clear written administration guidance for when PRN should be offered/given to people and it is recommended that the use of drink thickeners be clearly recorded. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were supported to make choices and decisions about their daily life and what they choose to participate in. People enjoy the meals and appear nutritious and offer choice. EVIDENCE: People can take part in a range of in-house activities that are arranged by the home. During October 2007 activities such as exercise programmes, birthday celebrations, entertainment events, hairdressing and nail care sessions had been arranged. A member of the staff team has the role of Activity Organiser and they arrange the programme as well as organising social activities with people. The company that owns the home (Meridian Healthcare Ltd) does not provide any budget for providing in-house social and leisure activities. Money is raised through fund raising events organised by the management and staff team throughout the year. As social and leisure activities play such an important Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 14 part in people’s quality of life it is recommended that Meridian Healthcare Ltd consider providing the home with a dedicated budget to provide such activities. People’s care plans had identified their cultural and religious needs. On a regular basis visits are arranged to a local church for both social and religious events. Churches from different denominations also visit people to provide religious services and communion. Residents and staff meet regularly to talk about what happens at the home and this includes people’s feedback and suggestions regarding social and leisure activities. Several comments were made, in the surveys people completed and returned to the CSCI, that there were not enough outside activities and trips organised. This issue has been raised in the previous inspection report and the recommendation was reiterated. During the site visit a number of visitors were seen coming and going round the home. People could see their visitors in the communal areas or in privacy at any reasonable time. People were supported to make day-to-day choices about their own routines. Residents meetings were arranged to seek people’s views on issues such as activities, menu items and decoration of the home. Where possible people control their own finances or are supported by their families. People are provided with a range of information about the service but also how to contact outside agencies if they have concerns that can not be dealt with through the home’s own complaint policy. It is recommended that the actions agreed at residents meetings be clearly recorded and then progress on achieving those actions be fed back at the next residents meetings to show that people’s view and ideas were being listened to. From a tour of the premises it was seen that people were encouraged to bring in personal items of furniture and other possessions to make their rooms more homely and familiar. People are asked about their meal preferences and nutritional needs on arrival. This information is recorded in care plans. Menus were seen and showed that a range of traditional freshly cooked meals were offered with alternatives choices for each meal time. Residents’ meetings were used to ask people their views on the quality of the meals and to suggest new menu items. Comments from a residents meeting confirmed that people at the meeting felt that the quality of the meals was good and some suggestions were raised about the teatime menu. A three-week menu was examined and discussed with the cook. She clearly demonstrated her understanding of people’s individual dietary needs and Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 15 various likes and dislikes. Food stocks were good, with fresh produce delivered every other day. The kitchen is appropriately equipped, with all appliances reported to be in full working order. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were aware of their right to raise concerns and there are the systems and practices in place to protect people from harm. EVIDENCE: The complaint policy and procedure used was a corporate policy developed by Meridian healthcare Ltd. A copy of the policy was made available to people on admission and copies were available through the home. The surveys returned to the CSCI all stated that people knew how to make a complaint and that, on the whole, staff listened to what they said and wanted. Records were maintained of formal and informal complaints and concerns received by the manager. These outline the concern and the actions taken to resolve the issue. Staff were provided with information and training in how to identify and respond to concerns of adult protection. The local authority Multi-Agency Adult protection Policy had been adopted and this set out clearly the procedures for providers of services to take if there was an incident/allegation of adult protection. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 17 The organisation also have their own policy and procedures. The manager stated that if there was any issue regarding adult protection then they have to contact the company’s own Protection of Vulnerable Adults (POVA) Manager. It appeared that the two policy’s and procedures did not totally correspond with each other and so it is recommended that the company policy and procedures be reviewed to ensure that they follow the local authority procedures. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The environment, layout and atmosphere of the building creates a comfortable, homely and safe place for people to live. EVIDENCE: The recommendation made at the previous inspection report that the outside grounds are free from any health and safety hazards had been actioned and the appropriate work carried out. The home employs a maintenance person who is responsible for any small repairs and heavy cleaning. The building was well maintained and clean and no unpleasant odours were found during a tour of the building. The furniture, fixtures and fittings were of Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 19 a high standard and contributed to the homely and comfortable feel to the building and the atmosphere that this created. The layout of the communal and private rooms allows for flexibility of use and gives people the opportunity of choice in where and with who they want to spend their time. The communal spaces offer a range of activity options for people from watching television, listen to music, seeing visitors or just spending time in private, The bedrooms seen were furnished and decorated to a good standard with some rooms offering the layout of a small separate seating area. People bring their own furniture and personal items to make their space more familiar and comforting and a television was provided in every bedroom. Adequate laundry facilities were provided to meet people’s needs and staff were following clear infection control guidelines in the handling and washing of soiled items. Appropriate hand washing facilities were available around the building. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were supported by a staff team that had the skills and knowledge to meet their needs and maintain their safety and wellbeing. EVIDENCE: The staff team was made up of the manager, a deputy manager, two senior care workers and a care team of around 31 staff covering the day and night shifts. In addition, there are two kitchen staff, five domestic staff and a maintenance worker. Between 8:00am and 8:00pm there are five care workers on duty as well as a senior worker. The manager and deputy work supernumerary hours. Between 8:00pm and 8:00am three staff work on the floor with each taking turns at being the lead care worker for the shift. Prior to the site visit the CSCI had received several comments through the surveys and direct from people’s relatives with worries about the numbers of staff working during the night. This issue had also been raised with the manager at the last inspection report. The manager assured the inspector that the night-time staffing levels were sufficient to meet people’s needs during this time. One issue that may cause people’s comments was that the building is Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 21 very spread out over two floors and so it may not be immediately obvious that staff were on duty. As this issue had been raised for the second time it is recommended that the staffing levels for the night shift be reviewed to make sure that they adequately meet peoples needs. According to information provided by the home 20 of the 31 permanent staff have achieved a NVQ Level 2 or higher. A further nine were currently undertaking the course. This level exceeds the 50 recommended target for staff vocational training. The home had a relaxed peaceful atmosphere. Staff did not rush and interactions with residents were pleasant. Staff spoken to were complimentary about working in the home and said they felt trained and supported to deliver a good service. Staff were also able to show that they had a good knowledge and understanding of people’s needs. Comments made by people and their families were generally very positive about the staff and the support they provided. Staff members have the role of ‘keyworker’ where they have specific responsibilities for supporting people. Staff underwent a thorough recruitment process that involved making sure that they had the correct references and checks so that they could work with vulnerable adults. Staff do start work at the home after a clear POVA First check and they are supervised and monitored until the full Criminal Records Bureau certificate is available. New staff undertook an Induction programme based on the national Skills for Care Induction Modules. In addition, staff had an initial company induction. Staff were then able to access a range of training events provided by the company and external training providers. Samples of staff records were seen that showed staff were participating in a range of training events and that this was an ongoing process. The issue of assessing staff competence was raised with the manager. The new Induction programme had a system where staff had to be judged as competent but there was no process for other training events. It is recommended that an evidential system be developed for assessing the competence of staff in implementing the skills and knowledge that they have learnt through participating in training events. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home supports people to express their views and has the required working practices and policies to protect people’s health and safety. EVIDENCE: Since the last inspection report the management structure of the home had changed. The manager was now supported by a deputy manager with their own key responsibilities and could act up in the managers absence. The two senior care workers also had their own key roles in the monitoring of standards. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 23 Comments made by staff highlighted that the management team were supportive and willing to listen to what staff had to say. The manager themselves holds the Registered Managers Award, was undertaking further management training and was being supported by her own line manager within Meridian Healthcare Ltd. To establish the quality of service provided an established system of quality assurance was used. This included monthly visits by the operations manager of Meridian healthcare Ltd who produces a written report of what they have found and any issues raised regarding the quality of the service. Regular meetings were arranged to allow people to raise any issues or concerns they have and to comment on areas such as activities and meals. In addition, an annual ‘satisfaction survey’ was carried out in May 2007 and involved asking people about the service they received. A report showing the results of the survey was produced and from this the manager developed their own informal action plan to resolve any issues that were raised. It is recommended that a formal plan of action be developed responding to the outcome of the annual quality assurance surveys. Some people look after their own finances or through the support of their family. The majority have an appointee who takes responsibility for the person benefits. Small amounts of people’s personal spending money was kept secure by the management. Records were maintained for all spending and receipts were kept for auditing purposes. It is recommended that the record of monies coming in and spent be more detailed. Staff will at times buy personal items for people if requested or felt they are needed, such as clothing. The policy for managing people’s personal finances was not totally clear on the procedures and recording to take in these circumstances or when people do not have sufficient monies to pay for personal items and activities. It is recommended that the policy and procedures for managing people’s personal monies be reviewed to ensure they fully protect people and are in line with the implications of the Mental Capacity Act. Information provided by the home (the AQAA) stated that all the required service check of gas, electric and other equipment was being carried out on a regular basis. The AQAA also stated that health and safety and infection control procedures were in place and being monitored. Health and safety audits are undertaken on a regular basis including the required fire safety checks. Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Fir Trees DS0000005591.V342460.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1)(a) Requirement To make sure that people are supported when their behaviour could cause them (or others) harm care plans and risk assessments must fully reflect those needs and the support guidance staff require to work with people safely. Timescale for action 30/11/07 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 OP1 Good Practice Recommendations It is recommended that the Statement of Purpose be reviewed and updated to reflect the aims and objectives of the services offered by the home. It is recommended that the care planning process be more person centred focused on clearly identifying and recording people’s needs and life stories and the actual support provided meeting those needs. It is recommended that care plan reviews clearly demonstrate the changes in people’s needs and support. DS0000005591.V342460.R01.S.doc Version 5.2 Page 26 2 OP7 Fir Trees 3 OP9 It is recommended that people’s use of PRN medication be reviewed and guidance sought from the relevant G.P as to the correct use of such medication. It is recommended that the use of drink thickeners be clearly recorded. It is recommended that written guidance be developed for when to offer/give people medication administered as PRN. As social and leisure activities play such an important part in people’s quality of life it is recommended that Meridian Healthcare Ltd consider providing the home with a dedicated budget to provide such activities. The registered person should make arrangements for residents to make trips out of the building. 4 OP12 5 OP14 It is recommended that the actions agreed at residents meetings be clearly recorded and then progress on achieving those actions be fed back at the next residents meetings to show that people’s view and ideas were being listened to. It is recommended that the company Adult protection policy and procedures be reviewed to ensure that they correspond with and follow the local authority procedures. It is recommended that the staffing levels for the night shift be reviewed to make sure that they adequately meet peoples needs. It is recommended that an evidential system be developed for assessing the competence of staff in implementing the skills and knowledge that they have learnt through participating in training events. It is recommended that a formal plan of action be developed responding to the outcome of the annual quality assurance surveys. It is recommended that the record of monies coming in and spent be more detailed. It is recommended that the policy and procedures for managing people’s personal monies be reviewed to ensure they fully protect people and are in line with the implications of the Mental Capacity Act. DS0000005591.V342460.R01.S.doc Version 5.2 Page 27 6 OP18 7 OP27 8 OP30 9 OP33 10 OP35 Fir Trees Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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