Inspection on 29/06/07 for Firs (Firwood Intermediate Rehabilitation Service)

This inspection was carried out on 29th June 2007.

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... 15/05/06

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 29th June 2007 10:30 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.V337379.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 (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 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 caroline.piper@eastsussex.gov.uk www.eastsussex.gov.uk/socialcare East Sussex County Council 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) 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.V337379.R01.S.doc Version 5.2 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. 15th May 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. The service is free for up to the six weeks that intermediate care is provided. Following this fees charged are in accordance with ESCC policy and procedures Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 5 and at the time of the inspection the charges are £98.60-£523.02 per week. The level of fees charged will depend on the outcome of a financial assessment. Charges are made for hairdressing, chiropody, outgoing telephone calls, newspapers/magazines and toiletries. The Statement of Purpose and a copy of the last Inspection report are available to view on the unit. A copy of the Service Users Guide is available to read in each of the service users bedrooms. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours on 30 June 2007. A further visit was made by the Inspector on 2 July 2007 for one hour to collect service users surveys and give feedback to the Manager. On 15 May 2007 the Inspector also visited the PCT’s Human Resource Department to view recruitment procedures. Prior to the Inspection the Acting Manager completed an Annual Quality Assurance Assessment (AQAA) 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. Nineteen service users were resident and five were spoken with individually in their bedroom. Of these five 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. Seven service user surveys were sent out and all came back completed. The Acting Manager, the senior nurse on duty, an agency nurse, two new care workers, care staff, the cook, a member of the housekeeping team, administrative staff, an occupational therapist and a physiotherapist and student were all spoken with. Two relatives were spoken with on the day and two relatives and a visitor were spoken with by telephone after the Inspection. General Practitioners comment cards were not sent out on this occasion. The assessor from the ESCC Adult Social Care Team at the local hospital who is based at Firwood House was also spoken with by telephone after the Inspection. Currently the Registered Manager is on extended leave and a Registered Manager from another ESCC care home is managing Firwood House during this period What the service does well: Staff was 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, ‘could not wish for better staff,’ ‘they are very helpful and always look after your needs,’ ‘staff are deightful,’ and ‘they go out of their way to help you.’ 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. 75 of the units care staff hold NVQ level 2 in care or above. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 7 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. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 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.V337379.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Potential new service users are individually assessed prior to any admission to ensure that their care needs can be met on the unit and there is good support from healthcare professionals working to enable service users to regain their independence and work towards returning home. EVIDENCE: The Statement of Purpose is detailed and is available to read on the unit with a copy of the last Inspection report. The Service Users Guide is available to read in service users bedrooms. Not all the service users spoken with had read the information but were aware that it was available to reference. 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, but one service user did not. One Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 11 service user spoken with stated they had relied on feedback from other residents where they lived and another spoke to other patients in the hospital. One service did not know anything about Firs prior to admission and would have welcomed more information. The AQAA detailed that the way service users receive information about Firs prior to admission is an area, which is it planned will be improved over the next twelve months. The service user surveys indicated that five service users felt they had received a contract and two had not. The eight service users documentation viewed and all had a completed contract in place, but several did not have the number of the bedroom recorded and were not complete so service users had not had all the information at the time of signing. This was discussed with the Acting Manager who stated this would be addressed, so a Requirement has not been made on this occasion. Service users have an initial assessment completed by an assessor working for one of ESCC’s Adult Service Departments Assessment Teams. The AQAA detailed that the admission process had been reviewed with only key staff now processing referrals and staff spoken with and documentation viewed confirmed that a copy of the assessment is now always sent to the unit for reference. All of the eight service user files viewed had a copy of an initial assessment. 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. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are not always 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. There are detailed policies and procedures in place to manage medicine to be followed to ensure the protection of service users, but staff should receive regular training updates. EVIDENCE: The AQAA detailed that all the documentation used has been re-developed with one new designated care plan with supporting risk assessments, and where possible service users are encouraged to be involved in the drawing up of their care plan. Eight service users documentation viewed, all had a care plan, but a number 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 Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 13 guidance to staff as to how care needs should be met. It was not possible to ascertain what all the service user’s care needs were, or if they were being met. A format has been put in place to enable a falls risk assessment to be completed. Three of the eight did not have a falls risk assessment completed and for the fourth it had been completed several days after admission. A number of supporting risks assessments detailing individual risks in relation to tasks being completed as part of the rehabilitation programme. All had a daily record being completed. The AQAA detailed that there is a weekly multidisciplinary meeting to monitor individual service users progress and there is now a dedicated assessor at Firs who will meet with service users and review their care needs whilst resident and for further care needs on discharge. There are detailed policies and procedures in place in relation to the administration of medication. A number of service users self medicated their own medicines and the unit has policies and procedures in place to support this activity. Risk assessment were viewed for three service users selfadministering, one had not been fully completed and should be. Several service users confirmed that they were self administrating and two showed the Inspector a chart to remind them of what time their medication was due. One service user had not been given the key to their lockable drawer to safely store their medication, which was discussed with the Acting Manager during the inspection who stated this would be addressed with immediate effect. The service users surveys identified that the majority of service users felt they always received medical support they needed. One comment was received that a medical appointment had been overlooked and had been missed. Training records viewed evidenced that not all staff had received an update of this training to meet the organisations requirements. Staff was observed to deliver care with dignity and respect. The five service users and three visitors stated that they were pleased with the overall care provided in the home. Comments included, ‘could not wish for better staff,’ ‘they are very helpful and always look after your needs,’ ‘staff are deightful,’ and ‘they go out of their way to help you.’ Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. 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. A varied diet is provided which offers choices at every meal. EVIDENCE: The AQAA detailed that following feedback from service users the range of activities have been expanded during the last year and various clubs have been set up to support the service users rehabilitation programme, including a breakfast club where service users work towards independence by getting their own breakfast and a gardening club. One relative had been present when the gardening club had been organised and stated he had spent a very enjoyable afternoon in the garden with his relative, when pots were painted and plants were potted. The majority of service user surveys and service users spoken with stated activities were always arranged. Service users spoke and detailed in the service user surveys some of the social activities they had participated in including making cards, made bookmarks, painting, word games and a special Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 15 film to watch. One service user stated they would like to have had a chance to go out of the building even if it was just for a walk down the road to get some fresh air. Another spoke of enjoying visit out of Firs being taken out by their friends and had not realised this was possible until they found this out by word of mouth from another service user. They felt it would be helpful if this could be detailed somewhere in Firs literature. Service users’ social care needs should be included on all service users individual care plans. Four of the service users spoken with felt their religious needs had been met whilst resident at Firs, one service user did not, who stated they had not been asked what their needs were and is a regular church attendee when at home. Visitors spoken with and the five service users spoken with 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 five service users and visitors spoken with confirmed this. The cook working on the day stated she held a basic food hygiene certificate. Fresh food is being used for all meals during the week with frozen meals only being used at the weekends. There is a four-week rotating menu in place detailing a choice at all meals and service users were observed choosing from the choice available. Lunch on the day was fish bake, leek and mushroom puffs, creamed potatoes, peas and mixed vegetables followed by pears and cream, yoghurts or ice cream sponge roll. Homemade cake is provided with afternoon tea. Staff were observed to be available to offer assistance and their was a social atmosphere during the meal. 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. A cooked breakfast is not available. Five service users stated they always liked the meals and two usually. Four of the five service users spoken with stated they enjoyed the meals and one they were all right, but unimaginative. Some comments received were ‘the meals are first class and more than enough and well presented. Easily equal to two dinners a day and the tea and breakfast are equally good. We should all put on weight staying here and there are ample opportunities for as many hot and cold drinks,’ ‘eighty percent perfect,’ ‘excellent,’ and ‘ ‘the midday meal is always excellent. The evening meal is sometimes less filling.’ Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures 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. Any complaints affecting the service will be managed by partnership working with the PCT and investigated in tandem by both the organisations. The AQAA detailed that no complaints in relation to Firs have been received since the last inspection. The CSCI have not received any concerns during this period. The five service users spoken with and visitors 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. Two visors stated staff had informed of the procedures if they had any concerns. There are detailed policies and procedures in place in relation to the protection of vulnerable adults and a whistle blowing policy. The three staff spoken with all confirmed they had an awareness of adult protection procedures and had Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 17 received training. Staff training records viewed detailed the majority of staff had attended at this training and for those six who had not the Acting Manager stated this was in the process of being addressed. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. People who use this service experience good quality outcomes in this area. 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 generally is to a good standard; furnishings are of a good quality, and domestic in style. Although there is some evidence of wear and tear to the décor in bedrooms and hallways, but the Acting Manager stated that discussions were already in progress to address this. One visitor to the unit stated it was a, ‘marvellous building. I could not believe it when I walked in.’ There are twenty single bedrooms which all meet the minimum space requirements. One bedroom predominantly used as a single bedroom, has the Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 19 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 two bathrooms, one with a standard bath and shower facility, and one with an assisted bath on the unit. There has been a decrease of one bathroom since the last Inspection as this area is now used for storage of specialist equipment when not being used by service users resident on the unit. Bathrooms are well decorated and furnished. 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 jointly use. There is a passenger lift between the ground, and first floor. 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. Records of the routine checks of the hot water temperatures at outlets accessed by service users were viewed, which recorded that hot water is maintained at close to the recommended safe temperature of 43°C. The five service users 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, had attended a range of training opportunities and stated there was good access to protective clothing. Feedback from the service user surveys, service users and visitors was that the home was fresh and clean and comments received were ‘spotless,’ and ‘it is always clean and very tidy and always fresh.’ Records were viewed of regular fire checks of the equipment in the building, which have been completed. There is an attractive garden at the rear of the building. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff is provided with opportunities for training to develop their skills and ensure the individual care needs of service users can be met. Detailed recruitment policies and procedures were in place, but it must be ensured that all staff has had the appropriate CRB checks to protect service users. EVIDENCE: Discussions with staff and records viewed confirmed the staffing levels in place. On the day staff on the unit appeared to be and spoke of being very busy. Two service users who had been admitted the previous afternoon were being admitted to the home during the morning of the Inspection. There was a Registered General Nurse on duty during the waking day with five care workers during the morning and three during the afternoon. Three care workers are on duty at night. There is still a reliance on agency and relief staff to work in the home, but further staff has been recruited, which has helped to address this and improve continuity. Housekeeping staff work in the home and undertake ancillary tasks and there is a reliance on agency staff to provide domestic Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 21 cover in the building due to difficulties in recruiting to current vacancies. This is an area detailed in the AQAA which it is felt could be improved. The majority of service users are only resident for short periods of care there is a high number of admissions and discharges. The dependency and care needs of individual service users continually changes and staff feedback confirmed that the number of care staff on duty is kept under review to ensure adequate staffing to meet the needs of the all the service users resident. Feedback from the service users surveys stated that four service users felt they always received the care and support they needed and one usually and all felt that staff listen and act on what they said. Feedback was varied when asked if staff are always available when you need them with four stating always, one usually and one sometimes. Feedback from service users spoken was also varied with three stating yes and two no. One service user commented on one particular day where there were a high number of agency/ relief staff on duty and that one had to be patient whilst awaiting for support on that day. Four of the service users spoken with who had used the emergency call bells confirmed that the call bells were answered promptly. The AQAA detailed that eight of the twelve care staff hold an NVQ Level 2 in care or above, which equates to seventy-five percent of the care staff. No further members are currently 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 during the Inspection. A visit was made to the PCT’s Human Resources Department for further evidence of the PCT’s recruitment procedures followed. The documentation for four care workers and four PCT staff was viewed, was well-structured and easy to reference and evidenced the recruitment practice in place. The four files viewed were for PCT staff recruited to work at Firs and all had an enhanced CRB check, but it was not evidenced that a Protection of Vulnerable Adults check has always been requested. It must also be ensured that PCT staffs working at Firs have an enhanced CRB check and not a standard CRB check which is not adequate. But ESCC has a detailed induction training programme in place, which new care staff are expected to complete. All new members of staff spoken with and records viewed con and was being made aware of the homes policies and procedures. The organisation has a yearly appraisal process in place for staff. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The overall management of the home is good with quality assurance procedures in place to monitor the service provided and systems to protect service users are in place, but it needs to be ensured that these are followed to meet the organisations requirments EVIDENCE: The Acting Manager has worked for East Sussex County Council for many years as a senior manager participating in a range of training opportunities. They have just completed the Registered Managers Award, NVQ 4 in Care, Certificate in Management and is an NVQ Assessor and Internal Verifier. There are clear lines of line management and accountability within the organisation. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 23 ESCC has a quality assurance plan in place. There are 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 copy of the minutes of the last meeting was viewed and during the afternoon of the Inspection a volunteer ran a meeting attended by a small group of service users. ESCC have collated feedback from the quality assurance process undertaken at Firs and the Manager confirmed that the outcome of the quality assurance for the period April 06 to March 07 is currently in the process of being collated and will detail that of the service users who responded eighty-two percent of the service users stated they were very happy with the service and fifteen percent stated they were satisfied. A formal process to gain feedback from other stakeholders has been developed. Regular quality assurance visits by a representative of ESCC are completed and recorded to meet the requirement under Regulation 26. The AQAA detailed that policies and procedures were in place, but these should evidence a regular review. Where a small ‘float’ of money is held for some service users and the financial records to support this activity were adequate. None of the service users spoken with had used this facility, but were aware that it was available. The two new staff spoken with and the sample 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 viewed recorded that not all of the staff had received moving and handling, first aid, basic food hygiene, or attended fire training updates. There were records of regular fire drills to meet the organisations requirements, but not that everyone had attended at the frequency required. One care worker was found to be providing moving and handling assistance but had not received any training. This was discussed with the Acting Manager who subsequently stated that training had been booked and until this the worker would not be undertaking this task. A system should be in place to ensure staff receives these updates within the required timescale, also that where training has been booked staff have attended. A detailed check of the environment and fire precautions had been completed and should be carried out to meet the timescales as detailed in ESCC’s policies and procedures. Not all service users had had an individual fire risk assessment completed to meet the organisations requirements. Samples of accident records were viewed and were detailed. The AQAA detailed that the maintenance of equipment and services has been carried out. Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 24 Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.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 3 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.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 OP7 Regulation 15 (1) 13 (4) Requirement That a system is in place to 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. This issue is outstanding since 28.02.05 and 30.08.04, and 28.02.06 and 16.05.06. That a falls risk assessment is completed for all service users on admission. This issue is outstanding since 30.06.06 4. OP38 23 (4) (d) That staff have received the required updates in moving and handling, basic food hygiene, fire prevention, and first aid, and a system be put in place to ensure that staff receive the appropriate updates within the required timescale. 31/10/07 Timescale for action 02/07/07 3. OP7 15 (1) 13 (4) 02/07/07 Firs (Firwood Intermediate Rehabilitation Service) DS0000059634.V337379.R01.S.doc Version 5.2 Page 27 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.V337379.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 - 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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