Inspection on 15/05/06 for Firs (Firwood Intermediate Rehabilitation Service)

This inspection was carried out on 15th May 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

Firs (Firwood Intermediate... 29/06/07

Firs (Firwood Intermediate... 10/01/06

Firs (Firwood Intermediate... 19/07/05

Firs (Firwood Intermediate... 05/01/05

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

CARE HOMES FOR OLDER PEOPLE Firs (Firwood Intermediate Rehabilitation Service) Firwood House Brassey Avenue Hampden Park Eastbourne East Sussex BN22 9QJ Lead Inspector Judy Gossedge Key Unannounced Inspection 15th May 2006 1:20 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 (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 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 (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Firs (Firwood Intermediate Rehabilitation Service) Firwood House Brassey Avenue Hampden Park Eastbourne East Sussex BN22 9QJ 01323 503758 01323 509741 Address 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) www.eastsussex.gov.uk/socialcare East Sussex County Council Miss Caroline Denise Piper Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. A maximum of twenty-two (22) service users to be accommodated on the first floor. That service users are over the age of sixty-five (65) years or over on admission. That nursing care be provided. That three (3) places will be available for service users between the age of fifty-five (55) and sixty-four (64). That only bedroom number 20 can be used as a twin room if requested by the service users. 10th January 2006 Date of last inspection Brief Description of the Service: Firwood House is run by East Sussex County Council (ESCC) the Registered Provider, working in partnership with the Eastbourne Downs NHS Primary Care Trust (PCT) and is the base for a range of services and facilities. Firwood House is purpose built on two floors, set in its own grounds in Hampden Park, which is located approximately three miles from Eastbourne town centre. There is a twenty-two bedded intermediate care unit on the first floor called Firs, which provides service users resident on the unit with a period of rehabilitation for up to six weeks. There are twenty single bedrooms and one further bedroom, which is a bedroom/sitting room and available for double occupancy. All the bedrooms have en-suite facilities of a toilet, wash-handbasin and shower. There are further assisted bathing facilities on the unit. Telephone facilities are in all the bedrooms. A dining area on the ground floor is for all service users accessing the building, a lounge and seating area with a kitchen facility is situated on the unit for the use of the service users resident on this unit. Level access is facilitated with the provision of a passenger lift in the building. An attractive garden is situated at the rear of the building. Downstairs is the Firwood Rehabilitation Unit open Monday to Friday, a day therapy service, the facilities of which are used by service users on the Firs unit. The Community Rehabilitation Service, Community Stroke Rehabilitation Service, Speech and Language Team and a Dietician are based at Firwood House and can also offer support and guidance. At the time of the inspection fees were documented to be free for up to the six weeks that intermediate care is provided. Charges are made for hairdressing, Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 5 chiropody, outgoing telephone calls, newspapers/magazines and toiletries. The Statement of Purpose and a copy of the last inspection report are available to view in the main reception area at the entrance to Firwood House. A copy of the Service Users Guide is available to read in each of the service users bedrooms. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours on 15 May 2006 and there were two Inspectors present during the inspection. A further visit was made by the Inspector for the unit on 16 May 2006 for four hours to obtain information and give feedback to the Manager. On 18 May 2006 the Inspector also visited the PCT’s Human Resource Department to view recruitment procedures. Following the last inspection 10 January 2006 the Inspector for the unit sent a letter to the Responsible Individual for ESCC detailing serious concerns that were highlighted during the inspection. A letter of reply was received and the responses to the issues raised were satisfactory. The CSCI also met with the Responsible Individual for the organisation and is awaiting a plan of action to address the issues raised. Prior to the inspection a pre-inspection questionnaire was sent to the unit to be completed with information required as part of the inspection process. This was returned and information detailed is quoted in this report. A tour of the premises took place to look at communal areas and a selection of service user’s bedrooms, rotas and care records were inspected. Sixteen service users were resident, with three service users due to go home during the day and eight were spoken with individually in their bedroom. Of these eight for four of the service users the care they had received during their stay was reviewed as part of the inspection process. The opportunity was also taken to observe the interaction between staff and service users in the communal areas. Ten service user surveys were sent out and six came back completed. The Manager, two nursing staff, a senior care officer, the cook, a member of the housekeeping team, the maintenance person, an occupational therapist and a physiotherapist were all spoken with. Nine staff questionnaires were sent out prior to the inspection and three completed questionnaires were returned. Five relatives were spoken with on the day. Two General Practitioners comment cards were sent out and one completed comment card was returned. Comment cards were also sent to the assessors at the ESCC Adult Social Care Team at the local hospital where the majority of referrals for admissions come from, but no completed comment cards were returned. What the service does well: Staff were observed to ensure that the service user’s privacy and dignity is respected. The relatives and all service users commented that they were pleased with the overall care provided in the home. Comments included ‘Although looking forward to going home, I will really miss being here’, ‘staff are very good’ and ‘the staff are very caring’. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 7 Service users are enabled to exercise choice and control over their lives whist resident on the unit. Staff work with service users to regain their independence and where possible return home. There is good support from healthcare professionals to help facilitate this. One relative spoken with commented, ‘I am very happy with the care provided. They had been involved me with a home visit to look at what is needed to be considered prior to any return home. I have felt included in my mothers care’. Another relative commented, ‘My relative has been supported and encouraged to regain their independence whilst on the unit’. 75 of the units care staff hold NVQ level 2 in care or above with further staff working towards the qualification. The standard of the environment is very good and ensures that service users are provided with a safe, attractive, clean and homely place to live. Feedback from the service users and relatives was that the home was fresh and clean. Two service users commented ‘The bedroom is kept to a very high standard’ and ‘Very good in every way’. What has improved since the last inspection? What they could do better: Pre-admission proceedures need to be improved with service users being provided with adequate information about Firs prior to admission and a copy of the assessment completed forwarded to staff on the unit prior to any admission. This is to ensure service users care needs can be met on the unit and identify and plan for any specific care needs or equipment required. A detailed written plan as to how the service user’s needs in respect of their health and welfare are to be met is not in place. Service users have a risk assessment undertaken where identified but these need to identify individual service user risks and not be a generic risk assessment. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 8 Trained nursing staff should be deployed on the unit as is detailed in the units Statement of Purpose. Two requirements have been made in relation to medication procedures. A robust recruitment procedure was not demonstrated to be in place. The Manager needs to be able to confirm where PCT staff are seconded to work on the unit the recruitment process undertaken with these staff and that a satisfactory CRB check has been undertaken by the PCT. Where new staff are employed by the PCT to work on the unit they will need to evidence a POVA First check has been received before working on the unit and whilst awaiting a CRB check staff must be closely supervised during this period. 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 (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 9 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 (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 10 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): 1,2,3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admissions process is poor with not all service users being provided with adequate information about Firs in advance of their admission to the unit. Staff are not always being provided with adequate information prior to admission to ensure each service users care needs can be met on the unit or identify and plan for any specific care needs. There is good support from healthcare professionals working in an attractive environment to enable service users to regain their independence and work towards returning home. EVIDENCE: The Statement of Purpose is detailed but needs to be kept up-to-date. At the last inspection two beds had been made available for emergency placements for service users discharged from hospital. This practice has ceased and the CSCI had not been aware of the changes to the service provided. The Service Users Guide is available to read in service users bedrooms. Not all the service Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 11 users spoken with had read the information but were aware that it was available to reference. One service user who had read the information stated that it was, ‘excellent’ and quoted information detailed within. Service users were asked if they had received information about Firs prior to admission. Five service user surveys stated that service users felt they had received adequate information about Firs, one service user did not and was, ‘disappointed from the last visit’. One service user spoken with stated she had relied on feedback from other residents where she lived and another spoke to other patients in the hospital. One service did not know anything about Firs prior to admission. The service user surveys indicated that four service users felt they had not received a contract, one had and one was not sure. Six service users documentation was viewed and all had a completed contract in place. Service users have an initial assessment completed by an assessor working for one of ESCC’s Adult Service Departments Assessment Teams. Currently all service users come straight from hospital. Staff spoken with and documentation viewed confirmed that a copy of this assessment is not always sent to the unit for reference. Of the six service user files viewed, two did not have a copy of an initial assessment and for the other four the detail provided in the assessment did not in always provide adequate information for staff to reference. One service user who had been admitted from a private hospital from another part of the county, had not had an assessment completed and was awaiting for an assessor to complete an assessment. A further service user had been admitted on to the unit at lunchtime of the first day. There was no information about this service user and staff were observed telephoning the hospital trying to ascertain more information. One member of staff from Firs had participated in an assessment of the service users care needs at the hospital, but there was no feedback following this visit available on the unit. It was identified during the afternoon that this service user used a specialist bed in hospital and at home which is not available at Firs. Staff were observed reviewing the available facilities on the unit, which meant the service user had to move from the bedroom initially allocated. One service user resident on the unit did not meet the unit’s admission criteria nor was participating in the rehabilitative service as detailed in the units Statement of Purpose. This service user was in a wheelchair during the inspection, which was not detailed on their care plan and needed two/three staff for transfers using a hoist. Concerns about this service users health had already resulted in a readmission to hospital. Feedback from staff indicated that since the last inspection there have been a number of service users admitted on to the unit where subsequently service users medical needs have not been able to be met, resulting in a re-admission back into hospital. Where possible senior staff on the unit have been visiting potential service users prior to admission to help ensure service users care needs can be met on the unit. Staff also spoke of a lack of control over admissions on to the unit and of service users arriving Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 12 without always a prior agreement to the admission. One comment received from the staff questionnaires was a request, ‘To have medically trained assessors so that appropriate service users are admitted’. The home accommodates service users for a period of rehabilitation for a period of up to six weeks. Occupational therapy and physiotherapy staff were spoken with and observed working on the unit during the inspection and working with service users to return home. Service users spoke of activities they had participated, home visits and had range of equipment, which had been provided to assist their mobility. On the second visit the Inspector sat in with a group of service users participating in a chair based exercise activity using the rehabilitation facilities on the ground floor of Firwood House. There was a pleasant atmosphere and good interaction between staff and service users was observed. One relative spoken with commented, ‘I am very happy with the care provided. They had been involved me with a home visit to look at what is needed to be considered prior to any return home. I have felt included in my mothers care.’ Another relative commented, ‘My relative has been supported and encouraged to regain their independence whilst on the unit’. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are not protected by a detailed individual plan of care being in place, where all their personal, social and health care needs are identified at the start of their stay and which informs staff of the care which needs to be provided. EVIDENCE: A format to record individual care plans has been put in place. But of the six service users documentation viewed, two did not have a care plan recorded and had been admitted to the unit six days earlier. One of these had also not had an assessment completed, so there was also no pre-assessment documentation for reference. It was not possible to ascertain what this service user’s care needs were, or if they were being met. The other four care plans viewed were limited in detail and did not evidence that all the care needs had been identified at the start of a period of care at Firs, did not fully describe all the service users’ health, personal and social care needs, nor provide guidance to staff as to how care needs should be met. Service users do not have a falls risk assessment completed unless concerns are identified and this does not Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 14 meet the National Minimum Standards. Two pre-assessments viewed indicated potential risks of falls and in both cases a falls risk assessment had not been recorded. A number of supporting risk assessments were seen, but were generic risk assessments and did not identify any individual risks to service users. A service user who was using and storing oxygen in their bedroom only had a generic risk assessment recorded. Regular reviews of care plans to check if a service user’s care needs has changed need to be evidenced. Communication sheets were not being used each day and in one instance a service user had not had a recording for five days. A daily tick box system is in place, which identifies care provided on the day but nothing else. Two service users had had urological tests requested but there was no recording of the outcome of this on their care plan. There are detailed policies and procedures in place in relation to the administration of medication. A number of service users self medicate their own medicines and the unit has policies and procedures in place to support this activity. Several service users confirmed that they were self administrating and one showed the Inspector a chart to remind them of what time their medication was due. A sample of the medication administration sheets were viewed and at times these were confusing as did not clearly indicate where a service user was self medicating and time had to be spent going through supporting documentation to clarify this. The control drugs book was not accurate and to help ensure safety in administration the front list of medication to be administered needs to be up to date. The senior nurse on duty rectified this during the inspection. The service users surveys identified that the majority of service users felt they always received medical support when they needed it, but one stated only sometimes and a comment received was, ‘It is a nightmare to get pain relief tablets when required’. Staff were observed to deliver care with dignity and respect. The relatives and all service users commented that they were pleased with the overall care provided in the home. Comments included ‘Although looking forward to going home, I will really miss being here’, ‘staff are very good’ and ‘the staff are very caring’. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 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): 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. Service users are enabled to exercise choice and control over their lives whist resident on the unit, with some opportunities to participate in social and recreational activities are provided, with a varied diet which offers choices at every meal. EVIDENCE: The Manager has ensured that there is a choice of activities available, which staff should offer each day for service users to choose which activity they would like to participate in. It was difficult to evidence all the activities which have taken place, as the recording of activities had not always been maintained. Service users spoke of some activities they had participated in. On the first afternoon there were no activities, but during the morning on the second day a small group of service users were engaged in a quiz, which was being run on the unit. Following this was an opportunity to join in an armchair exercise group. Service users social care needs should be included on service users individual care plans. Feedback from the service user survey was varied and stated activities were always or usually arranged. One relative did comment that there had not been as many activities as during their relatives previous stay. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 16 Relative’s spoken with and service users who had had visitors commented that there was flexible visiting and that staff are very welcoming. The care and support provided was observed to enable service users where possible to exercise choice whilst at Firs. The eight service user files viewed including the four service users whose care was reveiwed confirmed this. The cook working on the day stated she held a basic food hygiene certificate and confirmed attendance on a range of training opportunities. Since the last inspection fresh food is now being used for all meals during the week with frozen meals now only being used at the weekends. There is a four-week rotating menu in place detailing a choice at all meals and service users spoke of choosing from the choice available on the day. Lunch on the first day had been potato and leek bake, sausages, creamed potatoes, broccoli and mixed vegetables followed by rice pudding, lemon mousse, yoghurts or ice cream. Homemade cake had been provided with afternoon tea. Tea was observed in the evening, was well presented and consisted of homemade soup, cornish pasties, salad, a selection of sandwiches, a selection of different jellies and fresh fruit. Records had been maintained of individual food consumption to ensure service users had an adequate diet, but the recording should be developed to also include breakfast. The Inspector received varied feedback as to if a cooked breakfast is available for service users if they wish to choose this option. This was discussed with the Manager to be rectified as if this is not an option then this should be documented in the units Statement of Purpose. All but one service user who completed the service users survey feedback stated that they always liked the meals. Comments received were, ‘Excellent and beautifully presented’, ‘Do not enjoy the food as cannot taste it’. All service users spoken with spoke well of the food and comments were ‘Food good and plenty of it’, ’The meals are good and there is plenty of choice’. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable service users or their representatives to raise any concerns about the care being provided and to ensure that service users are protected from abuse. EVIDENCE: ESCC has a detailed compliments and complaints policy and procedure in place. Any complaints received are monitored through the line management arrangements in place within the organisation. One complaint has been received since the last inspection, which is currently being investigated under adult protection procedures. No complaints in relation to Firs have been received by the CSCI since the last inspection. Where asked service users and relatives confirmed that they would feel comfortable raising any concerns with the staff or the Manager. Not all the service users were aware of the complaints procedure, but knew the Service Users Guide was available to read which detailed this information. There are detailed policies and procedures in place in relation to the protection of vulnerable adults and a whistle blowing policy. The three completed staff questionnaires all confirmed they had an awareness of adult protection procedures. Staff training records provided with the pre-inspection questionnaire detailed staff attendance at this training. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is very good and ensures that service users are provided with a safe, attractive, clean and homely place to live. EVIDENCE: Décor in the unit is to a good standard, furnishings are of a good quality, and domestic in style. Service users are only in for a short period of time but a number of service users had taken the opportunity to personalise their bedroom. There is a separate lounge and seating area with kitchen facilities on the unit. There is a shared dining room on the ground floor which residents and service users who have come in to use the facilities in the building use. There is a passenger lift between the ground, and first floor. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 19 Specialist equipment is available for use on the unit. One comment received from a service user who was admitted on to the unit on the first day of the inspection was that they had had a specialist bed whilst in hospital and also at home. Staff on the unit were not aware of this prior to admission and there is not this type of specialist bed available on the unit. Similar issues have been raised following the last two inspections where toilet aids had not been provided or a specialist mattress. This issue was discussed again with the Manager during the inspection for a resolution. There are twenty single bedrooms which all meet the minimum space requirements. One bedroom predominantly used as a single bedroom, has the facility to be used by two service users who wish to share, as a double bedroom with a separate sitting area, or as two single bedrooms. All bedrooms have an emergency call bell system. All of the bedrooms have an en-suite facility of a shower, toilet and washhand- basin. There are also three bathrooms, one with a standard bath and shower facility, and two with assisted baths on the unit. Bathrooms are well decorated and furnished. A system of checking the bathrooms has been implemented to ensure that bathrooms are not used to store equipment, which has improved the environment in which to bathe. All the areas of the building are heated by an under floor central heating system and service users are able to control the temperature in their own bedroom. Hot water in a sample of seven of the wash hand basins and baths used by service users were tested, and were close to the recommended safe temperature of 43° C. Records of the routine checks of the hot water temperatures were also viewed. All service user spoken with confirmed that there was adequate heating and access to hot water. The unit was clean and free from offensive odours. One member of the housekeeping team spoken with was aware of procedures in place to control infection and had attended a range of training opportunities. The two other staff on the unit were agency staff who were observed to be provided with support and guidance from the permanent member of staff. The Manager confirmed that they are in the process of trying to recruit more housekeeping staff. Feedback from the service user survey was that the home was fresh and clean and one commented ‘Very good in every way’. Service users spoken with also felt the unit was kept clean and one commented ‘The bedroom is kept to a very high standard’. One relative did comment that the bedroom had become ‘messy’ at the weekend where less intensive cleaning is undertaken. The recording of routine fire checks were seen and were adequate. Again there was some wedging open of the internal en-suite door in service users bedrooms. An Immediate Requirement Form was left to seek further guidance Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 20 on this practice. The Manager has subsequently confirmed that following guidance from ESCC Fire and Rescue this is an acceptable practice as these are internal doors. There is an attractive garden at the back of Firwood and one service user spoke of enjoying sitting in the garden. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 21 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): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was not an adequate skill mix of staff, nor is a robust recruitment procedure followed to ensure service users are in safe hands at all times. EVIDENCE: On the day staff on the unit appeared to be and spoke of being very busy. Three service users were due to be discharged during the afternoon and one service user had been admitted at midday. Staff spoke of the difficulties of trying to admit and discharge groups of service users at the same time. The Inspectors noted that there were no trained staff deployed on the unit later in the afternoon. Feedback received and rotas viewed also evidenced there had been no trained nursing staff on the previous morning and there are times on the rota when this does occur. This did not reflect the staffing proposal from ESCC at the point of registration or as is detailed in Firs Statement of Purpose. An Immediate Requirement Form was left to address this issue. Two or three staff are currently on duty at night. There is still a high reliance on agency staff to cover the rota. The number of care staff on duty needs to be kept under review and increased as required to ensure that the changing care needs of the all the service users resident continue to be met, especially as one service user resident on the unit needed two/three staff for any transfers required. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 22 Feedback from the service users surveys stated that seven service users felt they always or usually received the care and support they needed. Comments received were, ‘Excellent’ and ‘Too short of staff’. Where services users if the team acted and listened to what service users said the response was varied. Seven service users stated staff were always or usually available when they needed them and one commented, ‘They come soon after the care button is pushed’, ‘The staff are very caring’. All the service users spoken with confirmed there appeared to be adequate staff on duty and that the call bells were answered promptly. Staff feedback from the completed questionnaires received were, ‘There is an excellent team at Firwood who work together, there is always plenty of help if needed and this is reflected through to the service users’, ‘Firwood provides a very supportive working environment. Standards are excellent. A good supportive team that delivers high quality person centred care. Provides high quality food to maintain adequate nutritional intake’ and ‘Utilizes all staff skills as well as accessing other staffs skills from other teams from downstairs services’. Inspectors received feedback from staff during the inspection, which indicated a good and supportive team. That staff have felt under a lot of pressure due to the varying care needs of service users admitted, with a number of service users having to be re-admitted back to hospital as their care needs could not be met on the unit and these service users then not taking part in the rehabilitative services provided. Also of pressure being put to admit service users on to the unit. This was observed on the evening of the first day where the duty team leader was advised of a potential admission of a service user, about whom there was inadequate information. The pre-inspection questionnaire detailed that seven care staff hold an NVQ Level 2 in care or above. That equates to 75 of the units care staff and two further members are working towards this qualification. All recruitment of ESCC staff is co-ordinated by the Personnel Section at ESCC’s head office and for the PCT is co-ordinated by the organisations Human Resources Department. It was possible to evidence the recruitment procedures for staff employed by ESCC. One ESCC member of staff and a relief member of staff only had evidence of one reference. The Manager subsequently was able to provide a copy of the second reference for both the members of staff. There was some recruitment documentation for PCT staff, but a visit was made to the PCT’s Human Resources Department for further evidence of the recruitment procedures followed. One member of the PCT staff did not have evidence of a CRB check in place. An Immediate Requirement Form was left requiring that a POVA First check be sought as an interim measure. PCT staff documentation viewed also highlighted that some staff only had a standard Criminal Records Bureau (CRB) disclosure, which is not adequate where an enhanced disclosure is required. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 23 The Manager needs to be able evidence where PCT staff are seconded to work on the unit, the recruitment process undertaken with these staff and that a satisfactory CRB check has been undertaken by the PCT. Where new staff are employed by the PCT to work on the unit they will need to evidence a POVA First check has been received before working on the unit and whilst awaiting a CRB check staff must be closely supervised during this period. It was not possible to confirm on the day with staff they were in the process of completing the required induction. The Manager stated and detailed in the pre-inspection questionnaire that it is ensured that all new staff are supported to complete the required induction programme and for one member of staff their documentation viewed evidenced this had been completed. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 24 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): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the management of the home is good with effective systems to monitor the quality of the service provided. For some service users there was limited assessment information, which could impact on the care being provided. Decisions are being made which affect the service provided on the unit and which are outside of the Registered Managers authority. EVIDENCE: The Registered Manager has worked for East Sussex County Council for a number of years as a senior manager participating in a range of training opportunities, has completed NVQ Level 4 in Management, is an NVQ Assessor and has commenced NVQ Level 4 in Care and the Registered Managers Award. There are clear lines of line management and accountability within the organisation. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 25 ESCC has a quality assurance plan in place, but this has not been fully maintained on the unit. There are some opportunities for service users and carers to put forward their views about the unit and the care that they receive through service users forums, a suggestion box on the unit and a questionnaire which it is asked is completed at the end of each stay on the unit. A sample of minutes from these forums were viewed and it is recommended that the frequency of the service user focus groups are reviewed as service users are resident for up to six weeks on the unit, and currently may miss the opportunity to participate in this forum. ESCC had confirmed that feedback from the quality assurance process undertaken at Firs was being collated to be available to read in April 2006. Also that a formal process to gain feedback from other stakeholders has been developed. This was not evidenced to have been completed and ESCC have been asked to confirm completion and how stakeholder feedback will be sought. Regular quality assurance visits by a representative of ESCC are completed and recorded to meet the requirement under Regulation 26 and are regularly sent to the CSCI. Where a small ‘float’ of money is held for some service users the financial records to support this activity were adequate. One service user who had used this facility confirmed they had received a receipt to confirm what was being held for them. The three staff questionnaires, staff spoken with and records viewed confirmed that staff supervision and team meetings occur on a regular and ongoing basis. Staff spoken with had attended a range of training opportunities and spoke of good access to training opportunities for personal development. Staff training records completed evidenced that the majority of staff had received moving and handling updates, first aid, basic food hygiene and fire training. Where a few updates are overdue a system should be in place to ensure staff receive these updates within the required timescale. A detailed check of the environment and fire precautions had been carried out to meet the timescales as detailed in ESCC’s policies and procedures. The preinspection questionnaire also detailed and the Manager confirmed that a PCT Fire Officer has visited and offered support on updating policies and procedures, training staff and facilitating fire drills. Accident records were viewed and filed so that any trends can be been identified. One service user had had a fall recorded in their notes but an accident form could not be found detailing the incident. It should be ensured that all falls are being recorded. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 26 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 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 27 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 OP3 Regulation 14 (1) (a) Requirement Timescale for action 16/05/06 2. OP7 15 (1) 13 (4) That initial assessments are fully completed at the start of any admission. This issue is outstanding since 30.08.05, 28.02.06 and 16.05.06 A copy of this is provided prior to any admission onto the unit to ensure that service users care needs can be met on the unit. That the admissions criteria for the home is followed to ensure that service users admitted on to the unit are as detailed in Firs Statement of Purpose. That a system is in place to 16/05/06 ensure that a written plan as to how the service user’s needs in respect of his health and welfare are to be met for all service users is in place, and are regularly reviewed. All service users have an individual risk that details individual risks to service users and how these risks are to be managed. This issue is outstanding since 28.02.05 and 30.08.04, and 28.02.06. DS0000059634.V289853.R01.S.doc Version 5.1 Firs (Firwood Intermediate Rehabilitation Service) Page 28 3. 4. OP7 OP9 15 (1) 13 (4) 13 (2) 5. OP22 23 (2) (l) (m) 6. OP27 19 (1) (b) (i) 19 (1) (b) (i) 7. OP29 8. OP29 19 (1) (b) (i) 24 (1) (2) (3) 9. OP33 That a falls risk assessment is completed for all service users on admission. That a system is put in place to ensure the controlled drugs register records are kept accurate and as per the accepted procedure. This issue is outstanding since the receipt of the previous report and 28.02.06 That where identified equipment is provided and available on admission for service users use. This issue is outstanding since 31.03.05 and 28.02.06. That at all times there are suitably qualified, competent and experienced persons working on the unit. That a recruitment procedure is in place, which demonstrates two references have been obtained and the correct level of CRB check is in place. That where a POVA First check is sought where a member of staff did not have evidence of a CRB check in place. The outcome of the service user quality assurance is made available to read. Feedback sought from other stakeholders. 30/06/06 30/06/06 30/06/06 16/05/06 30/06/06 16/05/06 31/08/06 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 Standard Good Practice Recommendations Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 29 Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V289853.R01.S.doc Version 5.1 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!