Inspection on 24/05/05 for Firlawn House Nursing Home

This inspection was carried out on 24th May 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 13/12/05

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 24th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Firlawn House Nursing Home Address The Street Holt Trowbridge Wiltshire BA14 6QH 01225 783333 01225 783478 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) Firlawn Nursing Home Limited Care Home with Nursing 38 Category(ies) of OP Old Age (38) registration, with number PD Physical Disability (2) of places TI Terminally ill (4) Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 4 persons in receipt of terminal care at any one time. 2. No more than 2 physically disabled residents at any one time. 3. The minimum staffing levels set out in the notice of decision dated 4 January 2005 must be met at all times. Date of last inspection 12th October 2004 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 invloved 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 D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 10am and was completed at 3pm. The inspector was able to freely tour the home and visit with the Service Users. The care records were reviewed, as were some of the updated homes’ policies. What the service does well: What has improved since the last inspection? All policies are being reviewed by the Manager ensuring that the homes’ policies are up to date with current practices. The Manager is currently reviewing all Service User contracts, again ensuring the information on the contracts relates to the service being provided. Employment files and contracts are also under review. The Manager has only been in post for a very short period of time but Service Users spoke positively about the new Manager. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 6 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 House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 5 A clear admission procedure is in place and all needs are assessed during the pre admission assessment. All contracts are currently under review. Service Users and families can visit the home as many times as they wish prior to admission. EVIDENCE: All Service Users are fully assessed by the Manager prior to admission to Firlawn to ensure that through the assessment process the home is able to meet the nursing care needs and social needs of the Service User. The assessment is detailed providing information of all current health care needs and social needs. A record of the assessment is kept on file. The Manager is currently reviewing all contracts provided to the Service Users, ensuring the contracts fully provide all information to Service Users regarding the service provided at the home. Service Users are encouraged and invited to visit the home prior to admission, to meet with staff and other Service Users and view the accommodation Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 9 provided. Due to poor health care needs pre admission visits do not always take place, however families and friends are encouraged to visit. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Health care needs of Service Users are monitored and action taken when health care needs change. The home is providing a good standard of nursing care. The care records do not fully address all aspects of care. All care is provided in the privacy of the Service Users bedroom or bathroom. EVIDENCE: Individual care plans are in place and some improvement has been made to the care records, however the standard of recorded information in the care records is variable, as are reviews. Risk assessments are not adequate. The pressure area risk assessments are not reviewed monthly ensuring any risk to the Service User has been identified and addressed. Falls risk assessments were not completed for Service Users who have a history of falls. The care plans were fully discussed with the Manager who is aware of the problem of a lack of documentation. The Manager is currently considering implementing a new care plan system, which will ensure all care needs are fully met. Fluid recording sheets were in place to record the amount of fluid a Service User was taking, however these were not all up to date. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 11 All Service Users are registered with a local GP. Service Users reported they could see their GP and the home would arrange it for them. During the tour of the building and visits with Service Users it was evident that the home is providing a good standard of nursing care. Service Users who were able to communicate also confirmed this and were complimentary of the care provided. All care was observed provided in privacy respecting the Service Users dignity. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Service Users are provided with a good choice of activities. Service Users may receive visitors at any time they wish. Meals are of a good standard with a varied menu and a daily choice. EVIDENCE: The home works very hard to provide a range of activities for different Service Users groups. Two different activities were observed with good attendance from Service Users. Care staff were heard encouraging Service Users to attend activities. Activities are recorded, however the Manager will be implementing a new system for recording which will provide an evaluation system to ensure the activity is appropriate and enjoyed by the Service Users. Another activities person is currently being recruited. Service Users are able to receive visitors at any time from families and friends, which was confirmed by several Service Users. Service Users reported the food as “always good”. The Service Users are provided with a weekly menu so that they are fully informed of what food is available. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a complaints policy and procedure in place. An Abuse policy is in place and staff are aware of local vulnerable adults procedures. EVIDENCE: There is a complaints procedure in place, a copy of which is situated in the entrance hall to the home for anyone to read. When asked by the inspector, Service Users reported they would complain to the Manager or provider if they had a problem. The home has not received any formal complaints. The Abuse policy and procedure has been reviewed and now is in line with local vulnerable adults procedure and guidelines, ensuring the homes’ policy safeguards the Service Users in the event of any abuse taking place. The staff were receiving further training on the subject of abuse. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 The home is well maintained providing a safe environment for Service Users. The home provides a good standard of accommodation for Service Users to live in, which is also clean. EVIDENCE: Both buildings are well furnished with domestic furnishings. Several rooms in the older building have recently been refurbished providing a good standard of accommodation for Service Users, which is also homely. The newer building is purpose built and again provides comfortable accommodation. Both buildings provide a dining room and a communal room. The large well maintained garden is situated between the two buildings with many of the bedrooms overlooking the garden. Many Service Users commented how much they enjoyed looking at the gardens. The gardens are easily accessable to Service Users. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 15 The inspector visited many of the bedrooms, which were well furnished with many personal items seen. The bedrooms were homely and individual. Two bedroom carpets were stained in bedrooms 3 and 8 and will need to be cleaned more frequently or replaced and a commode was seen in bedroom1, which was rusty and could not be effectively cleaned. All areas of the home were clean to a good standard of hygiene and cross infection issues were addressed. The care staff were observed wearing plastic aprons and gloves whilst attending to Service Users personal care needs, and using appropriate hand washing methods, avoiding cross infection between Service Users. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The number of staff available is sufficient to meet the nursing and personal care needs of the Service Users. The procedures for the recruitment of staff is satisfactory and provides the necessary safeguards to offer protection to the Service Users of the home. EVIDENCE: Firlawn has a few members of staff who have worked at the home for many years and have a good understanding of the Service Users groups care needs, and how the home operates. Agency staff are used when staff shortages occur. The home is registered to provide nursing care therefore a qualified nurse is on duty at all times to ensure the nursing needs of the Service Users are met at all times. The qualified nurse is supported by a team of carers who provide all personal care to Service Users. Care staff were observed during the inspection as busy but remained calm and Service Users needs were being met. Good verbal interaction between staff and Service Users was heard. The employment files of three members of staff were reviewed which were satisfactory, however the Manager was in the process of conducting her own review to check employment contracts were up to date and satisfactory. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 Mrs Bagnall has the experience and knowledge to manage the home effectively. Health and Safety issues are fully addressed providing a safe environment for Service Users to live in. EVIDENCE: The Manager Mrs Helen Bagnall is currently in the process of being registered with the CSCI. Mrs Bagnall is a qualified nurse and has been registered before as a manager of a nursing home, she has much experience in caring for older people and managing nursing homes. Fire records were satisfactory as was evidence of fire training for all staff. All accidents are recorded and regularly audited. Electrical equipment throughout the home is tested annually and servicing of hoists was taking place. The home is well maintained. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 4 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 3 Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 19 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 OP7 Regulation 15 Requirement The care plan format will be reviewed and changed if necessary to ensure all care needs are fully identifed and addressed clearly. All staff will receive training in writing an effective care plan to meet the needs of the Service User. All commodes will be audited for rust and replaced as needed. Timescale for action By 15th August 2005 By 15th August 2005 By 15th August 2005 2. OP7 15 3. OP26 23 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 OP24 OP8 Good Practice Recommendations Further cleaning to carpets with stains. Fluid charts should be kept up to date. Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 20 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, 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. Extracts may not be used or reproduced without the express permission of CSCI Firlawn House Nursing Home D51_D01_S15907_FIRLAWNHOUSE_V201404_240505_Stage4.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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