Inspection on 10/10/06 for The Firs

This inspection was carried out on 10th October 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.

Other inspections for this house

The Firs 08/03/10

The Firs 24/11/09

The Firs 24/11/08

The Firs 12/08/07

The Firs 01/12/05

The Firs 22/07/05

The Firs 01/03/05

The Firs 18/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Firs and 16 Margaret Road, The 141 Malvern Road Worcester Worcestershire WR2 4LN Lead Inspector Andrew Spearing-Brown Unannounced Inspection 08:00 10 October and 17 November 2006 th th 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 Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 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. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs and 16 Margaret Road, The Address 141 Malvern Road Worcester Worcestershire WR2 4LN 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) 01905 426194 F/P 01905 426194 Eldahurst Limited Mrs Sandra Lynne Ghalamkari Care Home 19 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (15) Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The Firs may accommodate a maximum of 15 people in categories OP, and PD(E) and DE(E). 16 Margaret Road may accommodate a maximum of 4 people. The Firs may only accommodate a maximum of 2 residents with a dementia type illness. Margaret Road may not accommodate any person with a physical disability. 1st December 2005 Date of last inspection Brief Description of the Service: The Firs provides board, accommodation and personal care for fifteen people over the age of sixty-five years with physical disabilities. 16 Margaret Road is a separate semi-detached house that is divided from The Firs by their joint back gardens. The two properties are registered as one care home. The home is located in the St Johns area of Worcester. The two buildings are adapted and extended domestic dwellings providing four single bedrooms in Margaret Road and eleven single bedrooms and two double bedrooms in The Firs. There is one single room in The Firs that measures slightly less than ten square meters. All other bedrooms meet or exceed the National Minimum Standards. A shaft lift is provided in The Firs and a stair lift in 16, Margaret Road. The registered proprietor is the company Eldahurst Limited. The responsible individual and the registered person is Mrs Sandra Lynne Ghalamkari. The pre inspection information received by the Commission prior to this inspection stated that fees at The Firs and Margaret Road currently range from £343.00 to £385.00 per week. Charges / fees do not include hairdressing, chiropody (private) newspapers, clothing, spectacles, cigarettes and alcohol. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspector from the Worcester office of the Commission for Social Care Inspection (CSCI) carried out this inspection. The focus of any inspection carried out by the CSCI is to assess the outcomes for people who use the service. As part of the overall inspection of the service offered at The Firs and Margaret Road two separate visits to the home were undertaken. The visits were unannounced and lasted a total of 14 hours, both visits started early morning while the night staff were still on duty. The last visit to the home took place on the 1st December 2005. This inspection takes into account information received by the CSCI since the previous inspection as well as the visits to the home. The majority of ‘key standards’ were assessed as part of this inspection; those not assessed will be assessed as part of a forthcoming visit to the home. Prior to the visit a pre inspection questionnaire was posted to the registered person requesting certain information. The inspector received the completed document prior to the first visit to the home. In addition to the pre-inspection questionnaire a number of other questionnaires were also sent to the home. A number of these were returned to the CSCI prior to the inspection and included comments made on behalf of residents by relatives. Comments from these questionnaires are included within this report. A number of comments were received from General Practitioners and other Health and Social Care professionals who visit the care home. In addition to the registered person discussions took place with a number of carers. Discussions took place with residents throughout the inspection. What the service does well: The registered person welcomes potential residents to spend some time within the home prior to admission as part of the homes admission procedure. It was evident that visitors are welcomed into the care home at any reasonable time. Furthermore potential residents and or their representatives are invited to visit the home prior to admission. Training in relation to dementia care continues to take place for staff members. Communal areas are warm and welcoming. A number of positive comments were received upon comments cards. ‘A very caring and well run rest home.’ ‘ very caring and homely establishment’ Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 6 ‘clean, calm and homely atmosphere with caring staff’ A range of activities are provided within the care home on a regular basis. The food served to residents on the day of the inspection was well prepared and tasty. What has improved since the last inspection? What they could do better: Further amendments are needed to both the service users guide and statement of purpose in order to meet the required regulations. Although the registered person has made efforts to improve care plans and risk assessments a range of shortfalls were evident. A new format was in place for care planning however those seen were insufficient in the detail given and where not up dated as required. A number of shortfalls were noted in relation to the management of medication which requires further improvement to those already achieved. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 7 The location where treatment such as chiropody is undertaken needs to be reviewed to ensure residents privacy is uphold. A number of training events need to be arranged such as safeguarding adults and moving and handling. A range of risk assessments regarding the environment and practices within the care home need addressing with a degree of urgency. Infection control matters need to be improved and the safe storage of hazardous items needs to be consist. Staffing levels need to be continually reviewed to ensure that they are in line with the need to meet care needs of residents. Improvements are required regarding some elements of the recruitment procedures within the home. 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. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 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 Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 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): Standards 1,2, 3, 4 and 5. Standard 6 is not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information for potential residents and their family does not contain all the required details to afford them the ability to make an informed choice regarding the suitability of the home to meet care needs. Pre-admission assessment documentation is insufficient, however the practice of potential residents visiting the home assists in the overall assessment process. Training in dementia care assists staff to meet care needs and assists to protect the well being of residents. EVIDENCE: During this inspection the registered person requested that the inspector reviewed recently up dated versions of the homes statement of purpose and service users guide. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 10 Both documents were briefly viewed as part of the visit to the home and initial comments were given to the registered person. The changes to the statement of purpose needed to be more detailed in order to satisfactorily meet the required regulations and associated National Minimum Standard. Following this inspection the registered person delivered a further revised copy of both documents to the commission. These revised documents were assessed against the regulations and National Minimum Standard. Despite the further review additional information is still required. Once these amendments are completed the registered person must forward a copy of the document to the local office of the commission. Once the service users guide document is completed it must be available to all current and prospective residents and their families / representatives. A signed copy of the homes terms and conditions was seen to be in place on one file viewed. The file of a recently admitted resident was viewed which contained an initial assessment. The assessment was not dated and contained basic details only. An admission assessment contained further details from which a care plan could be generated however this was done at the point of admission. The Firs and Margaret Road is registered to care for up to six persons who may have a dementia type illness. The care of persons with such an illness is specialised and therefore staff need to be suitability competent. The vast majority of staff have now received basic dementia training. This training needs to be ongoing and relevant to the care needs of residents. The inspector saw no evidence that the registered person confirms in writing that the home is able to meet identified care needs. Potential residents are invited to spend a day at the home prior to their planned or possible admission, although no key worker system (named worker) is in place a member of staff is allocated on that day. Intermediate care is not offered at The Firs and Margaret Road. The home has no plans to provide such as service in the future. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 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): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and associated risk assessments lacked sufficient detail or updating, which can potentially place individuals at risk. The provision of full and accurate documentation can assist in ensuring that care needs are met in a consistent manner. The management of medication was insufficient in some areas and in need of improvement, to fully safeguard residents. EVIDENCE: As part of this inspection a number of care plans were viewed and assessed against the National Minimum Standards. A visiting professional stated upon a comment card that staff had ‘tried to update their recording recently.’ Two separate comment cards received from medical professionals were complementary regarding the caring environment and the care provided. The Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 12 vast majority of relatives indicated that they were satisfied with the overall care provided within the home. Since the last inspection the registered person has taken steps to improve care planning within the home. The recently appointed deputy manager has taken on the responsibility of preparing care plans. The documents seen covered all the areas of potential care need listed under standard 3.3 of the National Minimum Standards however the boxes provided to record objectives and strategies to meet the objectives were small making it impossible to record in sufficient detail. Care plans seen were therefore cramped and difficult to comprehend. A template for recording reviews to the care plan did in some cases give additional information however the care plans were in general medical in the terminology used and therefore failed to cover other areas of need. Strategies for dealing with situations were at times insufficient and failed to provide staff with the necessary detail. Care plans must be reviewed on at least a monthly basis or more frequently to meet care needs. Although reviews were evident the frequency was not sufficient. It was of concern that only the deputy manager was recording information upon the care plan or subsequent reviews, as a result care plans were only reviewed if the deputy manager was either on duty at the time or was informed of a change at a later date. The practice in use resulted, at times, in matters getting overlook or omitted. The following up of situations was insufficient for example following a fall noted on one residents daily notes no entry was made for a total of 10 days. Another daily sheet record stated ‘ D/N (district / community nurse) to visit tomorrow morning’ no record existed of a visit taking place. An audit of documentation to establish whether information was transferred and crossreferenced in relation to falls gave some cause for concern. The terminology used on care plans continues to give some cause for concern. Correction fluid was used on one risk assessment viewed The care plans for residents residing at Margaret Road were held in the main house therefore making it difficult for staff to refer to them. Staff knowledge regarding the care needs of residents was mixed. Some staff were able to demonstrate a good knowledge of care needs while others were not. Documentation regarding bathing and residents weight were insufficient and gave some cause for concern in that they did not provide evidence that suitable action took place when concerns were raised elsewhere. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 13 Evidence that care plans were shared with residents was in place, as many were signed by the individual concerned. This is good practice and is encouraged. The management and recording of medication was assessed as part of the first day of this inspection; some elements were reviewed as part of the second visit. Over recent inspections the commission has noted improvement in the overall management of medication following previous concerns including immediate requirements. Overall the improvement has continued however a number of concerns were discussed with the senior carer on duty and the registered person. The security of medication was a cause for concern during both visits however these were for different reasons. Following the last inspection in December 2005 a letter was sent to the registered person prior to the issuing of the inspection report, which included a paragraph about the need to secure the medication trolley and the need for keys to be held by a nominated person. On arriving for the first part of this inspection the trolley was not chained to the wall and the keys were on the top of the trolley. A nominated person did not hold the keys to some controlled medication on the day of the second visit. An additional concern was raised as part of the first visit in relation to the small fridge used for medication, as it was not lockable. Furthermore the temperature of the fridge was not monitored and recorded. The registered person undertook to obtain a suitable thermometer. A digital thermometer was in place at the time of the second visit, however this was showing a very high reading. As a result of the above concerns the registered person undertook to purchase a new piece of equipment, which is lockable. The majority of the current months Medication Administration Record (MAR) sheets were viewed; these were generally in good order regarding their completion. A few shortfalls were brought to the attention of the persons mentioned above. 1. When medication is prescribed on a variable basis the actual dose given must be recorded. 2. When handwritten amendments are made to the MAR sheets a second signature of a person checking the original entry needs to be obtained – this was highlighted during the previous inspection. 3. The use of the code ‘O’ needs to be defined on the reverse of the MAR sheets. On one MAR sheet carers had recorded ‘ / ’ when medication was either not given or not required. The MAR sheet indicated that the morning medication was done at 8.00 am. However on the morning of the first visit staff started administering medication Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 14 at 9.10 am and finished at 9.50 am therefore almost 2 hours later than the time on the MAR sheet. This is of concern when some residents are prescribed medication at lunchtime therefore a gap of around 2 ½ - 3 ½ hours, which may not be a sufficient amount of time between doses. One box of antibiotic medication was audited against the MAR sheet and found to balance. Although items such as eye drops had the date of opening recorded upon the box, however other boxed or bottled items did not have the date of opening upon them. Two bottles of a liquid antibiotic medication were held within the fridge, both were belonging to the same person, neither showed the date of opening. A copy of the British National Formulary (reference book regarding medication) was available within the home however it was out of date. The supplying pharmacy is reported to of agreed to supply a more up to date version. A comment was made to the commission prior to this inspection regarding an observation of somebody having their ‘feet done’ within the dining room. Although no such practice was observed during this inspection a visiting professional was seen to be carrying out treatment within the small lounge, which is also used for hairdressing and where residents are permitted to smoke. The appropriateness of such practice-taking place needs to be reviewed in order to up hold residents privacy and dignity. The registered person demonstrated a caring philosophy within the home whereby following the death of a resident the bedroom is not filled until after the former residents funeral has taken place. As part of the future training plan for the home a course in palliative care is arranged. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities are provided to stimulate residents. Meals (other than those liquidised) are well prepared and meet the dietary needs of residents. EVIDENCE: On the day of the first visit of this inspection different activities took place. During the morning a music and movement session took place, an outside person undertook this session. As this was the first time she had visited The Firs the registered person sought the views of residents over lunch regarding the activity. During the afternoon staff and residents were engaged in some craftwork within the dining room. The second visit to the home coincided with an organist arriving to play music in the large lounge. A part time activities coordinator is employed. Information was available regarding planned events leading up to Christmas. Risk assessments regarding outings are not taking place. Holy communion takes place on a monthly basis. No other religious care needs were identified as part of this inspection. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 16 The registered person is aware of local advocacy groups if needed The result from the questionnaires returned to the commission prior to this inspection in relation to the question ‘Are there activities arranged by the home that you can take part in?’ was mixed in that 1 person answered ‘ Always’ 7 people answered ‘Usually’ and 4 people answered ‘Sometimes’. One additional comment was ‘Could do more’. Comments on the questionnaires completed by relatives / visitors showed that the registered person and her staff team welcome visits into the care home and demonstrated that they are able to visit relatives in private. The lunchtime menu was written on a board within the dining area. The board stated that lunch was going to be roast chicken, roast and boiled potatoes, cauliflower, carrots and stuffing. The sweet was a choice between sago or rhubarb crumble and custard. The inspector accepted the offer of joining residents for lunch. The meal served was as recorded above. It was well presented and hot. Residents consulted stated that they had enjoyed their meal. A small number of residents needed some assistance with their meal; this was carried out in a sensitive and unhurried manner. Some residents required their meal to be liquidised, this was done collectively and therefore denied residents the ability to enjoy different tastes; this needs to be reviewed. The results of a question on the questionnaire mentioned above was mixed in relation to whether individuals like the meals in the home. The majority of respondents answered ‘Usually.’ Other comments were ‘ Excellent’ and ‘ I would like it cut smaller.’ Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered person needs to ensure that residents representatives are aware of the homes complaints procedure and that staff undertake training regarding safeguarding adults. EVIDENCE: The commission have received no complaints regarding the service provided at The Firs and Margaret Road. Some relatives indicated that they were not aware of the homes complaints procedures. Information was displayed regarding the safeguarding of vulnerable adults. Other than the training included as part of NVQ (National Vocational Training) no training in relation to the safeguarding of vulnerable adults has not taken place. This needs to be arranged in the foreseeable future. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 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): Standards 19, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements regarding the environment continue in order to provide residents with a comfortable place to reside where care needs can be met. Some areas need to be assessed in relation to potential risks to residents. EVIDENCE: The Firs has a lounge, a parlour and a dining room. The dining room is situated within the conservatory, which can be affected by extremes of heat. The registered person has in the past explored replacing the roof with a more conventional type however this has not yet taken place. Communal areas within the main house are warm and welcoming. Pictures are displayed in the dining room of Worcester and residents undertaking activities or celebrating parties. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 19 Since the last inspection a new shower has been fitted within the main house. The area looked attractive and was an improvement upon the previous facility, however the shower lacks a thermostatic control and therefore the risk of scalding is present. This must be risk assessed and suitable action to safeguard residents must be taken. The wardrobe in one bedroom was not secured to prevent accidental toppling. Environmental risk assessments need to take place with a degree of urgency. Several residents bedrooms were viewed. Those seen demonstrated that residents are able to bring personal belongings into the home with them. The registered person has had liquid soap dispensers fitted within toilets, bathrooms and near to the dining room as previously required. Despite the availability of this soap bars of soap were however seen within communal areas of both the main house and the Margaret Road property. Bars of soap can be a risk of cross infection if shared. One comment was made about laundry going missing; this was brought to the attention of the registered person. Throughout this inspection no offensive odours were detected. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff on duty needs to be continually monitored to ensure care needs are able to met. Further improvements are needed regarding recruitment procedures to ensure that residents interests are protected. EVIDENCE: In response to a question on the questionnaires completed by relatives asking whether ‘there are always sufficient staff on duty’ the replies were split 50:50 regarding ‘Yes’ and ‘No’. A similar question upon the resident’s questionnaire asked ‘ Are the staff available when you need them?’ In response to this 3 people answered ‘Always’ while 7 stated ‘Usually’ and 1 stated ‘Sometimes’. In response to other different questions some respondents indicated that at times the home is short staffed. The number of staff on duty during this inspection was found to be sufficient to meet care needs however some concern was expressed regarding the level of Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 21 staffing during the night time. Currently 1 wakeful carer is on duty within both houses, this needs to be reviewed to ensure that care needs and health and safety requirements are met. A member of staff comes on duty at 7.00 am to assist staff with residents getting up. A notice board shows the names of staff on duty. Staffing levels including weekends will be assessed at a future inspection As 10 out of a total of 20 carers working at The Firs are reported to hold a level 2 National Vocational Qualification standard 28 is met. This standards states ‘A minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent’. The files of three recently appointed employees were viewed. The files were well organised and contained a range of different documents. Although improvement was noted from previous inspections shortfalls were still evident. Each file contained a Criminal Records Bureau (CRB) disclosure. It was also evident that either the CRB or a PoVA first (Protection of Vulnerable Adults) clearance was in place prior to the date of employment commencing. A contract of employment was in place for all three persons checked although this document was not read in any detail. Two persons were recruited from overseas. Different documentation was seen on each of the files including one Work Permit from the Home Office and some sworn translations of documents such as birth certificates and a ‘recommendation’. Despite having these documents others were missing such as application forms, interview notes and original references. Failure to carry out sufficient recruitment procedures could potential place residents at risk. The majority of staff have undertaken training in infection control, vital signs and health and safety. It was of concern that staff have not received suitable / sufficient training or refresher training in moving and handling; this training was reported to be booked for January 2007. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 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): Standards 33, 34, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Formal supervision of staff now in place can assist in safeguarding residents and meeting individual care needs. Improvements are needed in some areas around health and safety although many previous requirements are now met and therefore assisting with protecting residents. EVIDENCE: Following the last inspection the registered person was required to introduce a Quality Assurance system in line with the National Minimum Standards and the regulations. The registered person sought external advice who drew up a document covering the standards as a guide to demonstrate where improvements were needed. This document was completed in April 2006. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 23 Although it was pleasing to note that this piece of work was carried out it was noted that no further review or up date has taken place to the document. No cash is held on behalf of residents, any expenditure such as hairdressing is invoiced to residents representatives. A copy of the employers liability insurance is displayed. The formal supervision of staff in line with the standards is improving. The standard should be met by the time of the next inspection. Records evidencing that supervision has taken place were seen, these need to be dated and signed The registered person has purchased a range of commercially produced policies and procedures and was at the time of this inspection awaiting some revised documents. Although these are a suitable basis for procedures within the home they do need to be reviewed and amended to ensure that they are relevant to The Firs and Margaret Road. Accident records were viewed, however in some cases these failed to match with the daily notes and therefore improvement is required. A number of health and safety or servicing records were viewed as part of the inspection. The fire log was in good order and evidenced that the fire alarm is tested on a weekly basis and in sequential order as required. In addition it was evident that the monthly testing or visual checking of equipment, emergency lighting and door closures is taking place. Records evidenced that all staff listed have received some form of fire training over the past few months. It was recommended to the registered person that staff carrying out the in house training undertake the relevant training for trainers undertaken by the fire service. The inspector was informed of some forthcoming health and safety training for staff. A logbook for the areas covered is available and will be assessed as part of a future inspection once the training has taken place. Service records were available in relation to the passenger lift and stair lift as required under the Lifting Operations and Lifting Equipment Regulations 1998. Portable hoists need to be suitable serviced. The required landlord gas safety check was carried out during this inspection. The registered person undertook to take appropriate action in relation to a shortfall identified. It was noted that some staff were wearing a significant amount of jewellery. Items such as rings with stones or bracelets and necklaces can be hazardous to both residents and staff members in certain circumstances such as the Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 24 potential to damage skin tissue as well as the risk of harbouring germs. The registered person must review this matter and safeguard all concerned. The door to a cupboard under the stairs at Margaret Road was unsecured; as this home is registered to care for persons with a dementia type illness and the fact that the cupboard contained cleaning materials this was concerning. A cupboard containing a washing machine and washing powder was unsecured on the second visit; appropriate action was taken immediately to refit a lock. Risk assessments regarding the environment were lacking and in need of urgent attention. Training is reported elsewhere within this report. A shortfall was identified in relation to moving and handling. No member of staff is a first aider, this needs to be addressed in line with the required standard. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 25 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 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 3 2 2 2 Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4 Requirement The Statement of Purpose must be amended so that it includes all the information detailed in Regulation 4 and Schedule 1. Copies must be made available to the Commission for Social Care Inspection and available in the home to any service user or their representative. (Previously part met a extended timescale was previously given until 31/01/06. As this remains part met a further extension to the timescale is given.) 2 OP1 5 A Service User’s Guide, which includes all information detailed in Regulation 5 and Standard 1, must be available in the home and copies must be given to the Commission for social Care Inspection, all current, and any prospective, service users. (Previously part met a extended timescale was previously given Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 27 Timescale for action 31/01/07 31/01/07 until 31/01/06. As this remains part met a further extension to the timescale is given.) 3 OP3 14 (1) The registered person must ensure that a full assessment is undertaken and full documented prior to admission into the care home. A letter confirming the homes assessment and the ability to meet care needs must be sent to potential residents or their representative. 31/12/06 4 OP4 14(1)(d) 31/12/06 5 OP7 15 (1) The registered person must 31/01/07 ensure that care plans cover all aspects of care as set out in Standards 7 and 3 in sufficient and suitable detail to enable staff to carry out care tasks. Other documents must be up to date and be able to be crossreferenced to the care plan. The registered person must ensure that necessary follow up action is taken and recorded in relation to residents welfare and needs. (This requirement is unmet following a previous timescale of 01/12/05. This requirement must be met in full) 10/10/06 6 OP7 13 (1) (b) 7 OP7 15 (2) The registered person must ensure that care plans are reviewed on at least a monthly basis or more frequently to reflect changing care needs. 10/10/06 Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 28 8 OP7 15 (1) Although care plans must be securely held they must be available to care staff at all times. The registered person must ensure that risk assessments are undertaken in relation to all areas of residents care. (This requirement is unmet following a previous timescale of 01/12/05 – an extended timescale is given by which time this requirement must be met in full) 31/12/06 8 OP8 13 31/01/07 9 OP8 12 (4) (a) 31/01/07 The registered person must ensure that the terminology used within care plans and daily notes is in line with good practice and maintains residents rights to privacy and dignity. (This requirement is unmet following a previous timescale of 31/01/06 – an extended timescale is given by which time this requirement must be met in full) 10 OP9 13 (2) The registered person must 10/10/06 ensure the security of medication by having the trolley chained to the wall and the keys held by a nominated person. (Previous timescale of immediate and on going following the previous inspection on 01/12/05 not met. This requirement must be met without further delay) Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 29 11 OP9 13 (2) The registered person must ensure that handwritten MAR sheets are checked for accuracy by two people and signed by both. (Previous timescale of immediate and on going following the previous inspection on 01/12/05 not met. This requirement must be met without further delay) 10/10/06 12 OP9 13 (2) The registered person must ensure that the date of opening is recorded on medication such as eye drops as well as other medication not included within the monitored dose system. (Previous timescale of immediate and on going following the previous inspection on 01/12/05 not met. This requirement must be met without further delay) 10/10/06 13 OP9 13 (2) The registered person must 10/10/06 ensure that Medication Administration Record (MAR) sheets are completed fully and accurately at the time of administration. If medication is prescribed on a variable dose the dose given must be recorded. The correct use of ‘coding’ must be used. The registered person must undertake a review of the time when medication is administered to ensure that safe systems are in place. 10/10/06 14 OP9 13 (2) 15 OP10 12 (4) The registered person must 31/01/07 ensure that resident privacy and dignity is up held at all times. A review of current practices regarding treatments undertaken DS0000018684.V308981.R01.S.doc Version 5.2 Page 30 Firs and 16 Margaret Road, The must take place 16 OP18 13 (6) The registered person must ensure that all staff are suitable training and have sufficient knowledge regarding the safeguarding of vulnerable people and the associated procedures. 28/02/07 17 OP19 13 (4) The registered person must 31/12/06 ensure that environmental risk assessments are carried out throughout the care home and appropriate action must be taken in relation to identified hazardous situations such as the securing of wardrobes to prevent accidental toppling over. The registered person must undertake a risk assessment in relation to the potential risk of scalding from the shower. Suitable action must take place following the risk assessment. 15/01/07 18 OP25 13 (4) 19 OP26 13 (3) The registered person must carry 31/01/07 out a further review within the home regarding the risk of cross infection by means of having bars of soap available within communal areas of the home. Recruitment procedures must be developed and implemented in accordance with the requirements of Regulation 19, Schedule 2 and Standard 29. (Previous timescale of 31/03/05 and 05/07/05 not met. Revised timescale of 01/12/05 part met. This requirement must now be met without further delay). 10/10/06 20 OP29 19 21 OP30 13 (4) (5) 23 (4) (b) The registered person must ensure that all staff attend DS0000018684.V308981.R01.S.doc 31/01/07 Version 5.2 Page 31 Firs and 16 Margaret Road, The OP38 mandatory training. (Previous timescales of 31/05/05 31/10/5 and 28/02/06 not met. New timescale given by which time a full action plan must be devised with suitable timescales) 22 OP33 24 (1) The registered person must ensure that continual reviewing of quality assurance documents takes place and that records are maintained. All members of staff must receive formal supervision that includes all aspects of practice, philosophy of care in the home and career development needs at least 6 times a year. (Previous timescale of 31/05/05 and 30/09/05 not met. An extended timescale is given) 31/01/06 31/01/07 23 OP36 18 28/02/07 24 OP37 17 Policies and procedures within the home must be specific and relevant to the home. Risk assessments must be carried out and recorded for all the safe working practices topics covered in Standards 38.2 and 38.3 (This standard was not fully assessed as part of the inspection carried out on 01/12/06. This requirement was not met during this inspection. A revised timescale is given for full compliance) 31/01/07 25 OP38 13 31/01/07 26 OP38 13 (4) The registered person must ensure that all hazardous items, including cleaning materials are DS0000018684.V308981.R01.S.doc 17/11/06 Firs and 16 Margaret Road, The Version 5.2 Page 32 held securely at all times. (The previous timescale of 01/12/05 was not met. This requirement must be met immediately and must be on going 27 OP38 13 The registered person must address the situation regarding staff wearing excessive jewellery. 31/12/06 28 OP38 13 (4) The registered person must 31/01/07 make suitable arrangements in relation to training of staff in first aid. 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 OP15 OP19 Good Practice Recommendations Review the practice of liquidising lunch collectively. A programme of routine maintenance and renewal of fabric and decoration should be produced and implemented. (Not assessed on this occasion) A monitoring system should be implemented to ensure water temperature valves are working efficiently and risks from Legionnella bacteria are addressed. (Not assessed on this occasion) A business or financial plan should be available for the establishment that is open to inspection and reviewed annually. DS0000018684.V308981.R01.S.doc Version 5.2 Page 33 3 OP25 4 OP37 Firs and 16 Margaret Road, The (Not assessed on this occasion) 5 OP38 It is strongly recommended that person who carry out in house fire awareness training undertake fire warden training. Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Firs and 16 Margaret Road, The DS0000018684.V308981.R01.S.doc Version 5.2 Page 35 - 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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