CARE HOME ADULTS 18-65
Firlawn Firlawn 402 Chessington Road West Ewell Surrey KT19 9EG Lead Inspector
Graham Cheney Unannounced Inspection 9th December 2005 11:20 Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 Adults 18-65. 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. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Firlawn Address Firlawn 402 Chessington Road West Ewell Surrey KT19 9EG 020 8786 0514 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) EMAS Limited Company Mrs Jess Puah Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated will be 25 - 60 YEARS 3rd May 2005 Date of last inspection 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 DS0000013642.V265217.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was the home’s second inspection for the year 2005/2006. This was an unannounced visit, which meant that staff and residents did not know that it was due to happen. The inspection started at 11.20 a.m. however on arrival at the home the inspector could not get any response from knocking on the front door, although it was apparent that builders were working at the rear of the premises. Given that the CSCI had not been informed that the building work had commenced nor what plans had been made to ensure the safety and well being of the residents, the inspector went to Oaklawn, the sister home next door owned by the same company. Oaklawn’s manager Mr Puah who is also the responsible individual for Firlawn responded and explained that his wife who had been on duty in the home had an emergency dental appointed and had to leave in a hurry. On entering Firlawn two residents were observed in a small sitting area watching television and builders were working on an extension to the rear of the premises. At the time of the inspection the main lounge/dining area was open to the elements, making the home cold and there were no staff present to supervise and care for the residents. Mr Puah explained that he had arranged for a member of staff from Sapling, the third home in the group situated along the same road, to provide cover for Oaklawn while he covered Firlawn in Mrs Puah’s absence. The inspector went to Firlawn and confirmed that staff cover was in place. Mr Puah also said that one of the residents had gone next door for the day to minimise the effect of the building work. The two remaining residents appeared unconcerned by the builders and Mr Puah stated that they were both fairly independent and had only been alone for a brief period while he had popped next door to check on residents there. Mr Puah acknowledged that there was little evidence to confirm how long the residents had been alone. A requirement has been made regarding the staffing arrangements for the home. The inspector spent time with both the residents, one of whom was new to the home, prior to looking at care plans, records and various documents. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The home failed to notify the Commission for Social Care Inspection that they had admitted the new resident earlier than expected and prior to their application to vary the categories of registration being agreed. This was a Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 7 serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. The home failed to notify CSCI of the commencement of building work in the home and provide detailed risk assessments and plans for ensuring the safety and well being of residents during the disruption. This was a serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. At the commencement of the inspection no staff were present in the home leaving the two residents alone and at potential risk. This was a serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. 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 DS0000013642.V265217.R01.S.doc Version 5.0 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 9 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 the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 the following standard(s): 6, 7 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: The resident who spoke to the inspector said that the building works had not been a problem to him and although he had only been in the home for a week he was happy with the care support being provided. He liked the home and said he got on well with the owners, who were from the same ethnic background and culture. Care plans had been completed for both of the long term residents providing a good level of information about their needs and wishes. A similar plan was being developed for the new resident. Residents were encouraged and supported to be as independent as they were able and involved in what was happening in the home. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 11 The home has responsibility for the personal finances of two of the residents each having their own bank account. Records were in place and all expenditure receipted. It was recommended that the amount of cash held for residents in each service should be reviewed and kept to a minimum. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 13, 14 Evidence gathered during this inspection confirmed that the home meets all 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: Residents go into the local community on a regular basis, which included attending day care. Other trips included leisure activities, shopping and having meals out. The home has its own transport for residents. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 the following standard(s): 20 Evidence gathered during this inspection confirmed that the home meets the assessed standard. This meant that the home was able to demonstrate that residents’ were receiving medication prescribed by their GP in an appropriate manner. EVIDENCE: Standard 20 was assessed 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. ed and records of all incoming and disposed of medication were being kept. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 the following standard(s): Not assessed on this occasion. EVIDENCE: Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 the following standard(s): 24, 30 The home failed to notify CSCI of the commencement of building work in the home and provide detailed risk assessments and plans for ensuring the safety and well being of residents during the disruption. This was a serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. The home therefore failed to comply with the assessed standards. EVIDENCE: On entering Firlawn two residents were observed in a small sitting area watching television and builders were working on an extension to the rear of the premises. At the time of the inspection the main lounge/dining area was open to the elements, making the home cold and there were no staff present to supervise and care for the residents. 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. The extension to the home will provide a further room plus en suite facilities and the Responsible Individual was confident that this would meet the National Minimum Standards.
Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36 At the commencement of the inspection no staff were present in the home leaving the two residents alone and at potential risk. This was a serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. Although it was not established how long residents had been left alone, the home was considered to be failing to meet the assessed standards. EVIDENCE: On entering Firlawn two residents were observed in a small sitting area watching television and builders were working on an extension to the rear of the premises. At the time of the inspection the main lounge/dining area was open to the elements, making the home cold and there were no staff present to supervise and care for the residents. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 17 Mr Puah explained that his wife Mrs Puah the home’s manager had an emergency dental appointment and has left the home, he had arranged for a member of staff from Sapling, the third home in the group situated along the same road, to provide cover for Oaklawn while he covered Firlawn in Mrs Puah’s absence. The inspector went to Oaklawn and confirmed that staff cover was in place. Mr Puah also said that one of the residents had gone next door for the day to minimise the effect of the building work. The two remaining residents appeared unconcerned by the builders and Mr Puah stated that they were both fairly independent and had only been alone for a brief period while he had popped next door to check on residents there. Mr Puah acknowledged that there was little evidence to confirm how long the residents had been alone. A requirement has been made regarding the staffing arrangements for the home. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 41, 42 Given the failings to ensure the home is properly staffed at all times and failing to notify CSCI of significant events which could effect the well being of residents none of the assessed standards were considered met. Residents were put in unnecessary risks by these failings. EVIDENCE: The home failed to notify the Commission for Social Care Inspection that they had admitted the new resident earlier than expected and prior to their application to vary the categories of registration being agreed. This was a serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. The home failed to notify CSCI of the commencement of building work in the home and provide detailed risk assessments and plans for ensuring the safety and well being of residents during the disruption. This was a serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 19 At the commencement of the inspection no staff were present in the home leaving the two residents alone and at potential risk. This was a serious concern and a requirement has been made in this report, the matter has also been dealt with under a separate cover. Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 20 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 X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 1 X X X X X 1 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 1 X 1 1 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Firlawn Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 1 X X X 1 1 X DS0000013642.V265217.R01.S.doc Version 5.0 Page 21 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 YA42 Regulation Requirement Timescale for action 22/12/05 2 YA42 3 YA33 12(1)(a)13(4)(c) The registered persons must provide CSCI with detailed risk assessments and plans for safeguarding residents during the building works at the home. 37 The registered persons must notify CSCI on any incidents that affect or could affect the safety and well being of residents promptly. 12(1)18(1)(a) The registered persons must ensure that the home is appropriately staffed at all times. 09/12/05 09/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Firlawn DS0000013642.V265217.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Surrey Area Office 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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