CARE HOME ADULTS 18-65
Firlawn 402 Chessington Road West Ewell Surrey KT19 9EG Lead Inspector
Graham Cheney Announced 03 May 2005 14:00 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Firlawn Address 402 Chessington Road, West Ewell, Surrey, KT19 9EG 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) 020 87860514 EMAS Limited Company Mrs Jess Puah CRH Care Home 3 Category(ies) of LD Learning Disability, 3 registration, with number of places Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age range of the persons to be accommodated will be 25 - 60 years. Date of last inspection 11 November 2004 Brief Description of the Service: Firlawn provides services for up to three service users with a learning disability. The property is a bungalow, which comprises of a large lounge/dining room and small separate sitting area, single bedroom accommodation, kitchen, laundry and two bathrooms. There are no en-suite facilities however, the three bedrooms are sited near to the bathroom. The bungalow is located off a main road, with ample parking for 4 cars. There is a large garden to the rear of the property which is shared by the companys sister home Oaklawn next door. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was the home’s first inspection for the year 2005/2006. This was an announced visit, which meant that staff and residents knew that it was due to happen. The inspection started at 2.00 p.m. and the inspector had the opportunity to meet both of the current residents. This was the first time the inspector had been to Firlawn and the first part of the visit was taken up with an introduction to one of the residents, a member of staff and a tour of the building. The inspector met the second resident on his return from day care. The rest of the time was spent observing staff and residents together, looking at records and reports and talking to the manager about how the home was run. Both of the residents had some difficulty with verbal communication, but were able to express themselves in a variety of ways that staff were able to recognise and respond to appropriately. The inspector was made very welcome and would like to thank the residents and staff. What the service does well:
As stated above the residents had some difficulties with verbal communication but observations indicated that the relationship between residents and staff was relaxed and very friendly, creating a warm and homely feel in the home. Staff demonstrated a good level of understanding of the residents’ behaviours and what they wanted to communicate. Residents were encouraged and supported to be as independent as they were able and involved in what was happening in the home. The manager said that they had got to know both residents well and understood their likes and dislikes, for example they had found that one of them likes to watch sport, while the other prefers cartoons. A music therapist attends the home and works with both residents and the manager felt that they had benefited greatly from this. Residents can also have hand and foot massages, which again they were said to enjoy. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 6 Residents also go into the local community on a regular basis, which included attending day care, leisure activities, shopping and having meals out. The home has its own transport for residents. One of the residents did not get on well in crowds and it appeared that going out for a drive was one of the most popular things that residents enjoyed. The residents have the opportunity of a holiday, which staff felt they appeared to enjoy. What has improved since the last inspection? 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.
Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4 The home was generally operating effectively in respect of these standards. Information about the home was up to date, although more details about the registered manager were required (Please see below). Such information was readily available to residents and provided a good level of detail about the home, which would help prospective residents or their supporters to make an informed choice as to whether the home would be a suitable place to live. EVIDENCE: Sampling of care plans provided evidence that the home has established a sound process of assessing residents’ needs and aspirations Other than adding more information about the registered manager’s experience and qualification the home’s statement of purpose and service user guide were in line with the Standard and Regulations. The home’s complaints procedure has been looked at and made easier for residents or their supporters to follow if they have a problem. Although readily available these had very limited value to the existing residents who were not able to take on board such details. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 9 Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 10 Evidence gathered from this inspection indicated that each of these standards was being met effectively. This gives confidence that each individual’s needs and aspirations were being recognised and met, to the best ability of the staff. EVIDENCE: The current residents both had some difficulties with verbal communication and comprehension, but observations indicated that the relationship between them and staff was relaxed and very friendly, creating a warm and homely feel in the home. Staff demonstrated a good level of understanding of the residents’ behaviours and what they wanted to communicate. Residents were encouraged and supported to be as independent as they were able and involved in what was happening in the home. In relation to NMS 6 and 10 there was no indication that the current residents would be able to comprehend that care plans contained information about them or that this was being kept confidentially. This did not detract from the judgement on compliance with these standards. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 16, 17 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. This meant that the home was able to demonstrate that residents were encouraged and supported to lead as independent and fulfilling life as they were able. EVIDENCE: Given the residents’ difficulties with verbal communication and comprehension, observations of the interactions with staff indicated that they were able to express themselves in a variety of ways that staff were able to recognise and respond to appropriately. The manager said that they had got to know both residents well and understood their likes and dislikes, i.e. with meals and they had found that one of them likes to watch sport, while the other prefers cartoons.
Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 12 Residents also go into the local community on a regular basis, which included attending day care, leisure activities, shopping and having meals out. The home has its own transport for residents. One of the residents did not get on well in crowds and it appeared that going out for a drive was one of the most popular things that residents enjoyed. The residents have the opportunity of a holiday, which staff felt they appeared to enjoy. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 20, 21 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. This meant that the home was able to demonstrate that residents’ health and personal care needs were being appropriately met. EVIDENCE: Standard 20 was assessed on this occasion and the practice for administering medication complied with the Royal Pharmaceutical Society’s guidance. On the evidence presented the home was therefore obtaining, storing, administering and recording medication appropriately. It was recommended that the quantities of medication received be recorded on the medication record sheets rather than in a separate book. A music therapist attends the home and works with both residents and the manager felt that they had benefited greatly from this. Residents can also have hand and foot massages, which again they were said to enjoy. The home has had to address the issues of bereavement recently with the death of one of the residents. Discussion with the manager suggested that this was well managed with the other residents being appropriately informed of what had happened and supported. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Evidence gathered during this inspection confirmed that the home meets the assessed standard. This meant that the home was able to demonstrate that residents’ views were important and acted upon. EVIDENCE: The home’s complaints procedure has been looked at and made easier for residents or their supporters to follow if they have a problem. It remains debatable as to whether the residents would be able to follow such a procedure, but observations of the interactions between residents and staff indicated that staff understood the residents well and were able to respond to different behaviours appropriately. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 28, 30 Firlawn was a pre-existing, (before 2002) registered small care home. Given this the evidence gathered during this inspection confirmed that the home meets each of the assessed standards and provides a reasonable level of accommodation appropriate to the needs of the current residents. EVIDENCE: The home was generally operating to a good standard. Having been originally registered as a small care home it did not have to meet the same standards as a larger or more recently registered service, for example washbasins had not been fitted in residents’ rooms. Given the level of dependency of the current residents this was not an issue as they both required support with their personal care. On the day of inspection the home was very clean and tidy and well maintained. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, 36 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. Staff appeared to be enthusiastic and committed to supporting residents, with training and development given a priority. EVIDENCE: Training and development of staff has been given priority with staff undertaking a range of training to help them care for and support the residents. The manager was looking to become an assessor for the NVQ. The manager demonstrated that she now has regular supervision sessions with all staff to provide support and guidance. As stated above the residents had some difficulties with verbal communication but observations indicated a sound relationship between residents and staff, creating a warm and homely feel in the home. Staff demonstrated a good level of understanding of the residents’ behaviours and what they wanted to communicate. Residents were encouraged and supported to be as independent as they were able and involved in what was happening in the home. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 17 All staff were subject to CRB and POVA checks before they commence duty and any issues identified were appropriately managed. The manager was advised that once seen by the inspector CRB checks should be disposed off to ensure compliance with the Data Protection legislation. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 42 Evidence gathered during this inspection confirmed that, the home meets each of the assessed standards and was seen to be well run, with sound and accountable management support. EVIDENCE: The home’s owners have started to carry out checks to make sure that a good quality of service is being provided to the residents. These include quality and health & safety audits. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 x 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 2 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Firlawn Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 3 x H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 20 no 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. Standard YA1 Regulation 4 Requirement More information about the registered manager’s experience and qualification must be included in the home’s statement of purpose. Timescale for action 2 months 03.06.05 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. Refer to Standard YA20 YA34 Good Practice Recommendations It was recommended that the quantities of medication received be recorded on the medication record sheets rather than in a separate book. The manager was advised that once seen by the inspector CRB checks should be disposed off to ensure compliance with the Data Protection legislation. Firlawn H58_s13642_Firlawn_v214654_030505 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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