Inspection on 24/04/06 for Firbank House Nursing Home

This inspection was carried out on 24th April 2006.

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

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

Other inspections for this house

Firbank House Nursing Home 12/11/09

Firbank House Nursing Home 30/08/07

Firbank House Nursing Home 06/12/06

Firbank House Nursing Home 26/01/06

Firbank House Nursing Home 21/06/05

Firbank House Nursing Home 19/01/05

Firbank House Nursing Home 28/07/04

Firbank House Nursing Home 26/02/04

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 Firbank House Nursing Home 24 Smallshaw Lane Ashton-under-Lyne Tameside OL6 8PN Lead Inspector Mrs Fiona Bryan Unannounced Inspection 24th April 2006 07.30 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 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 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. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Firbank House Nursing Home Address 24 Smallshaw Lane Ashton-under-Lyne Tameside OL6 8PN 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 343 1251 0161 343 1007 Partnership Caring Limited Care Home 42 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (42), Physical disability (22), Physical disability over 65 years of age (22) Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No service user under 55 years of age can be admitted to the establishment. Two first level Registered Nurses to be on duty between 8 am - 5 pm. One first level Nurse to be on duty between 5 pm - 8 am. Managers hours to be supernumerary to 2 & 3 above. No more than 30 places can be used for nursing care. Date of last inspection 26th January 2006 Brief Description of the Service: Firbank House is situated near to Ashton-under-Lyne town centre. The home consists of two buildings, referred to as the main building and the annex, and is able to accommodate up to 42 service users and provides both personal and nursing care. The home is owned by Partnership Caring Limited, which is a private company, and is under the day-to-day control of a manager who is also a registered nurse. Twenty-one service users are accommodated in each building with rooms being spread over two floors. There are a total of 36 single rooms and three double rooms, of which the majority have en-suite facilities. Seven communal rooms offer a variety of settings in which service users are able to receive visitors, socialise and participate in activities. The home is close to local shops and bus routes. There is ample parking for those who choose to travel to the home by car. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection began on 24th April 2006 and took place over two days. Time was spent talking to residents, relatives and staff and observing the home’s routine and staff interaction with residents. Four residents were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and residents’ records were examined, including records of care, medication records, employment and training records, and staff duty rotas. Prior to the inspection, comments cards were sent to GP’s and other professionals who visit the home on a regular basis. At the time of writing this report five responses had been received, which provided mainly positive views of the home. The manager currently in post has not applied for registration with the CSCI as she anticipates that she will be resigning from the position in the near future. The registered provider has been requested to keep the CSCI informed about progress in relation to the recruitment of a replacement manager. What the service does well: Residents were complimentary about the staff, saying that they were friendly and helpful. One resident said they were “smashing” and several felt that the home was a “good” home with a pleasant and relaxed atmosphere. Positive comments were also received about the manager – one resident said, “she is very good, if they (staff) are short she pitches in”. During the inspection staff were observed to interact well with residents and appeared to have developed positive relationships with them. Routines within the home seemed fairly flexible and residents felt they had some degree of choice in how and where to spend their day. Visitors are made welcome and are able to visit at any reasonable time. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 6 Although more thought is needed as to how the formal complaints procedure can be made more widely known to residents and relatives, everyone asked said they felt confident any concerns would be dealt with properly. Procedures for dealing with residents’ money were satisfactory. What has improved since the last inspection? What they could do better: Although the home has a Statement of Purpose and Service User Guide to provide current and prospective residents with information about the services provided, these were not widely accessible and most residents and relatives were unaware that written information was available. Some of the details contained in these documents was inaccurate and needs to be updated. Residents must also be given detailed terms and conditions, stating how much they must pay and what services are included in the fees. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 7 Shortfalls in the assessment and planning of care lead to a risk that residents will not receive the proper care they need. Also there was some doubt as to whether care was always being delivered in the way in which it had been planned and residents’ health care needs were not always monitored accurately. There was little evidence that the home really considered residents with more diverse needs, for example, because of their cultural, religious or ethnic background or due to their specific disabilities, therefore particular needs for some residents may not be identified or met. Medication storage and administration procedures must be improved as some practices put residents at risk. Although the majority of residents were quite positive about the food provided by the home, improvements must be made to the standard of food provided for residents requiring soft and pureed diets and a proper menu must be developed to ensure that some choice is available to them. The home does not have a maintenance programme in place and minimal improvements were noted to the environment since the last inspection. Much of the furniture in both communal rooms and bedrooms was old and worn, scratched and stained. Areas of the home were untidy or needed cleaning. Although staffing levels in care and nursing sectors had improved, the numbers of cleaning and laundry hours fell a little short of recommended guidelines and this was reflected in the presentation of the home. No progress had been made in enrolling staff for NVQ training, so the home does not meet the current target for providing trained care staff. The home has no quality monitoring systems in place and there are no formal means for consultation with residents in order to gain feedback from them about how the home is meeting their needs. Without such information the home cannot form a plan to develop and improve the service. Shortfalls in some health and safety practices have the potential to put residents or staff at risk. 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. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 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 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home’s statement of purpose and service user guide are not widely available and residents do not receive sufficient written information regarding the terms and conditions of their stay; therefore residents may not always be clear about the services the home provides to meet their needs. Residents’ needs are not fully assessed before they come into the home. Residents’ diverse needs are not fully considered. Further staff training is required in topics specific to the needs of the residents staff are caring for. Therefore, residents are at risk that their needs may not be met. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 10 EVIDENCE: The statement of purpose and service user guide had been amended in January 2006. Only one copy was available in the home and the manager stated that it was shown to prospective residents and relatives when they visited or on request. As the information was not displayed in a prominent position in the home, for example, in the reception areas of each building, it was unclear how accessible it was for anyone wishing to read it. In the reception area of the annexe the inspection report that was displayed was two years out of date. Examination of the service user guide indicated that some of the information was inaccurate, for example, it referred to an annual quality assurance programme and resident/relative meetings but none have taken place in recent months. There was also information stating that residents would be involved in their care planning but there was no evidence to support that this happened in practice. Residents could not recall having seen the service user guide, although one said their husband had received a “brochure”. Residents could also not recall having been asked by staff about their care needs, although several stated that staff had been very helpful when they first arrived and they had been helped to “settle in”. One visitor stated that they had received a brochure prior to their relative being admitted to the home and they felt the majority of information it provided had been accurate. Residents do not receive a contract or statement of terms and conditions on entering the home. Residents funded by the Local Authority receive a copy of the individual service agreement between the Local Authority and the home but this does not provide any information about how much of the fee they have to pay or what is included in the fee and what additional services or goods they have to pay extra for. Residents who are self-funding receive a contract from the home but some of the information was inaccurate or contradictory to the service user guide, for example, the contract stated that Firbank House was a non-smoking home whereas the service user guide said there was a lounge designated for residents who wished to smoke. The contract also said that residents receiving personal care only had to pay for their own incontinence products when they do not. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 11 Four residents were case tracked. Three of the four had no full care management plan, although one of these had an overview assessment from Social Services. Assessments undertaken by the home were not completed properly and therefore did not always identify residents’ care needs accurately. Where care needs had been identified, there was not always a corresponding care plan. Residents with diverse needs, either cultural or as a result of particular disabilities, had not had those needs properly considered. Two of the four residents case tracked had been admitted for respite care and assessment details for both these residents were especially limited. The overview assessment from Social Services for one of these residents provided a small amount of further detail but this had not been transferred on to the home’s own admission documents and was not therefore easily accessible to the carers. One resident had been admitted as an emergency but full assessment details had not been obtained subsequently, although he had been living at the home for over two weeks. Since the last inspection a number of staff have received some training in the care of people with dementia. The training has been in the form of a video followed by a questionnaire to test their understanding. Staff have not yet received any other training in topics specific to the needs of the residents they care for. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 poor. This judgement has been made using available evidence, including a visit to this service. The care planning system is not consistent and does not therefore always provide staff with the information they need to satisfactorily meet residents’ personal, health care or social needs. Some procedures in respect of the storage and administration of medicines put residents at risk. Personal support is offered in a way that promotes privacy and dignity. EVIDENCE: Four residents were case tracked. Care plans were in place for all residents but they were often vague, for example, “keep clean and tidy at all times”, or did not address all the needs identified during the assessment of the resident. Care plans, in the main, were not person centred and did not recognise the diverse needs of some residents. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 13 Interventions in the care plans were not always carried out as planned, for example, one resident at risk of weight loss was required to have their food intake monitored and recorded but the corresponding food charts had not been completed accurately. In this case, lack of information and detail in the care records meant that a review of the resident that had been scheduled to take place was unsatisfactory, as the regular nurse was off sick and the temporary nurse working in her absence did not know the resident and could not obtain appropriate information from the records. Another resident at risk of weight loss had not been weighed since 4 February 2006. Their care plan stated that they should be weighed monthly. If it is not possible to weigh a resident because of their physical condition, consideration should be given as to other means to monitor their nutritional status, for example, by measuring the mid upper arm circumference and the care plan should be amended to reflect this. Although it appeared that care plans had been reviewed, closer examination found that there had been changes to some residents’ conditions, for example, where their GP had been contacted but care plans had not been updated accordingly. A different format of care plans was used for the two residents admitted for respite care. These care plans were pre-written and provided spaces for staff to complete specific detail about the care of that resident. In both cases the care plans were very basic and had not been fully completed. One resident had fallen four times in three weeks but had not had their falls risk assessment or care plan updated. This resident’s condition had deteriorated quickly over three weeks and they had presented with several new health care issues. Although there was evidence from the daily record that interventions had been put in place to address them and it was apparent that consultation had taken place with the resident’s family and GP, care plans had not been developed to ensure that the care interventions were evaluated effectively. Risk assessments were either not fully completed, inaccurate or had not been reviewed monthly. For example, the Waterlow assessment for one resident did not take into account the resident’s skin type, continence needs, mobility, appetite or heart condition and the score was 13. A subsequent Waterlow assessment undertaken by the FNC co-ordinator scored 24. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 14 The wound care plan for one resident was dated 27 February 2006 and this had not been reviewed since. Although the daily record indicated that the dressings had been renewed, there was no formal evaluation or report of improvement or deterioration of the wounds. It was evident from the daily record that the type of dressing required for one wound had changed but the wound care plan did not reflect this. Examination of a number of residents’ medication administration records indicated that medicines had not been signed for on receipt into the home in the majority of cases. The home utilises resident photographs as a formal system of identification prior to medication administration. On the day of inspection there were a number of resident photographs missing. Duplicate dispensing labels were attached to some MAR charts. The practice of requesting duplicate labels from the supplying pharmacy must not be continued, as labels may be placed over previously printed directions, thus obliterating the record of the medicine. Staff members with responsibility for medication administration were identified by the means of a staff signature sheet, which was located in the medication administration record file. Medication administration at the home was observed. Medicines were taken out of the storage trolley and left on the desk in the nurses’ office, unattended for long periods, whilst the nurse went to administer medicines to residents. One resident at the home had received medication crushed to assist swallowing. The daily record for that resident indicated that the GP had agreed this course of action with staff. The decision to administer medication covertly must be undertaken by all members of the multi-disciplinary team, which includes carers, and relatives of the resident. If covert administration is deemed necessary, a written policy must be developed which is resident specific. Prior authorisation must be obtained from the prescriber before medication can be crushed or the form altered in any non-licensed way. This authorisation may be in the form of a specific prescription from the prescriber. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 15 Controlled medicines had been stored and recorded satisfactorily. However, handwritten instructions had been added to the MAR chart for one resident prescribed Oramorphine, advising staff to “please give regularly”. Handwritten instructions must be clear and countersigned by a second member of staff. This resident’s care plan, on examination, did not contain any further information about how often “regularly” meant and as the resident was also prescribed Fentanyl patches, the GP should have been asked to review the dosage if it was apparent that the resident was experiencing break through pain. A large stock of insulin was stored in the drugs fridge in the manager’s office. Neither the fridge nor the office was locked. The temperature of the fridge had not been monitored and recorded daily. Records indicated that residents had been seen by GP’s, opticians and podiatrists. Feedback from three GP’s who visit the home, via comments cards, indicated that they were all generally satisfied with the care the residents they visited were receiving. Residents said staff were kind and helpful – “they are very good”, “they answer the nurse call if I ring”, “staff treat me well – no bother”, “staff are alrightsmashing”. However, none of the residents were aware of their care plan and did not think they had a key worker. Residents, for the most part, looked clean and tidy although some ladies had facial hair. Two relatives stated that they were generally happy with the standard of personal hygiene that their relative was assisted to maintain. Staff were generally quite knowledgeable about what care residents needed and were able to give examples of ways in which they could help residents to maintain their privacy and dignity. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 adequate . This judgement has been made using available evidence, including a visit to this service. Although some effort has been made to provide social stimulation, lack of consultation with residents and poor information gathering about their lifestyle preferences means that some residents’ social, cultural and recreational needs may not be met. Routines are fairly flexible so residents are able to make some choices about their lives. Meals were mainly satisfactory for residents with no special dietary needs but the provision of soft and pureed diets must be reviewed to ensure residents are offered meals of the same quality and choice. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 17 EVIDENCE: Four residents were case tracked. Three of the four files had no details regarding the residents’ social histories; one contained a limited amount of information in the overview assessment provided by Social Services. Three of the four files did not provide a care plan to address the residents’ social care needs. Since the last inspection some attempts have been made to provide opportunities for social stimulation and staff felt that this area had improved. A list of activities was displayed on a notice board in the reception area of the annexe. Activities planned included bingo, dominoes, jigsaws, manicures, reading and letter writing, Keep Fit and creative activities. Various jigsaws and board games, such as Connect-4, were located in the lounges. Residents mainly spoke of participating in the Keep Fit class on a Thursday, which a number of them enjoyed very much, and playing card games or watching TV. One visitor said she had not seen any activities taking place and her relative had not been invited to participate in any social events – she had been told by the resident that staff did not go into their room much, except for at meal times. It was not possible to conclude if the activities programme was carried out as it was displayed, as there were very limited records in the residents’ care files about how they spent their day. The manager stated that an activities organiser had just been employed who was working between several homes within the Tameside Consortium and planned to spend 1.5 hours per week at the home on a Monday. The inspection started at 7:30am and on arrival at the home the inspector met five residents who were already up and dressed in the main building and three residents who were up in the annexe. The rest of the residents were still in bed or in the process of getting dressed. In the main building, all the residents had been given a cup of tea and were waiting for breakfast, which they said was served about 9:00am. One resident was already eating some cereal. Residents stated that they were able to get up and go to bed at a time of their choosing and could go and spend time in their own room during the day if they wished. One resident had brought things from home for his room and said it was “nice and cosy”. The manager stated that another room was about to be redecorated as the resident did not like the colour scheme. The room belonging to another resident, who spent the majority of time in bed, was not very personalised although they were not unduly concerned about this. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 18 More consideration needs to be given as to how staff meet the diverse needs of some residents, for example, one resident’s wife said that she thought he was missing telephoning his brother who lives in Poland, as when he lived at home he would telephone him every 3-4 weeks. The introduction of a key worker system could help in assisting residents’ to personalise their rooms and develop person centred social activities tailored to individuals’ preferences. Residents said that their visitors were made welcome and they were able to see them in their own rooms if they wished. Information is displayed in the main building and annexe regarding the advocacy service from the Citizens’ Advice Bureau and an advocate usually attends care review meetings. The service user guide states that residents are involved in planning their care and there is a policy to ensure residents have access to their care file. However, no residents or relatives seemed to be aware of this. Residents who were able to eat solid food said they liked the meals provided by the home, in the main. One resident said that the food was home cooked and there was usually some choice. Another resident said that the food was “quite good” and that there was always a choice. Another resident said there was a limited choice and the food was “alright”. Residents who required a soft or pureed diet were not so complimentary about the food provided for them; one resident said it was “not very inspiring” and was uninteresting to eat. Another resident said she did not like the tea she was given. One resident, who had a poor appetite, said staff always came and asked her each day what she would like and she could ask for anything she fancied, within reason. This resident said she was often served too much food, which she found over facing. A member of staff observed that meals were plated and served from the kitchen in the main building and, consequently, all the meals tended to be a similar size, which did not take into account residents’ appetites and preferences. The menu rotates over three weeks. Examination of the menu indicated that it needed reviewing, as there was not a good balance of meals provided on some days, for example, the tea for one day was pea and ham soup, bread and butter and mashed potato. There is no menu for residents requiring soft/ pureed diets and when the chef was asked what was being prepared for them on the day of the inspection it seemed that there was no forward planning for these meals. The manager acknowledged that the menus for soft diets needed developing. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 19 Lunch on the day of the inspection was jacket potato with tuna mayonnaise and side salad. Residents said the food was tasty and enjoyable. The meal for residents requiring soft diet was less appetising and little thought had gone into the presentation. Carers were assisting those residents who needed help on a one to one basis and were chatting with them as they ate their meal, but did not know what the soft diet was and were not therefore able to tell the residents what they were eating. At tea, resident were asked if they wanted sausage or steak pie and this was served with mashed potato and peas. The meals looked and smelled appetising. Residents requiring soft diets were served fish which was received with variable comments. Hot drinks were served to residents mid morning and mid afternoon. The chef said that biscuits were also served. More consideration could be given as to the variety of snacks offered to residents between meals as there was no evidence that they were offered fruit or cake, for example. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 20 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 adequate. This judgement has been made using available evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that residents’ views are listened to and acted upon. Ongoing staff training is providing them with sufficient knowledge of adult protection issues to ensure that residents are protected from abuse. EVIDENCE: A copy of the home’s complaints procedure is contained in the service user guide, but, as stated elsewhere in this report, there was some doubt as to how accessible this information was to current residents and relatives. The complaints procedure provided contact details for the CSCI and timescales by which a complainant could expect a response. A record of complaints received had been maintained, which included details of the actions taken to rectify the complaints. Residents said that they had never had to make a complaint and they were unsure of the procedure. However, everyone was able to identify at least one member of staff that they felt confident to approach if they had any concerns. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 21 The home has a policy regarding the prevention of abuse. The policy needs updating as it does not refer to the Tameside adult protection procedures and is not clear enough, referring to a “form” that must be completed – the manager said that this was the incident form used for reporting incidents in the Tameside area – the policy should detail when and where incident forms should be sent, etc. A number of staff have received some training in the prevention of abuse and dealing with challenging behaviour, in the form of videos with follow-up questionnaires. The manager said that all the staff would receive this training. Staff said that they would report any untoward incidents to the manager and were confident they would be dealt with appropriately. Residents thought that staff were friendly and helpful and treated them well and with consideration. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 22 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, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The overall quality of the furnishings and fittings is poor and does not create a comfortable and safe environment for residents to live in. EVIDENCE: There had been a small number of improvements to the environment since the last inspection. A new bathroom suite had been fitted in the top floor bathroom of the main building and two bathrooms in the annexe had been redecorated. One bedroom in the main building had been redecorated and the maintenance person was in the process of decorating a room in the annexe. The manager said the main kitchen was going to be refurbished in the near future. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 23 However, there was no detailed maintenance plan in progress and an arrangement that decorators were going to come in to the home after completing work at one of the other homes within the group had not materialised. Lounges and dining rooms in the annexe were untidy and unappealing, with stained and scratched furniture, chairs without cushions and dining tables with mismatching mats. The first floor lounge/dining room had a mattress propped up against the mantelpiece and a large tub of carpet shampoo on the windowsill. The ground floor dining room had used drinking glasses left on the side unit, together with a dirty dishcloth and sauce and vinegar bottles that needed cleaning. In the main building the communal rooms were cleaner and tidier, although much of the furniture was also worn and shabby. Many of the divan beds were not covered with valance sheets and the divan bases were dirty and worn. By first appearance, beds looked made but closer inspection found bottom sheets that were rumpled and dirty. Newspapers from several weeks previously were stacked up in one resident’s room. Communal toiletries and flannels had been left in the top floor bathroom. Residents said that they were happy with the cleanliness of the home and confirmed that the domestic staff cleaned their room every day. Since the last inspection laundry baskets have been purchased to ensure that clean clothes are not transported in the same containers that have been used for dirty clothes. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected 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 area is adequate. This judgement has been made using available evidence, including a visit to this service. Progress has been made in addressing nursing and care staff shortages but understaffing in ancillary areas has a detrimental impact on standards of cleanliness and tidiness in the home. Recruitment procedures protect residents from abuse. Although some progress has been made in providing staff training, a lot more work must be done to ensure staff have all the skills and knowledge to care for the residents effectively. EVIDENCE: Examination of staff rotas over a three-week period indicated that there were sufficient numbers of nurses and carers to meet residents’ needs for the majority of time. Staff, residents and relatives all said that there were generally enough staff on duty. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 25 However, the home only employs two cleaning staff for a total time of between 54 – 60 hours per week. There is only one domestic working for six hours to clean both buildings on four/five days of the week. Guidelines recommend that a total of 73 hours per week be employed for cleaning for a home the size of Firbank House. The numbers of cleaning staff is reflected in the standards of cleanliness and tidiness in the home. One person works in the laundry each day but there is no-one working in the laundry on Sundays, when the domestic staff member on duty has to cover both the cleaning and laundry tasks. Guidelines recommend that in a home this size, a further five hours’ laundry cover should be added to the existing staff levels. The home does not meet the targets for the numbers of care staff employed who have completed NVQ’s. The manager said that ten places had been requested for NVQ level 2 training, four places for NVQ level 3 and two places for NVQ level 4 from Tameside Training Consortium but the training had not yet commenced. The timescale from the last inspection in respect of NVQ training has not yet expired and will therefore remain in situ until it the registered provider has confirmed that the training has commenced. Three staff personnel files were examined. None had been recruited since the last inspection. All files contained application forms, terms and conditions, job descriptions and appropriate references. All members of staff had obtained disclosure certificates from the CRB. One member of staff, who commenced employment in November 2005, said she attended an interview with the manager and had to supply two references. She confirmed that she had obtained a CRB disclosure certificate. Since the last inspection the manager has commenced a training programme, which has mainly consisted of video programmes followed by questionnaires to test staff understanding of the subject. Records showed that 13 staff had received training regarding abuse, nine staff had seen a video regarding the fire drill and evacuation and five staff had seen the video regarding Alzheimer’s Disease which included information on dealing with challenging behaviour. Some staff had received moving and handling training just before last inspection but a lot of staff still require updates in this area and one member of staff who commenced employment in November 2005 said she had not received moving and handling or fire safety training. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 26 The manager said that she had developed the training programme in response to the requirements from the last inspection, concentrating on the topics specifically highlighted as being required. Further training in other topics, such as First Aid and Health and Safety, is planned. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The systems for resident consultation in this home are poor, with little evidence that residents’ views are sought or acted upon and there is no clear development plan and vision for the home. Procedures for dealing with residents’ finances protect their interests. Staff do not receive regular formal supervision and may therefore lack clarity and direction regarding the aims and objectives of the home. A number of shortfalls in health and safety practices leave staff and residents at risk of harm or injury. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 28 EVIDENCE: The CSCI has agreed not to pursue an application for registration from the manager currently in post, as she intends to resign her position in the near future. The registered provider has been requested to keep the CSCI informed regarding the advertisement for and recruitment of a replacement manager. The home does not have any formal system of quality monitoring in place and does not have an annual development plan to drive forward improvements to the service. No residents/relatives’ meetings have taken place and no resident surveys have been distributed. No measures have been taken within the home to seek the views of residents, relatives or other stakeholders on how the service is meeting their needs and there is no recognized means of obtaining feedback, although care reviews do take place for residents placed by the Local Authority. Some staff meetings have taken place and staff said that meetings were a two way process between themselves and the manager where they were able to put forward ideas and suggestions. Staff said that they found the manager supportive and approachable. Regulation 26 reports have been sent to the CSCI, completed by the manager. The majority of residents are assisted with their finances by their families. Invoices are usually supplied for sundry expenses, such as hairdressing and newspaper bills, whilst a very small number of relatives leave a “float” which is kept in the safe in the office. Individual ledger sheets are maintained for each resident detailing the balance of the account. No recent supervision records were available in the staff training or personnel files and the manager acknowledged that formal supervision was sporadic. The maintenance person undertakes some health and safety checks of the buildings and equipment but there was no evidence that identified faults were always rectified, for example, it had been recorded for the previous three weeks that when the fire alarm was tested two doors in the main building did not automatically release and shut. This fault had also been identified by outside contractors who came to the home on 15 February 2006 to undertake the annual service of the fire alarm and emergency lighting systems. At this time two detectors had also failed in the annexe and there was no record as to whether these faults had been addressed. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 29 There was no record that fixtures and equipment such window restrictors, bed rails, mattresses and wheelchairs were checked regularly for faults and to ensure they were safe to use. A number of cleaning products were found in various parts of the home, including the lounges and hallways. These products must be stored securely. Boxes of wipes and gloves were left on top of radiators and could present a fire hazard. Although some staff have seen a video regarding fire drills and evacuation, there was no record of actual fire drills having taken place in the home that staff participated in. Staff need to have the opportunity to relate the information they got from the video into the practicalities of the actions they would take at the home in the event of fire. As stated previously, medicines were left unlocked and unattended in the office in the main building for some time whilst the nurse was administering them. A storeroom on the first floor of the annexe was unlocked – as this room contains sharps bins, it must be kept locked at all times. Staff were observed using the hoist appropriately. During case tracking it was noted from the daily record for one resident that they had sustained a fall. No accident record had been completed in respect of this. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 30 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 1 1 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 2 X 1 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The registered person must ensure that the home’s Statement of Purpose and Service User Guide are up to date and accurate in the information they provide. The registered person must ensure that all residents receive a copy of the terms and conditions of their stay at the home, including all the details stated in NMS 2.2 The registered person must ensure that detailed assessments are undertaken for all residents prior to them entering the home. (Previous timescale of 31/03/06 not met). The registered person must ensure that staff receive further training specific to the care they have to deliver to the residents living at the home. The registered person must ensure that arrangements are made with due regard to the cultural background or disability of any resident. Timescale for action 30/06/06 2 OP2 5 30/06/06 3 OP3 14 30/06/06 4 OP4 18 30/09/06 5 OP4 4 30/06/06 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 32 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. 6 Standard OP7 Regulation 15 Requirement The registered person must ensure that care plans are detailed, accurate and developed to address all residents’ health, personal and social care needs. (Previous timescale of 31/03/06 not met). The registered person must ensure that actions stated as required in the care plan are carried out properly. The registered person must ensure that care plans are reviewed at least once a month or more often if necessary so they reflect residents’ changing needs. The registered person must ensure that risk assessments are accurate and reviewed to reflect changes to the residents’ condition. (Previous timescale of 31/03/06 not met). The registered person must ensure that the treatment and outcome of pressure sores are recorded in individual care plans. The registered person must ensure that a record is maintained of residents’ nutrition and any action taken. Timescale for action 15/06/06 7 OP7 15 15/06/06 8 OP7 15 15/06/06 9 OP8 13 15/06/06 10 OP8 17 15/06/06 11 OP8 17 15/06/06 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 33 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. 12 Standard OP9 Regulation 13 Requirement The registered person must ensure that handwritten medication details on the medication administration records are clear. They must be signed and dated and validated by an additional member of staff. (Previous timescale of 31/03/06 not met). The registered person must ensure that photographs of residents used for identification purposes are kept up to date. (Previous timescale of 31/03/06 not met). The registered person must ensure that duplicate dispensing labels are not attached to medication administration records. The registered person must ensure that all staff responsible for administering medication follow procedures in line with guidelines from the Royal Pharmaceutical Society.. The registered person must ensure that medicines are checked and recorded on receipt in to the home. Timescale for action 15/06/06 13 OP9 13 30/06/06 14 OP9 13 15/06/06 15 OP9 13 15/06/06 16 OP9 13 15/06/06 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 34 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. 17 Standard OP9 Regulation 13 Requirement The registered person must ensure that the temperature of the medicines refrigerators are monitored and recorded daily using a maximum/minimum thermometer and that staff members understand the action to take if the temperature recorded is outside the normal range. (Previous timescale of 31/03/06 not met). The registered person must ensure that where covert medication administration is required for a resident a specific policy for that individual in respect of this is developed. The registered person must ensure that the medicines refrigerator is kept locked at all times. The registered person must ensure that information is provided to resident about how they can access their care files. The registered person must ensure that a menu is provided to residents who require soft or liquefied food. The registered person must ensure that worn and stained lounge and dining room furniture is replaced. Timescale for action 15/06/06 18 OP9 13 30/06/06 19 OP9 13 30/06/06 20 OP14 15 31/07/06 21 OP15 12 30/06/06 22 OP20 16 31/08/06 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 35 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. 23 Standard OP24 Regulation 16 Requirement The registered person must ensure that old and worn divan beds are replaced and that the bases of divan beds are cleaned. The registered person must ensure that suitable standards of hygiene and tidiness are maintained. The registered person must ensure that care staff are supported to undertake NVQ training to ensure that the target ratio is achieved. The registered person must ensure that staff receive updates in all mandatory health and safety topics. (Previous timescale of 30/04/06 not met). The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the home. This system must provide for consultation with residents. The registered person must ensure that staff receive appropriate supervision. The registered person must ensure that fire drills are carried out at suitable intervals. (Previous timescale of 31/03/06 not met). Timescale for action 31/08/06 24 OP26 16 15/06/06 25 OP28 18 31/08/06 26 OP30 18 31/08/06 27 OP33 24 31/08/06 28 29 OP36 OP38 18 23 31/08/06 31/07/06 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 36 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. 30 Standard OP38 Regulation 23 Requirement The registered person must ensure that faults identified in the fire alarm system are rectified. The registered person must ensure that adequate safety checks are made of the building and equipment. The registered person must ensure that combustible items are not placed on top of radiators. The registered person must ensure that a record is maintained of any accident affecting a resident. The registered person must ensure that sharps boxes are stored in a locked room. The registered person must ensure that cleaning products are stored in a locked cupboard. (Previous timescale of 31/03/06 not met). Timescale for action 15/06/06 31 OP38 23 15/06/06 32 OP38 23 15/06/06 33 OP38 23 15/06/06 34 35 OP38 OP38 23 COSHH 1988 15/06/06 15/06/06 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 10 11 12 Refer to Standard OP1 OP4 OP5 OP8 OP12 OP12 OP15 OP15 OP15 OP18 OP19 OP27 Good Practice Recommendations The registered person should ensure that the home’s statement of purpose and service user guide are freely available to prospective and current residents. The registered person should continue the programme of staff training in dementia care, challenging behaviour and prevention of abuse. The registered person should ensure that full assessments are undertaken within 48 hours of residents admitted into the home as an emergency. The registered person should ensure that in the event that a resident cannot be weighed other measures are used to assess their nutritional status. The registered person should ensure that the programme of recreational and social activities continues to be developed to meet the needs of the residents. The registered person should consider the development of a key worker system to maximise person centred care and assist in meeting residents’ diverse needs. The registered person should ensure that meals are served in a way that meets residents’ individual preferences for portion sizes. The registered person should consider how the presentation of liquefied meals could be enhanced. The registered person should ensure that residents are offered a variety of snacks between meals. The registered person should review the home’s adult protection policies to ensure they are clear and accurate. The registered person should ensure that a maintenance programme is developed and actioned for redecoration and refurbishment of the home. The registered person should ensure that there are sufficient ancillary staff employed to maintain satisfactory standards of hygiene and tidiness in the home. Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 38 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Firbank House Nursing Home DS0000025433.V290618.R01.S.doc Version 5.1 Page 39 - 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!