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Inspection on 06/04/06 for Firgrove Nursing Home

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

This inspection was carried out on 6th 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.

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

The service is very welcoming to relatives and they are encouraged to visit residents at any time of the day. Two visitors commented that they are always offered a cup of tea when they visit. The residents spoken with liked their rooms. Some residents made very positive comments about the staff saying they were kind caring and committed. A full and robust assessment of residents needs is now carried out before residents come to live in the home and used to ensure that the Firgrove is going to be a suitable place for them to live. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. There are two passenger lifts.

What has improved since the last inspection?

Since the last inspection, the home has reviewed its system of care planning which when fully completed should identify residents` needs and the individual support required to meet them. The trip hazard noted at the last inspection has been removed.

What the care home could do better:

The majority of the requirements made at this inspection have previously been raised as areas for improvement at Firgrove Nursing Home. There are concerns at the level of documentation and recording in the home. The danger of not maintaining accurate records is always that staff may not provide safe and consistent care and that changes in needs cannot be tracked. The manager has started the process of supervision, however this needs to be more proactive to assist staff to improve the quality of care and provide safety for the residents. The care staff require practical supervision by qualified nurses in order to improve the delivery of care. The method of reviewing care plans needs to be improved. The staff confirmed that the care needs of residents had changed often many weeks before. An example of this was a resident who according to the care plan could eat without assistance. Staff confirmed that this resident had required assisting with meals for at least a week. The records had been signed by the manager as being reviewed. As identified, the level of basic care provided at the home is good, but the records in place does not reflect the work staff undertake. The way risk assessments are recorded should be reviewed to cover all potentially risky activities and to more comprehensively detail how the controls in place manage the risk.Furniture and equipment should be maintained in good condition. It is clear from all the evidence that this home would benefit from a robust quality assurance programme. This would enable the manager to identify issues, which affect the resident`s quality of care and ensure they are addressed and or rectified.

CARE HOMES FOR OLDER PEOPLE Firgrove Nursing Home Keymer Road Burgess Hill West Sussex RH15 0AL Lead Inspector Mrs Judith Farrell Unannounced Inspection 6th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Firgrove Nursing Home DS0000048351.V288782.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. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 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 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) 01444 233843 Firgrove Care Home Limited Mrs Sareeta Kumaree Lollchand Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (6), Physical disability of places over 65 years of age (6) Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 6 service users in the PD, PD (E) category maybe admitted Only service users over the age of 50 years in the category of Physical Disability (PD) maybe admitted A maximum of 35 service users may be accommodated at any one time 8th December 2005 Date of last inspection Brief Description of the Service: 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, a lounge/dining area, which is roofed in glass and has tables with umbrellas to provide shade when needed and a small reception/sitting area. There is a large garden to the rear of 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 DS0000048351.V288782.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9.45 hours on Thursday 6th April 2006. This is the first Key inspection of this year. A tour of the premises took place, rotas and care records were inspected. Ten of the thirty-one service users and seven staff members were spoken with. The Inspectors observed the lunchtime and teatime meal being served. Three inspectors were involved in the inspection. Mrs Farrell (the lead Inspector) Mrs Riddle the second Inspector and Mrs Datoo who is a specialised inspector in pharmacy and only looked at the regulations and the standard regarding medication. She spent 2hrs at the home. Both other inspectors spent 5 hours touring the home and talking to residents. A further 4 hours were spent in discussion with the manager and examining records. Residents and staff members were spoken with, to gain a sense of what it was like to live in the Firgrove Nursing Home. Some residents and relatives spoke highly about the staff at the home and described them as friendly and caring. One relative said “staff are always so polite”. Comments from residents included “they do just what I tell them I think they are just fine”. The residents have different levels of communication abilities and therefore it was difficult to ascertain all their views on how their needs are met. It was noted that although the care staff are committed to the resident’s wellbeing and some good interaction and support was observed to some residents, the inspectors were concerned that the care staff do not have a clear understanding of the needs of the most vulnerable residents and how these should be met. Some comments from residents and staff were gathered regarding poor communication between staff and themselves this was also observed by the inspectors. The Inspectors would like to thank the management, staff and residents for their hospitality and cooperation throughout the inspection. What the service does well: The service is very welcoming to relatives and they are encouraged to visit residents at any time of the day. Two visitors commented that they are always offered a cup of tea when they visit. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 6 The residents spoken with liked their rooms. Some residents made very positive comments about the staff saying they were kind caring and committed. A full and robust assessment of residents needs is now carried out before residents come to live in the home and used to ensure that the Firgrove is going to be a suitable place for them to live. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. There are two passenger lifts. What has improved since the last inspection? What they could do better: The majority of the requirements made at this inspection have previously been raised as areas for improvement at Firgrove Nursing Home. There are concerns at the level of documentation and recording in the home. The danger of not maintaining accurate records is always that staff may not provide safe and consistent care and that changes in needs cannot be tracked. The manager has started the process of supervision, however this needs to be more proactive to assist staff to improve the quality of care and provide safety for the residents. The care staff require practical supervision by qualified nurses in order to improve the delivery of care. The method of reviewing care plans needs to be improved. The staff confirmed that the care needs of residents had changed often many weeks before. An example of this was a resident who according to the care plan could eat without assistance. Staff confirmed that this resident had required assisting with meals for at least a week. The records had been signed by the manager as being reviewed. As identified, the level of basic care provided at the home is good, but the records in place does not reflect the work staff undertake. The way risk assessments are recorded should be reviewed to cover all potentially risky activities and to more comprehensively detail how the controls in place manage the risk. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 7 Furniture and equipment should be maintained in good condition. It is clear from all the evidence that this home would benefit from a robust quality assurance programme. This would enable the manager to identify issues, which affect the resident’s quality of care and ensure they are addressed and or rectified. 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 DS0000048351.V288782.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 Firgrove Nursing Home DS0000048351.V288782.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): 1,3,4 The outcome for the residents in this area is adequate. Arrangements are in place to ensure that the health care needs of residents are identified and recorded. A written agreement identifying that the home can meet the care needs should be given to the resident or their advocate Staff must have sufficient knowledge and abilities to meet the needs of the residents admitted otherwise this could potentially place the residents at risk. EVIDENCE: The home’s Statement of Purpose and Service Users Guide is good and provides sufficient information so that prospective service users are clear about the services the home provides to meet their needs. Five pre admission assessment documents were looked at and they clearly showed that the admission procedure was thorough and well recorded. This procedure ensures that new resident’s needs are properly assessed and planned for. Three of the five residents spoken with, were able to provide Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 10 significant information about their care needs, these had all been recorded. The staff members on duty were aware of the assessments but were not all able to fully undertake the care needed due to lack of understanding of the different conditions. This was particularly noted in relation to dementia care. The inspectors saw examples of staff being unable to communicate effectively with residents who have communication issues. This included a resident who was being assisted to a chair, staff failed to communicate with the resident even when moving him in a backward direction and sitting him down in a chair. There was evidence to demonstrate that residents are offered a trial period at the home, before a placement becomes permanent. This should be followed up by the home informing residents in writing that they are able to meet their needs at the end of the trial period. This home does not provide intermediate care. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The outcome for the residents in this area is adequate. The system of care planning does not provide robust up-to-date support plans to guide staff in the delivery of identified care needs. Service users and their relatives or advocates are not formally involved on a regular basis in developing and reviewing the plans in place to support residents. There are some shortfalls particularly in relation to communication and training which have a potential to place residents at risk. The home was able to demonstrate good medication practices. EVIDENCE: The care plans for five residents were viewed; the manager stated that significant improvements had been made since the last inspection. All care plans examined had a review date on them. However some residents health care needs had changed but the areas of concern had only been recorded in the daily notes not in the care plans. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 12 There was no written evidence that residents or their relatives have been consulted in developing or reviewing the care plans. The National Minimum Standards recommend that residents or their relatives should sign their agreement to the contents of the care plan and to any review. Evidence of this was not available to the inspectors in those plans examined. One relative spoken with, did say that she had been consulted about the plan on one occasion some time ago. Two residents spoken with could not confirm that they had been consulted regarding care planning. Other residents were unable to assist inspectors due to lack of cognitive ability. Medication policy and procedures were available to staff. Updating the disposal procedure was discussed with the manager. No residents had responsibility for their own medicines. Medicines were in locked storage, including a fridge. It was recommended that staff were made aware of the storage information on medicine packaging. Records of medicine receipt, administration or refusal and disposal were sampled. Staff said that the supplying pharmacist gave advice. A resident said that she felt happy and safe in the home and that the nurses told her about each of her medicines. The home has a range of risk assessments in place in respect of varying aspects of service users’ lives. Some further work in this area is required to ensure the risks associated with all activities are considered. Many of the risk assessments in place require additional information about the effect controls in place have on the level of risk. This includes risk of choking, falling and how to deal with challenging behaviour. It was noted that bedroom doors have no locks on them. This could lead to resident’s dignity and privacy not being respected. The manager was reminded that doors to service users private accommodation should be fitted with locks suited to service user’s capabilities and accessible to staff in emergencies. Service users are provided with keys unless their risk assessment suggests otherwise. There were no risk assessments regarding locks seen in the care plan. However there was documented evidence that residents and relatives had been asked if they wish to have a lock on their doors. Other issue identified were that there was no evidence to support that residents had made a positive choice to share a bedroom. The manager was advised to undertake an audit of the care plans to assess the quality. The manager advised that there is a very good working relationship with the resident’s GPs and the district nurse service. All residents are funded and Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 13 requiring nursing care. District nurses are coming into the home to undertake care of one resident. The manager confirmed that this was due to staff being unable to undertake this task because they had not been trained to do so. The residents can choose which GP they wish to register with, in the locality. Residents spoken to discussed how they are assisted to attend all hospital outpatients, dentist, eye, and hearing appointments. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 14 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): 12,13,14,15 The outcome for the residents in this area is adequate. Routines in the home could be more flexible. Most residents who could communicate said that their social needs were met as far as possible taking into account their increased physical frailty. Opportunities are offered for more able residents to be involved in activities and for all residents to have contact with family, friends and the local community. The home is not pro-active in offering a choice of meals. EVIDENCE: It was clear from observation that Firgrove Nursing Homes is substantially routine driven, particularly in relation to meal times and the provision of personal care. There is little flexibility about what time residents can take their meals and rotas for getting up, bedtime, bathing and room cleaning unless residents can clearly communicate their wishes. The inspection took place on a Thursday and during this time service users were observed watching television or listening to music. Staffing levels were adequate for the number of service users. One resident who was in the garden room (which is where the majority of activities take place) informed the Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 15 inspector that they had started a quiz but some relatives came to visit their relative and they had to stop. Staff informed the inspectors that they undertake the majority of the activities. A resident commented that ‘staff will put on music or a video without asking if we want to have these on’. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. There are two passenger lifts and the provider would like to add that there are a range of pictures on the wall and a range of social and recreational activities. Some residents did say they would like to have a more robust programme of activities. The manager stated that there was a programme of activities however this was not always followed. Staff stated that during the summer residents like to go into the garden, which was seen to be large and well kept, with an attractive large well-stocked fishpond. Staff also stated that no activities take place at the weekends because they are so many visitors. They were unaware of what type of activities they might be able to undertake with more dependant residents, as this had not been mentioned to them. Both Inspectors observed lunch and tea in different areas with the residents. Residents interviewed said the food was good and they could choose a different main meal, but that they would have to let the cook know in plenty of time otherwise they would have to wait. The cook confirmed she has to serve lunches before she can prepare any other food. Residents said there was more choice for supper. Home made cake is offered at tea time. The Inspectors observed staff assisting residents to eat. There was some poor communication noted and this was fed back to the manager. There are no nutritional risk assessments in place for those residents who cannot communicate their needs and preferences. A drink is served to residents in the evening. Feedback from residents indicated that biscuit’s or snacks are not always offered with this drink. When an evening snack is not provided, the time without food exceeds twelve hours. Quality auditing could be used to identify residents’ wishes and preferences. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The outcome for the residents in this area is adequate. Complaints are being forwarded to the management from care staff. However the recording of the outcomes of these complaints is at present inadequate this might lead to lessons not being learned and issues not being resolved. The recruitment process does protect residents from abuse. EVIDENCE: All service users who could communicate were spoken with and were able to explain what they would do if they were not happy about any aspect of their care. Similarly, the relatives expressed that should they wish to raise a complaint they would either inform care staff on duty or speak to the Manager. A relative was noted to have raised a complaint with the manager regarding the amount of time it was taking to replace her relatives call bell pendent. No action was recorded however the manager stated that it was being sorted out. The complaints file/book was viewed however it did not hold enough information to audit that any action that had taken place with regard to the complaint. The manager was advised that there needs to be a system developed to ensure that complaints or concerns are recorded in a clear auditable way. The manager was reminded that a record of all complaints should be made and includes details of investigation and any action taken. It was reported that most staff have had some training on how to protect residents. The staff interviewed had mixed levels of knowledge about the Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 17 vulnerability of residents and what constitutes abuse. A copy of the protection policy, which now includes the guidelines set out by West Sussex Multi-Agency Policy and Procedure for Protecting Vulnerable Adults, was confirmed by the manager as in place. Staff files were seen and all contained CRB checks. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The outcome for the residents in this area is adequate. Resident’s benefit from an environment, which provides choice of space, however, a number of maintenance and safety issues need to be addressed as they could pose a potential risk to the safety of the residents. EVIDENCE: 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. Two vertical lifts provide access to each of these floors. Communal facilities, which are located on the ground floor, include a sun lounge, a lounge/dining area, which is roofed in glass and has tables with umbrellas to provide shade when needed and a small reception/sitting area. There is a large garden to the rear of 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 DS0000048351.V288782.R01.S.doc Version 5.1 Page 19 A tour of the premises was undertaken with the manager present. Some toilet aids were found to be rusty and these need to be made good. Some comodes were also found to be rusty, though the manager did say that she had replaced twelve of them in the last few weeks. Many of the resident’s bedroom doors were wedged open with metal wedges. The inner kitchen door and laundry door were also wedged open. The Laundry door also had a closure problem. An immediate requirement was left with the manager regarding the wedging open of fire doors. Bedrooms viewed were clean and odour free however the carpet in some of the bedrooms is worn. The manager stated that new carpet had been measured for but she was unaware if it had been been ordered. These matters were discussed with the manager at the time of inspection. Residents in their bedrooms at the time of inspection stated that they were happy with their rooms. It is recommended that an audit of aids and equipment be undertaken to ensure that it is all in good condition and working order. In one room there was an additional heater which was so hot that the inspector could only hold her hand against this for a few moments. This heater was positioned next to a comode, and had been placed in a room with a resident who was at high risk of falling. The manager could not explain why the heater had been placed in the room but had it removed at once. The Inspectors also found another heater in another room which was also very hot, this was also removed. The manager was unaware if there was any problem with the heating. Bathrooms are noted to be used as storage for the hoists. Some hoists were found not to have been cleaned recently. Staff were asked whose responsibility it was to clean equipment, they said everyone. The COSH cupboard was locked. However sluices which had chemicals in were not. The length of time taken by staff to respond to call bells was discussed with the manager and it is recommended that monitoring of this takes place. Staff interviewed were clear about infection control measures regarding hand washing, wearing of gloves and aprons, however were less sure about the home’s policies regarding the cleaning of equipment and how not ensuring equipment is clean and rust free might inpact on infection control issues. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29,30 The outcome for the residents in this area is adequate. This judgement has been made from evidence during the visit to this service. The procedures for the recruitment of staff ensure that residents are protected. The deployment, time management and skills of staff may not be sufficient to meet the needs of the residents. EVIDENCE: On the day of inspection, there were a sufficient number of staff to support the needs of residents as detailed in the care plans. Staff spoken with confirmed that staffing levels were adequate at this time. The duty rota was viewed and five staff files examined closely. It was noted that some evidence was missing from the files. This evidence must have been present to have gained a CRB but had not been photo copied and placed in the file. The manager was advised to develop some sort of checklist, which would assist her in the auditing of the files. The residents who spoke with the inspectors commented how nice staff were and how they felt relaxed and happy to ask for help. The Inspectors observed lots of positive interaction between residents who were able to communicate meaningfully with staff. However both inspectors saw incidents where communication was poor, and staff who were engaged in non-activity when residents needed help. One relative stated “this is not uncommon I help other residents (at tea time mostly). It’s not that staff are unkind or unhelpful, on Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 21 the contrary staff are only too happy to help if you ask them but they just don’t seem to see what needs to be done”. Staff training is ongoing. Staff interviewed, confirmed that they had not all had training in First Aid, Fire Safety and Protection of Vulnerable Adults or Moving and Handling. The current monitoring and recording of training does not allow the manager to clearly see what each member of staff has undertaken. It was therefore recommended that a training matrix be developed for ease of reference. At present there is one member of staff with an NVQ level 3 in care and 3 staff who hold equivalent qualifications, 2 members of staff with NVQ 2 and one training at the moment. This is still not eqiuvalent to 50 of care staff. One member of staff who discussed the NVQ training, stated that they would like to undertake the traning but is unable to do this because of the cost. The manager did inform the Inspectors that the provider had offered to meet half of the costs. Induction training is provided and staff confirmed that this is carried out with the aid of the ‘blue book’. This blue book is a recording system. The blue book was viewed and the manager was advised to discuss the content and the assessment process with ‘Skills for Care’ to confirm it meets their standard. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36, 38 The outcome for the residents in this area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Management systems within the home do not ensure that residents receive a service which meets its purpose and aims and objectives. There are no thorough systems for reviewing the quality of care delivered to residents in the home. The resident’s financial interests are safeguarded. Some practices, environmental issues and lack of documentation do not protect the health, safety and welfare of the residents. EVIDENCE: Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 23 The manager is a 1st level registered nursed who is registered with the Commission. Staff were very positive about the working environment and made very positive statements about the manager. They talked about one to one meetings they had with the manager, which they felt benefited the resident. However they did feel that they should have staff meetings to air issues. All staff interviewed were able to confirm that they had received formal supervision in the last six months. However staff were unable to confirm that they had received all mandatory training this included prevention of abuse, first aid and fire. It was clear from speaking to staff on the day of inspection that they were aware of the homes health and safety policies however some poor practices were observed. This involved the cleaning of equipment used by residents. Based on observations made by both inspectors during the inspection, it is considered that the manager should be providing closer supervision of practice and observation in relation to the delivery of care. There is clear reference to a Quality Assurance process in the Statement of Purpose and Service Users Guide however the manager stated that she is still no way forward in this issue. Mrs Riddle and Mrs Farrell discussed and reiterated the importance of the Quality Assurance system as the way to provide evidence that the home is run in the best interests of the service users. It was also reiterated that this review of quality of care needs to be formatted into a report and made available to the Commission. A quality assurance questionaire was seen at the time of the last inspection. However, the manager stated that there had been no further development of a quality assurance system since then. Residents and relatives spoken with on the day expressed views that support the view of the inspectors, that the current arrangement is insufficient to fully meet this standard. It was noted that not all acidents or incidents have been recorded in the acidents book. The manager stated that this would be adressed immediately. Residents said they the home had no dealings with their personal finances. The manager confirmed this. Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 3 x 1 Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 25 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 OP7 Regulation 15 Requirement All residents must have a written plan of care, which is relevant to their current needs. All aspects of care must be included. This requirement remains unmet This is the third time this has been a requirement. All fire doors must be kept closed at all times unless held open by a device, which meets the guidance of the fire service. This requirement remains unmet. This is the third time this has been made a requirement A system for reviewing the quality of care in the home must be established. This requirement remains unmet. This is the third time this has been made a requirement. All staff must receive training for the work they are to perform. This requirement remains unmet. This is the third time this has been made a requirement. This should include the following DS0000048351.V288782.R01.S.doc Timescale for action 30/05/06 2. OP19 23 (4)(c)(i) 06/04/06 3. OP33 24 30/05/06 4. OP28 18(1)(c)(i ) 01/07/06 Firgrove Nursing Home Version 5.1 Page 26 Standards. OP18 OP26 OP38 OP4 OP30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Firgrove Nursing Home DS0000048351.V288782.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Worthing LO 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. 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