Inspection on 13/12/05 for Firlawn House Nursing Home

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Firlawn House Nursing Home 02/10/08

Firlawn House Nursing Home 05/10/06

Firlawn House Nursing Home 24/05/05

Firlawn House Nursing Home 12/10/04

Firlawn House Nursing Home 21/04/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Firlawn House Nursing Home The Street Holt Trowbridge Wiltshire BA14 6QH Lead Inspector Karen Mandle Unannounced Inspection 13th December 2005 11:00 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 Firlawn House Nursing Home DS0000015907.V261819.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 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. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Firlawn House Nursing Home Address The Street Holt Trowbridge Wiltshire BA14 6QH 01225 783333 01225 783478 normadoveton@firlawn.co.uk 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) Firlawn Nursing Home Limited Mrs Helen Marie Bagnall Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (2), Terminally ill (4) of places Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 4 persons in receipt of terminal care at any one time No more than 2 physically disabled residents at any one time The minimum staffing levels set out in the notice of decision dated 4 January 2005 must be met at all times 24th May 2005 Date of last inspection Brief Description of the Service: Firlawn Nursing Home is registered to provide nursing care for 38 older people. The home consists of two buildings on one site with a large well-maintained garden between the two homes. One Home provides accommodation for 14 Service Users and the other, a newer home provides accommodation for 24 Service Users. All rooms are single many of which have an en-suite facility. Each home has its own dining room and communal lounge.The home is located in the village of Holt which is a few miles from Trowbridge and 3 miles from Melksham in Wiltshire.Firlawn is privately owned and the providers remain actively involved in the day-to-day running of the home. The Manager is Mrs Helen Bagnall who has been in post for only a short period at Firlawn but has much experience in managing nursing homes. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 11am and was completed 4.45pm. The inspector toured the building and visited with service users to observe the care being provided and gain the views of the service provided from the service users. The care records were reviewed, as were the medications. The Registered Manager Mrs Helen Bagnall was available to assist the inspector. What the service does well: What has improved since the last inspection? What they could do better: The care plans should be reviewed monthly or when care needs changed. Service users weights should be more closely monitored to ensure that all Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 6 nutritional needs are being met. The employment files should contain proof of identity for employees. 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 House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 the following standard(s): 3 A clear admission procedure is in place and all needs are assessed during the pre admission assessment. EVIDENCE: The Manager or Deputy Manager assess each service user prior to admission to Firlawn Nursing Home ensuring that through the assessment procedure the home is able to meet both the nursing needs and social needs of the service user. An assessment was reviewed which had taken place during the morning of the inspection which provided information relating to current heath care needs and long-term care needs. A record of the assessment is kept on the service users’ file. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, and 10 The health care needs of service users are monitored and appropriate action taken when health care needs change. The standard of the care plans is improving apart from regular reviews taking place. The medication procedure was safe. The privacy and dignity of the service users is supported by the care team. EVIDENCE: The Manager has implemented a new care plan system, which the majority of service users now have in place. The Manager has provided individual training to the staff that are responsible of the implementation of the care plans. Generally the care plans provided detailed information of health care needs. The inspector reviewed four care plans. The care plans had not all been reviewed monthly and did not provide evidence of monthly weights of service users being monitored. The inspector toured the home and visited with service users. The service users who were able to communicate informed the inspector that they were happy with the care provided and felt that all their health care needs were Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 10 met. Service users who were unable to communicate had care/fluid charts in place providing evidence of close monitoring by the care staff. The charts were kept up to date through out the inspection. All service users are registered with a local GP who visits on request and written evidence of the GPs’ visits was seen. Service users at risk of pressure breakdown had all the appropriate equipment in place. The medication procedure was reviewed and all medication was stored safely as was the medication trolley. The home had recently changed the medication procedure to a monitored dosage system to try and ensure a safer method of administering medications to service users. The stock medication control was satisfactory. The control medications were limited, accurate and stored correctly. The Manager has recently renewed the medication policy, which is up to date with current legislation. However handwritten medication orders were not countersigned by two trained nurses ensuring the safety of the order. The inspector observed a good standard of personal care being provided. Service users who were able to communicate confirmed that all nursing care and personal care was performed in the privacy of their bedroom or bathroom. This was also observed taking place whilst the inspector toured the building. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 the following standard(s): 12, 14 and 15 Firlawn provides a good activities programme for the service users. Service users are provided with support to make choices and have control of their own lives where possible. Service users’ enjoyed the food and a varied well balanced diet is provided by the home. EVIDENCE: The home continues to provide a range of activities. An activities person is now employed for 25 hours per week and the Provider of Firlawn continues with the weekly art class which is popular with the service users. A new system of recording has been implemented providing much more detail about the activities provided and the outcome of the activity. Service users who were able to communicate confirmed that they were supported with choice as to when they went to bed or what activities they wished to do. Each service user is provided with information of the weekly activities and the weekly menu. Service users were complimentary of the standard of food provided which they described as “home cooked”. Service users were observed having lunch in the dining room or in their bedrooms as they choose. Service users requiring assistance with their meals were observed being provided with help from the care team on a one to one basis. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 A complaints policy and procedure is in place. Staff had received abuse awareness training and were informed of the local vulnerable adults procedure. EVIDENCE: A complaints policy and procedure is in place, which is available in the entrance hall to the home for service users and visitors to read. The home has not received any formal complaints. Three service users were asked whom they would talk to if they had concerns or a complaint to make, all replied that they would talk to Helen the Manager. An “Abuse Awareness” policy is in place and a revised and improved “Whistle Blowing” policy is also now in place. All the staff had recently received training in abuse awareness and the local vulnerable adults procedure. The Manager is fully informed of the local vulnerable adults procedure and is confident to implement the procedure where needed. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 the following standard(s): 19, 24 and 26 The home is well maintained providing a safe environment for service users and staff. The home is clean and infection control measures in place. The bedrooms are well furnished and personalised. EVIDENCE: Firlawn is well maintained through out and provides a comfortable standard of accommodation for service users to live in. A full time maintenance person is employed who oversees the maintenance of both buildings ensuring a safe environment for service users and staff. The décor and the furnishings are domestic and homely. Many of the bedrooms were visited which were personalised and homely. All bedrooms were well furnished. However an odour was noted in one ground floor bedroom, which was identified to the Manager. Service users were complimentary of the standard of accommodation. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 14 The home was generally clean through out. The communal bathrooms were cleaned to a good standard. Infection control measures are in place with adequate hand washing facilities provided for the care staff. Clinical waste is dealt with appropriately. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 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, 29 and 30 The number of care/nursing staff was sufficient to meeting the care needs of the service users. The recruitment procedures do not fully protect service users. Staff had been provided with appropriate training in line with service users needs. EVIDENCE: The home was providing nursing care for 32 service users at the time of the inspection. A team of 6 carers and 2 RGN’s, the Manager and Deputy Manager both of who are qualified nurses were on duty. This staffing level is sufficient to meet the care and nursing needs of the service users. Agency staff had been used when the agreed staffing notice could not be met. Three employment files were reviewed which did not provide proof of identification of the person. However appropriate police checks had been made and references obtained. A training manager is now in post providing more in-house training and ensuring that all mandatory training has been provided. Training records are in place. A high percentage of care staff has obtained NVQ Level 2 and several carers have now commenced Level 3. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 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): 35, 36 and 38 The staff do not received documented one to one supervision. EVIDENCE: The Registered Manager informed the inspector she is currently reviewing the systems in place regarding service users financial arrangements within the home, therefore the inspector will fully review standard 35 at the next inspection. The Registered Manager openly discussed the lack of documented supervision, which she is currently working towards implementing. However the care staff are supervised by the trained nurses when they are providing care to service users. The home is well maintained through out with health and safety issues being addressed. The fire log indicated that weekly checks are made of the alarm Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 17 system and staff was provided with fire training. All accidents are recorded and it was noted that a low incident of falls take place. The Manager commented that the care staff were good at observing and monitoring service users at risk of falling. Electrical equipment is tested annually as were the lifting hoists. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 3 Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO 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 The Registered Person will ensure that all care plans are reviewed monthly or when care needs changed. The Registered Person will ensure evidence is available in the care plans that service users are being weighed monthly. The Registered Person will ensure that handwritten orders are countersigned by two trained nurses. The Registered Person will ensure that all staff will be provided with one to one supervision. The Registered Person will ensure that all employment files have proof of identity. Timescale for action 01/02/06 2. OP7 15 01/02/06 3. OP9 13(2) 01/02/06 4 OP36 18(2) 21/02/06 5 OP29 19 01/02/06 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 Good Practice Recommendations DS0000015907.V261819.R01.S.doc Version 5.0 Page 20 Firlawn House Nursing Home 1. Standard OP24 The Registered Person should ensure that bedrooms at risk of having an odour should be cleaned more regularly. Firlawn House Nursing Home DS0000015907.V261819.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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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