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Inspection on 06/12/06 for Firbank House Nursing Home

Also see our care home review for Firbank House Nursing Home for more information

This inspection was carried out on 6th December 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Visitors are made welcome at the home and the staff are friendly and pleasant. The atmosphere in the home is relaxed and informal and residents said there were no strict routines and they were able to choose for themselves how to spend their day. Interaction between staff and residents during the site visit was positive and helpful. The owner of the home has taken seriously the issues that were highlighted at the first key inspection and following inspections that showed that the home was not providing a good service and appointed an operations manager to work with the manager to try to put things right.

What has improved since the last inspection?

Since the first key inspection the home has made a big effort to improve in a number of areas. Assessments and care plans for residents were much more detailed and up to date and provided staff with good information about what they needed to do to care for and monitor the residents properly. The home was much cleaner and tidier and some redecoration and refurbishment had taken place, which needs to be continued. The numbers of nurses and care staff on duty each day were better which meant residents could be more confident that their needs could be met.

What the care home could do better:

The home still needs to consider how it can provide more social and mental stimulation for residents, as there were few regular activities organised and residents said there was "not much to do". Staff have started to get more information about residents` past interests, hobbies and preferences and should now use this to develop a recreational and leisure programme for residents, which suits their expectations and abilities. Although some training had been given to some staff in a range of topics the home must make sure that all staff have updated training in health and safety topics such as fire safety. Staff also need more training in specific topics that are relevant to the care they are expected to provide to residents, such as training in the care of people with dementia. All staff also need to attend training in the prevention of abuse. The main area of concern at this site visit was the poor recruitment procedures that had been used. Staff had not always had proper checks to make sure they were suitable to work in a care home and this puts residents at risk.

CARE HOMES FOR OLDER PEOPLE Firbank House Nursing Home 24 Smallshaw Lane Ashton-under-Lyne Tameside OL6 8PN Lead Inspector Fiona Bryan Unannounced Inspection 6th December 2006 09:15 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.V323256.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. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 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 firbankhouse@aol.com Partnership Caring Limited ** Post Vacant *** 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.V323256.R01.S.doc Version 5.2 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. Manager’s hours to be supernumerary to 2 & 3 above. No more than 30 places can be used for nursing care. Date of last inspection 2nd October 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. Nursing and personal care can be provided for up to 42 residents. 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. Fees for accommodation and care at the home range from £271.44 to £409.49 per week. Extra charges are made for sundry items such as toiletries and newspapers and services such as hairdressing and chiropody. 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.V323256.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by 2 inspectors and was the second key inspection this year, where all the key standards were assessed. Since the first key inspection a number of concerns were raised by other professionals visiting the home so there have been a further 2 random inspections to monitor how the home was progressing; the first was carried out in August 2006 and looked mainly at how the care needs for residents were assessed and planned, the food provided by the home, staffing levels and the environment; the second random inspection was carried out in October 2006 and looked mainly at the environment provided for residents. Short reports of both these inspections were given to the home and are available on request for any member of the public wishing to read them. During the site visit for this inspection time was spent talking to residents 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 was examined including records of care, medication records, employment and training records and staff duty rotas. Since the first key inspection a new manager has been appointed who is in the process of applying for registration with the CSCI. What the service does well: What has improved since the last inspection? Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 6 Since the first key inspection the home has made a big effort to improve in a number of areas. Assessments and care plans for residents were much more detailed and up to date and provided staff with good information about what they needed to do to care for and monitor the residents properly. The home was much cleaner and tidier and some redecoration and refurbishment had taken place, which needs to be continued. The numbers of nurses and care staff on duty each day were better which meant residents could be more confident that their needs could be met. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. Residents are given enough information to be able make an informed decision on whether to come into the home. Improvements in the assessment of residents before they enter the home ensure that the staff are aware of what care they will need to provide. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the home’s statement of purpose and service users’ guide is provided in each resident’s room. The administrator said that each resident is given a contract as soon as the home has received details from the local authority about how much they will contribute to the cost. The contract for one resident was examined. This Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 9 contained details about how much of the fee the resident had to pay and what services were included in the fees. The administrator said that when the fees were increased all residents or their representatives were notified by letter. Four residents were case tracked. Since the last inspection there had been a complete review of all residents’ records and a new system of documentation had been introduced. Three of the residents’ files contained detailed assessments of each resident, and the overall organisation and amount of information was vastly improved since the last inspection. Nutritional risk assessments and waterlow scores had been undertaken, which required the assessor to determine whether the resident was of average, below average or above average weight. It was unclear how this was determined and the manager reported that the home was going to introduce a system whereby the resident’s BMI (body mass index) would be calculated as a more accurate assessment. The full assessment for one resident who had been admitted to the home a few days before the site visit had not been completed and although some care plans had been written to address some of the main care needs for this person, some significant care needs had not been properly recorded or planned for. However the home had accessed other professional advice within the short period of time that the resident had been at the home, and the inspector was of the opinion that staff were fully aware of the care needs of the resident and the shortfall was only in the recording of these needs. The manager guaranteed that the resident’s care file would be completed with all relevant details without delay. Another resident who had been admitted to the home a short time before the site visit did have the majority of their assessment and care plan details completed. Intermediate care is not provided at Firbank House. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Improvements in risk assessment and care planning mean that staff are provided with the information they need to meet and monitor the residents’ needs. The procedures for dealing with medicines generally protect the residents; some minor improvements need to be made. Residents felt they were treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents were case tracked. Changes to the system of documentation have created significant improvements in the quality of information and records held for each resident. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 11 Care plans were usually person-centred and in the main addressed all the needs identified during the assessment of the resident. Care plans had been reviewed monthly or more frequently and risk assessments had been undertaken for the risk of falls, pressure sores and poor nutrition. As discussed in the previous section, the assessment and care plans for one resident who had recently been admitted to the home had not been fully completed. Every effort should be made to ensure that all the relevant documentation is completed as soon as possible after admission to ensure that staff have all the details to care for and monitor the resident properly. Some care plans were rather vague, for example advising “regular positional changes”, “regular thickened fluids” and “eye/mouth care as required”. However charts completed by staff that were kept in the resident’s room showed that the resident’s position was being changed every 2-3 hours and there was a mouth care pack in the room that had obviously been used. Staff should make sure that care plans are also written when a resident has new care needs that develop after they have been admitted to the home, for example one resident had been suffering with nausea and vomiting for several days and a care plan should have been in place to help staff address and monitor this. Records showed that residents had seen GP’s, opticians, audiologists, dentists, chiropodists and dieticians and some had attended hospital outpatient appointments. The daily record for one resident indicated that the pressure mattress they were on was no longer suitable and needed upgrading to a better one. This had been discussed with the manager and it was reported that a more appropriate mattress would be obtained. Some of the care plans had been signed by the resident or their representative to say that they had been involved in planning their care. Examination of residents’ medication administration records showed that medicines were generally administered satisfactorily. A record was not however always kept of medicines being received into the home and this must be done to provide a clear audit trail of all medicines held at the home. Also where medicine administration instructions are handwritten by staff, these should be countersigned by a second member of staff to reduce the risk of error. Interaction between staff and residents was friendly, patient and professional. Staff took residents to their own rooms to attend hygiene needs and doors were closed whilst this care was carried out. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. The range of activities provided by the home is limited and further work is needed to ensure that the home satisfies all of the residents’ social and recreational needs. Visitors are encouraged and welcomed into the home and routines are flexible to provide residents with some choice about their daily routines. The home has made some progress to improve the provision of a varied menu to enable residents to exercise choice over what they eat. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have a designated activities organiser. Care staff try to arrange and provide some social activities when they have time. Residents enjoy a Keep Fit session once a week but there are no other social events that occur on a regular basis. One resident said there had been a service of worship recently but did not know if this was arranged regularly. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 13 One resident said there was “not much going on” and another said there were few activities arranged but they were “not much of a joiner in anyway”. One resident said she preferred to stay in her room. She enjoyed watching television and reading the newspaper and she confirmed that daily newspapers had been obtained for her. A Christmas party on 18th December 2006, was advertised on the notice board. Since the last inspection staff have started to write more detailed care plans to try to identify and address residents’ social care needs. Expansion of the key worker system could help staff to use this information, to build on and create more options for social and mental stimulation for individual residents to suit their abilities and expectations. Information about the advocacy service was displayed around the home and residents said they had some choice about how they spent their day. The atmosphere within the home was relaxed and routines seemed to be flexible. Since the last key inspection the home has been working on the meals provided and revising the menus. A menu was displayed on the notice board in the reception area of the main building. Lunch on the day of the site visit was soup, hotpot or egg and chips, followed by stewed apples and custard. The evening meal was chicken chasseur with boiled or mashed potatoes, broccoli and cauliflower, followed by sago pudding. Alternatives of omelettes, jacket potatoes with various fillings or pies were also suggested. The dining areas in both buildings looked cleaner, tidier and more hospitable, and provided a much pleasanter dining experience for residents. Dining tables were nicely set with tablecloths, place mats and napkins. Comments about the food provided were variable. One resident said the food was “OK” and another said it was “edible” but that the food varied from day to day – some days it was “not bad” but other days the meat was too tough. Residents agreed that they had a choice but were not sure if there was any supper available. The manager said there was, but consideration should be given as to how to ensure that residents are aware of this, especially as the evening meal is served at 4.30pm and residents may want something else to eat before they go to bed. Staff should make sure that residents who are served meals in bed are supervised and able to easily reach and eat their food. One resident had eaten very little of the first course but was not really sat up enough to be able to eat Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 14 it properly. The meal had been served about an hour earlier and they were unable to reach the stewed apple and custard, which had grown cold. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 15 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 adequate. The home has a complaints procedure and residents felt any concerns would be dealt with in a satisfactory way. Further staff training is required and safeguarding adults procedures need to be applied to ensure that residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint’s procedure is displayed in the reception area of both buildings. This needs to be amended slightly as it did not include details of the timescales by which complainants could expect a response. As at the last key inspection, residents did not seem to be aware of the official policy about making complaints but said they would see the nurse in charge or the manager and were confident their concerns would be addressed. The manager said that there had been no formal complaints since she started working at the home in September 2006. Some staff, but not all, have received training in the prevention of abuse and safe guarding adults. All staff need to attend this training. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 16 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 adequate. Recent thorough cleaning has significantly improved the hygiene and tidiness of the home, making it a more pleasant environment for people to live in and visit. Ongoing refurbishment is still required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was conducted. Following the last random inspection contract cleaners were purchased to thoroughly clean the whole home and both buildings were much cleaner, tidier and more inviting for residents to live in. Staff were starting to put up Christmas decorations. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 17 All the carpets that were identified as requiring replacement at the last key inspection have now been replaced and all the others have been steam cleaned. There were no curtains in the dining room in the main building. The manager explained that they had shrunk when being washed and would be replaced. An empty room in the main building was in the process of being redecorated and another room had just been redecorated. Many of the towels looked worn and threadbare and should be replaced and some hospital blankets were observed which detracts from the homely feel. In room 38, water was very slow going down the plughole and was only lukewarm. The manager said this would be looked at. Although liquid soap was available in the staff toilet, there was also a bar of dirty soap, which could harbour bacteria and should therefore be removed. Two residents were being fed enterally via electric pumps. In both cases the pumps and surrounding areas were clean and hygienic. This is an improvement from the last key inspection when both were very dirty with dried on feed. The television reception in residents’ bedrooms in the annexe was of very poor quality and the aerial/reception should be improved. Two open tubs of Epaderm cream (i.e. with no lids and open to bacteria) were left in the bathroom. Although some parts of the home were still a bit cluttered, for example the lounge in the annexe, which contained a set of sit-on weighing scales and 2 hoists, in general a big improvement was noted in the tidiness of the home and both buildings appeared to be clean, with no offensive smells noted, although the lack of sufficient domestic staff is still a cause for concern and is discussed in more detail in the next section. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 18 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 poor. There are enough nursing and care staff to meet residents’ needs but understaffing in ancillary areas may lead to a decline in the standards of cleanliness and tidiness in the home. The home does not meet the standards for the percentage of care staff that have completed NVQ training and further training is required to ensure staff have the skills and knowledge to care for the residents. Recruitment procedures do not always protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the staff duty rotas and discussion with the manager confirmed that enough nursing and care staff were being provided to meet the residents’ needs. However, as identified at the last key inspection in April 2006 and the two random inspections in August and October 2006, the home continues to employ insufficient domestic staff. There is still only one domestic working for six hours to clean both buildings on four/five days of the week. Following the last random inspection on 2nd October 2006, when the home was found to be Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 19 very dirty and untidy, the owner paid for contract cleaners to thoroughly clean both buildings and the home was much cleaner at this site visit. However, the inspectors were concerned that the 2 domestic staff employed will not be able to maintain the standard that has been achieved on a long-term basis and still recommend that more domestic staff are employed. The manager and the owner acknowledged this and reported that they have been trying and will continue to try to recruit another part time domestic. The manager reported that four of the 22 care staff employed at the home held NVQ level 2 (one of these also held NVQ level 3). All other care staff working days except one and some care staff working nights enrolled in September 2006 to undertake the training. The personnel files for 2 new members of staff were examined. One staff member had not fully completed their application form and the other had only provided an employment history up to 2003. In both cases it was unclear on what day their employment had started. However, it was apparent that the employees’ CRB disclosure certificates had only been received at the home after they started employment, and there was no evidence that POVA First checks had been carried out. The owner did say that he had been advised that once the CRB certificate was received the confirmation of the POVA First checks could be destroyed. However this confirmation needs to remain on file as proof that checks were made about the employees’ suitability. Employment histories for both employees had not been thoroughly accounted for and checked and inadequate references had been obtained. It was unclear if one employee was legally entitled to work in the UK. The inspector also noted that the employee questionnaire to monitor equality and diversity in staff recruitment asked for staff’s “Christian name”. This should be amended as not all staff will have Christian names. Since the last key inspection, all staff have had moving and handling training and efforts have been made to develop a more structured training programme. Some staff have received training in fire safety, prevention of abuse and safe guarding adults, risk assessment, first aid, medication management and caring for people with confusion. This training programme needs to be continued and developed to ensure all staff have training in the topics that are relevant to them – mandatory health and safety training in for example fire safety was not up to date for all staff. One domestic had not received COSHH training or advice regarding HIV awareness. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 20 Also the home needs to consider the quality of the training provided and if possible source external agencies to deliver some of the training and use a variety of training methods, as much of it appears to be in the form of videos or DVD’s, which some staff may not find as beneficial as an actual trainer delivering the session. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 21 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 adequate. The systems for resident consultation in this home have slightly improved with some evidence that residents’ views are sought and the home has a clearer development plan to continue to improve the service. Procedures for dealing with residents’ finances protect their interests. There have been some improvements in record keeping in respect of health and safety but staff must ensure that procedures are followed properly to prevent risk of harm or injury to residents. This judgement has been made using available evidence including a visit to this service. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 22 EVIDENCE: There has been no manager that has been registered with the CSCI for over a year but since the last key inspection a new manager has been appointed who is in the process of applying for registration. Some questionnaires had been sent out to residents or their representatives and also to the GP’s who regularly visit the home to attend their patients. It was noted that the comments from the GP’s were very positive. However, it was unclear what had been done to improve the service as a result of the feedback from residents and the results had not been made widely available to other interested parties. An operations manager has been appointed who visits the home and provides detailed reports of her findings to the CSCI. It was reported that the process had been started for the home to be accredited with the Investors In People award. The administrator deals with the personal allowance for 4 residents only. Records were available for all transactions, which were satisfactory. The home employs a maintenance person who works 4 ½ days a week. New recording systems have been started, which when fully operational will be more comprehensive and clearer to audit. The maintenance person had been recording the health and safety checks of the building and equipment in a short hand notebook. The manager said that details of all the checks that had been made would be transferred to the new logbook. Records showed that the last fire drill took place on 27/11/06 when 11 staff attended. Inspection of the accident records confirmed that accidents were well recorded and analysed to identify if possible any causes and reduce further risk. Several residents were observed being wheeled in wheelchairs with no footrests. This practice presents a risk of injury to residents. As previously stated in this report unopened containers of ointment and cream belonging to residents were left in the bathroom. These should be stored safely and the lids kept on to prevent contamination. Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 24 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 OP18 Regulation 13 Timescale for action The registered person shall make 30/04/07 arrangements, by training staff and other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (all staff must receive training in the prevention of abuse and safe guarding adults). The registered person shall not employ a person to work at the care home unless….he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001. (All employees must have provided a complete application form and full employment history which can be verified, 2 appropriate references, one of which must be from the person’s previous employer and have obtained a CRB and if necessary a POVA First). The registered person shall ensure that persons employed to DS0000025433.V323256.R01.S.doc Requirement 2 OP29 19 31/01/07 3 OP30 18 30/04/07 Page 25 Firbank House Nursing Home Version 5.2 work at the care home receive training appropriate to the work they are to perform. (Relevant staff must receive training in fire safety, first aid, COSHH, food hygiene and infection control. (Previous timescale of 30/04/06 not met). Staff must also receive training in other topics that are specific to the care they are expected to provide, such as dementia care and dealing with challenging behaviour The registered person should ensure that footplates are attached to all wheelchairs when using them to transport residents to prevent the risk of injury. 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 OP7 Good Practice Recommendations The registered person should ensure that care plans are written as soon as possible after a resident’s admission to the home to ensure that all staff have the information about the care they need to provide. The registered person must ensure that medicines are checked and recorded on receipt in to the home. The registered person should ensure that handwritten medication details on the medicines administration records are signed and dated, and an additional member of staff validates the details. The registered person should consider expanding and developing the key worker system to maximise person centred care and assist in creating a programme of DS0000025433.V323256.R01.S.doc Version 5.2 Page 26 2. 3. OP9 OP9 4. OP12 Firbank House Nursing Home recreational and social activities that meet individual needs. 5 6 6. OP15 OP19 OP19 The registered person should ensure that all residents are made aware of the options available for supper. The registered person should ensure that worn and threadbare towels and bedding are replaced. The registered person should ensure that the programme for the redecoration and refurbishment of the home continues. The registered person should ensure that the television aerial for the annexe is dealt with to improve the reception for residents in the building. The registered person should ensure that there are sufficient ancillary staff employed to maintain satisfactory standards of hygiene and tidiness in the home. 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 should ensure that work permits are verifiable. The registered person should ensure that in order to demonstrate staff training a record is kept of the dates on which staff attended. The registered person should ensure that any creams or ointments belonging to residents are kept in their rooms and are kept clean and free from contamination by ensuring the lids are in place. The registered person should ensure that footplates are attached to all wheelchairs when using them to transport residents to prevent the risk of injury. 7. OP19 8. OP27 9. OP28 10. 11. OP29 OP30 12 OP38 13 OP38 Firbank House Nursing Home DS0000025433.V323256.R01.S.doc Version 5.2 Page 27 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: 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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