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Inspection on 19/07/05 for Firgrove Nursing Home

Also see our care home review for Firgrove Nursing Home for more information

This inspection was carried out on 19th July 2005.

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.

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

Residents live in a home which was clean, tidy and free from offensive odours. Residents said the home was always very clean which was important to them. They said they were happy with the communal areas which were light and airy. Residents benefit from well maintained large gardens which were accessible to them. The home was well maintained and pleasantly decorated. Residents were not admitted to the home unless an assessment had been carried out to make sure the home could meet their needs. Residents praised the food saying they got plenty to eat, were offered a choice at all mealtimes and liked the meals they had. Staff were seen to assist and encourage residents to have lots of hot and cold drinks throughout the day. Residents who needed specialist nursing equipment had this provided for them. Residents benefit from staff who are trained and supported by management.

What has improved since the last inspection?

New staff had received appropriate induction training on being employed at the home. The Commission for Social Care Inspection had been informed incidents within the care home, in line with the regulations.

What the care home could do better:

Not all residents had a written plan of how their identified needs were to be met. There was no evidence that a change in the resident`s condition was appropriately followed up. The practice of using wheelchairs and some recliner type chairs without footplates put residents at risk of injury. All possible risks to residents should be identified and measures taken to reduce them. Residents must be treated with dignity and respect at all times. The system of how staff are split into teams to assist residents should be reviewed to make sure residents get the assistance they need at the appropriate time. Fire doors must not be left open or propped open with wedges. Alternatives which meet with the guidance of the fire service must be used. Staff should be appropriately supervised by the manager. Staff recruitment and employment checks are not complete and do not demonstrate that all staff are fit to work with vulnerable adults. A system of reviewing the quality of care in the home must be established.

CARE HOMES FOR OLDER PEOPLE Firgrove Nursing Home Keymer Road Burgess Hill West Sussex RH15 0AL Lead Inspector Hellen Tomlinson Unannounced 19 July 2005, 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Firgrove Nursing Home Address Keymer Road, Burgess Hill, West Sussex, RH15 0AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01444 233843 Firgrove Care Limited Mrs Rajendrapersad Lallchand Care Home (CRH) with nursing (N) 35 Category(ies) of Physical disability (PD), (6) registration, with number Old age, not falling within any other category of places (OP), (35) Physical disability over 65 years of age (PD(E)), (6) Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 A maximum of 6 service users in the PD, PD(E), category may be admitted 2 Only service users over the age of 50 years in the category of Physical Disability (PD) may be admitted 3 A maximum of 35 service users may be accommodated at any one time. Date of last inspection 14 September 2005 Brief Description of the Service: Firgrove is registered as a care home with nursing to accommodate up to thirty-five residents in the category of old age, not falling within any other category (OP). The care home is also registered to accommodate up to six residents in the catgory physical disability (PD) and up to six residents in the category physical disability who are aged over 65 years. The maximum number of residents who may be accommodated at any one time is thirty-five. The home is a two storey converted detached house in a residential area of Burgess Hill, West Sussex. Accommodation is provided in twenty-three single and six double rooms, which are located on the ground and first floors. A vertical lift provides access to each of these floors. Communal facilities, which are located on the ground floor, include a sun lounge, an lounge/dining area which is roofed in glass and has table with umberellas to provide shade when needed and a small reception/sitting area. There is a large garden to the rear ot the property which is accessible to residents from a patio area outside the garden lounge. There is private parking to the front of the house. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 10.25am and left the home at 6.30pm. The registered manager, Mrs Sareeta Lollchand, was present throughout the inspection. The registered provider was present for the final hour of the inspection. Over the course of the inspection thirteen residents, five visitors and four staff members were spoken with. Staff were observed giving support and assistance. Three residents files were examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined. What the service does well: What has improved since the last inspection? What they could do better: Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 6 Not all residents had a written plan of how their identified needs were to be met. There was no evidence that a change in the resident’s condition was appropriately followed up. The practice of using wheelchairs and some recliner type chairs without footplates put residents at risk of injury. All possible risks to residents should be identified and measures taken to reduce them. Residents must be treated with dignity and respect at all times. The system of how staff are split into teams to assist residents should be reviewed to make sure residents get the assistance they need at the appropriate time. Fire doors must not be left open or propped open with wedges. Alternatives which meet with the guidance of the fire service must be used. Staff should be appropriately supervised by the manager. Staff recruitment and employment checks are not complete and do not demonstrate that all staff are fit to work with vulnerable adults. A system of reviewing the quality of care in the home must be established. 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. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents were not accommodated in the home unless an assessment of their needs had been carried out. EVIDENCE: The residents whose files were examined had been seen by the registered manager before becoming accommodated in the home. The information in this assessment was comprehensive and covered all areas of the person’s life. Assessments from other professionals were present where this was relevant. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, 10 and 11 The written care plans varied in the information provided. Health care needs were assessed and met. The storage and administration of medicines was safe and met current guidance. The residents did not feel their dignity was protected by some practices in the home. EVIDENCE: On some of the care plans seen there was very good information about the resident’s needs and how these should be met. The practice in the home of keeping all paperwork for the resident, since admission, on one file, led to a lot of out of date information being present. This led to confusion as to the current condition and needs of the resident. For one resident there were two conflicting plans for the prevention of pressure care. For another a plan for the management of incontinence was present whilst another plan said the resident had a catheter. This made the care needed for the resident unclear. The written plans of care should contain only relevant information for the current situation for each resident. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 10 Notes regarding each resident’s condition were not written daily. Those seen had some information which asked for follow up and none was present. For one resident a member of staff had noted a change in condition and written “keep an eye on it”. Nothing further was written about this. The use of these notes should be reviewed and all changes in condition followed up appropriately. Assessments for the risk of developing pressure sores, moving and handling, continence and risk of becoming malnourished were present. These had been reviewed at regular intervals. The information from these was translated into how the staff should meet the needs identified. Bed rails were seen in use without protectors fitted. These should be in place at all times. Adequate risk assessments for the safe use of bed rails had not been carried out. A full risk assessment, which identifies any possible alternatives, must be carried out for all residents. The medication in the home was safely stored. The administration of medication, to the residents, was carried out by the qualified nurses in the home. The practices met with current guidance and legislation. The home received support from the local community pharmacist. Residents discussed with the inspector some practices which they felt led to their dignity not being protected. They said they often had to wait too long before being assisted to the toilet, when they had requested help. This was observed by the inspector and seen to cause distress to one resident. The system of staff splitting into teams to assist residents and not helping those from another team appeared to be the cause for this. They discussed that sometimes certain staff members spoke to them abruptly. This was not observed during the inspection when staff were seen to be polite, calm and friendly with the residents, including when they were unaware the inspector was observing them. The inspector pointed out, to the registered manager, other practices which were not dignified for the resident, for example, residents being positioned in the hallway, in wheelchairs, in their night wear without clothing to protect their privacy. Staff should be trained to respect the privacy and dignity of the residents at all times. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed. EVIDENCE: Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Any issues or concerns brought to the attention of the registered manager would be acted upon. The procedures for reporting allegations of abuse did not adequately protect residents. EVIDENCE: Residents said the registered manager was present in the home a lot of the time. If they had had cause to raise any issue with her she had resolved the matter for them. Visitors spoken with said they found the manager and other staff approachable and would feel confident to raise any concerns they had. No complaints had been received by the service, since the last inspection. Some staff had received training about protecting vulnerable adults. Those spoken with were aware of their responsibilities to protect the people in their care. The procedures for reporting any allegation of abuse were not in line with the current West Sussex guidelines with regard to the suspension of staff. These should be amended and all persons who may be in a charge of the home must be aware of the correct procedure to follow. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,22 and 26 The home was well maintained. Some aspects of fire safety in the home could put residents at risk. Specialist equipment needed by individual residents was available for them. The home was clean and airy. EVIDENCE: The home was clean with no offensive odours. The layout of the lounges and the glass roofs made the home airy and bright. The décor was tasteful. The residents said they liked the environment of the home and it was always clean. There were sufficient numbers of domestic staff on duty. Staff wore protective clothing appropriately. All areas of the home and gardens were well maintained with bedrooms being re-decorated when they became vacant. Bedroom doors were wedged open and cupboard doors, which should be shut and locked for fire prevention, were left open and unlocked. All fire doors must be closed, at all times, or held open with a device which meets the guidance of the fire service. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 14 Pressure relieving mattresses and cushions were in use for residents. Moving and handling equipment was present and staff had been trained in the safe use of this. The call system for the residents was convenient for their use with pendants being supplied which could be worn round the resident’s neck. All residents were encouraged to wear their pendants at all times. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Adequate numbers of staff with appropriate knowledge and skills were employed to meet the needs of the residents accommodated. The recruitment procedures were not adequate to ensure protection for the vulnerable adults in the home. Not all staff had received training appropriate for the work they were to perform. EVIDENCE: The duty rota for week commencing the 18th July 2005 was seen. This showed sufficient numbers of staff on duty for the number and dependency of the residents. A qualified nurse was on duty at all times. The system of working for the staff and the deployment of the staff on duty should be reviewed in order to make sure residents needs are met promptly. Two staff files were examined. The information contained did not give a clear or full history of the persons employment record up to them working in the care home. References had been obtained. For one person not all checks for working with vulnerable adults had been obtained. The registered manager was reminded of her responsibility to ensure this person was not with residents whilst unsupervised. Appropriate training was offered by the home. The registered manager discussed that some staff were reluctant to attend and this led to them not receiving statutory training, such as fire prevention and moving and handling. All staff must receive training to ensure they are competent to carry out the work they are employed to do. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 There was no system in the home of ensuring it was run in the best interests of the residents. Some practices did not safeguard the residents from harm. EVIDENCE: There was no quality review system in the home. The registered manager said she used to do questionnaires, but these had not been produced for some time. No staff meetings took place. No resident’s meetings took place. The residents said they would approach the manager if they were not happy with any aspect of the service. Some system for reviewing the care offered must be developed. The registered person said a risk assessment of the premises had been carried out. This included the bedrooms on the first floor with a balcony that overlooked the lounge. It was discussed that residents using these rooms should be individually assessed for the risk of falling over the balcony railing. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 17 This was raised with particular reference to one resident who was seen to be unsteady on his feet. Staff were seen to use most wheelchairs without footplates attached. This practice poses a serious risk to the safety of the resident and must not continue. All wheelchairs must have footplates fitted and used correctly. The carpet in one bedroom was torn and presented a trip hazard to the resident in that room. This must be repaired or replaced. The accident book which was in current use did not meet data protection legislation. A correct book was present and should be used. Accidents were appropriately recorded and reported to the Commission. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 1 x x x x 2 Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 7 10 19 Regulation 15 12(4)(a) 23 (4)(c )(i) 19 and Schedule 2 24 13(4)(a) Requirement All residents must have a written plan of care which is relevant to their current needs. The staff must respect the privacy and dignity of residents at all times. All fire doors must be kept closed at all times unless held open by a device which meets the guidance of the fire service. All information in Schedule 2 must be obtained prior to any person starting work in the care home. A system for reviewing the quality of care in the home must be established. Risk assessments for individual residents using the rooms with balconies must be carried out. The carpet in a bedroom which is torn must be repaired or replaced. Wheelchairs must not be used without footplates in place. All staff must receive training for the work they are to perform. Timescale for action 30/9/05 30/7/05 19/7/05 4. 29 19/7/05 5. 6. 33 38 31/8/05 30/7/05 7. 8. 38 30 13(4)(c ) 18(1)(c )(i) 19/7/05 31/8/05 Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 20 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. Refer to Standard 36 8 18 Good Practice Recommendations Staff should be appropriately supervised. All changes in condition should be noted and appropriately followed up. The procedures for reporting any allegation of abuse should reflect the West Sussex guidance. Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 2nd Floor , Ridgeworth House, Liverpool Gardens Worthing West Sussex BN11 1RY 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 Firgrove Nursing Home H60-H11 S48351 Firgrove Nursing Home V233505 Unannounced Stage 4.doc Version 1.30 Page 22 - 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. 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