Inspection on 11/09/07 for The Firs Residential Home

This inspection was carried out on 11th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Firs Residential Home 22/08/06

The Firs Residential Home 09/11/05

The Firs Residential Home 13/07/05

The Firs Residential Home 08/12/04

The Firs Residential Home 24/05/04

The Firs Residential Home 04/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Firs Residential Home, The 186 Grange Road Felixstowe Suffolk IP11 2QF Lead Inspector Mary Jeffries Unannounced Inspection 11th September 2007 15:30 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 Residential Home, The DS0000024387.V350874.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 Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs Residential Home, The Address 186 Grange Road Felixstowe Suffolk IP11 2QF 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) 01394 283278 01394 284504 keri.sherwood@anchor.org.uk Anchor Trust Mr Simon John Manning Care Home 40 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (20) of places Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 1 The home may accommodate up to 20 people over the age of 65 years, of either sex, who require care by reason of old age. 2 The home may accommodate up to 30 people over the age of 65 years, of either sex, who require care by reason of dementia. 3 The maximum number accommodated must not exceed 40 persons. 22nd August 2006 Date of last inspection Brief Description of the Service: The Firs Residential Home for Older People was built in 1991 on the land adjacent to a former local authority home. The home offers accommodation and care for up to forty service users, within four individual living units, each accommodating ten people. The two living units situated on the first floor of the home are allocated for older people with a diagnosis of dementia, therefore presenting more complex individual needs. One unit on the ground floor, Willow, is for flexible use; residents with dementia may be accommodated on this unit. The home is owned and administered by Anchor Homes Trust, a non-profit making organisation that provides housing and residential care throughout the country. Twelve of the forty beds are offered on a private basis and the remaining twenty-eight beds are block purchased by Suffolk Social Care Services. The home is situated in a quiet road in a residential area of Felixstowe. There are several local shops close by and a superstore a short distance away which includes a pharmacy, a post office and local GP practice. The home is purpose built and offers a high standard of accommodation on two floors. The home has one room, which is allocated for respite care. The Service User Guide does not states the current fees. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. An Annual Quality Assurance Assessment (AQAA) was provided by the home prior to the inspection. The inspection was facilitated by a number of senior staff. A number of other members of staff were spoken with and gave assistance. Two residents returned “Have Your Say” surveys. Four relatives returned “Have Your Say” surveys. Two members of staff returned “Have Your Say surveys. The inspection occurred on an afternoon and early evening in September 2007 and took five hours. Three residents were tracked. Observations of staff and resident interaction took place and, and a number of documents were examined including residents’ care plans, medication records, the staff rota, training records and records relating to health and safety. A random unannounced inspection was undertaken in December 2006, to follow up on a number of requirements made at the key inspection undertaken on August 22nd 2006, and also to conduct a final site visit in respect of a major variation application. The home is funded by a mix of Block Contract & Private Fee Paying Residents with 1 block contract bed identified for respite care. The block contract includes 16 for dementia care and 12 for older people. The fees were not set out in the Service User Guide. There was one vacancy on Pine Unit at the time of the inspection. What the service does well: The Firs provides small group living in an attractive well-maintained building. Residents are encouraged to maintain their independence. Residents can expect to have good access to health services. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 6 Residents are well protected through the complaints procedure and through safeguarding practices. 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 Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, 4,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be fully assessed before moving to the home, and for the home to be able to meet their identified needs. EVIDENCE: Residents were found to have Service User Guides in their rooms at the random inspection. Both residents who responded to the “Have your Say“ survey stated that they received enough information about the home. Two of the relatives who responded stated that they always get enough information about the home; two stated that they usually do. The Service User Guide states that prior to admission any potential resident is invited to visit the home, and can stay for a night or two if they wish. A Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 10 recently admitted resident spoken with advised that they could have visited but that they didn’t, because they knew the home was good by reputation. At the last key inspection a requirement was made that the home apply immediately for a variation to its registration. The home was then operating outside of its registration in accommodating an elderly person whose main requirement for care was on account of mental disorder. An application for a variation was received, but subsequently withdrawn as the resident left the home. The site visit undertaken in December 2006 found that everything was in place to recommend that the variation application be approved. The variation was for the home to accommodate an additional ten residents with dementia, with the total number of places remaining the same. The home intends for Willow unit to accommodate residents who may or may not have a diagnosis of dementia. The AQAA stated that, “We complete a pre-assessment process prior to admission of our residents and continue this through person centred planning.” At the time the AQAA was completed the Registered Manger reported that the local authority was responsible for funding 27 of the residents in the home, ten of which had been admitted within the previous twelve months and that and that all 27 had received a council or health body assessment prior to admission. The home does not provide intermediate treatment. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a care plan, but cannot be assured that all of their needs will be identified in a regular reviewing process. EVIDENCE: Three care plans were inspected. The format used had not been modified, as is intended. All required information had been included on additional sheets where necessary, as an addition to the basic format used by the organisation. Residents’ files inspected contained a written assessment in relation to mobility and any risk involved in their care. The home is aiming to have introduced the new care plans for all residents by December 2007. All residents tracked had care plans, however, the care plan for one resident who had been had been admitted over a month prior to the inspection had not been fully completed. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 12 One of two files inspected at the random inspection showed that there had been a full review with Social Care Services in January 2006, but that last monthly review undertaken by the home was August 2006. For the other resident whose care plan was inspected on that occasion, not all areas of the plan were evidenced as having been recently reviewed. On that occasion the Registered Manager advised that this resident was still self-medicating, and the resident’s notes included a recent entry that they had chosen for the home to dispense all of their medications apart from three. The file did not show that aspect of care to have been recently considered at review. A self-medication risk assessment, undertaken in July 2005, was last signed as reviewed in November 2005, prior to a scheduled review in January 2006. This file was amongst the three inspected on this occasion, and this risk assessment had not been updated or subsequently reviewed. A requirement was made that care plans must evidence they have been regularly and fully reviewed in line with the standard. As stated one of the care plans inspected had not been fully reviewed on a monthly basis, however the manual handling part of the plan had been reviewed and updated. The other care plan inspected did not have evidence of regular full reviews in line with the standard. The AQAA stated that nearly all of the residents funded but social care services had been reviewed within the last twelve moths, but the absence of regular monthly reviews within the home means that although care staff showed a good knowledge of residents’ identified needs, a regular overview is not guaranteed and needs could go unidentified. The two residents who responded to the “Have your Say“ survey stated that they usually receive the care and support that they need, and that staff were usually there when they need them. One of the relatives who responded to the survey indicated that the home always meets the needs of their relative; two indicated that it usually did, and one indicated that it only sometimes did. One indicated that the home always gave the support and care to their relative that they expected or agreed, three indicated that it usually does. Both residents who responded to the survey indicated that they always receive the medical support that they need. The AQAA stated that one resident admitted to the home in the last twelve months had developed pressure ulcers, however, it also stated that it had no policy or procedure for how these must be responded to. A resident spoken with advised that if you wanted to see a doctor you could, all you had to do was ask, but that the carers usually thought of it before they did. Residents’ files inspected showed evidence of appointments with a range of health care professionals. District nurses regularly attend the home. The home reported a medication error to the CSCI in April 2007, and reported that it had consulted with the G.P. The AQAA stated that audit and assurance Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 13 systems were now in place for the administration of medicine. These were monthly and linked into the ordering process and there was also a weekly audit. One senior carer is responsible or the medication. They were spoken to in detail. The senior advised that they thought the medication had improved considerably. One relative commented that their relative’s medication is always given on time. They also stated, however, that there had been a number of problems with supply. This matter had been raised in a resident and relative meeting; the notes stated that a complaint had been made to the pharmacy from the home. The senior advised that the problems that had occurred had been with interim prescriptions, a system had been put in place within the home and to check deliveries meet expectations. Medical records and storage were inspected. There were just two omissions in the records which were otherwise complete. There was central storage of all medicines including medicine trolleys. Metal trolleys were in place; medicines requiring refrigeration were clearly and separately identified at the time of delivery. Storage facilities for controlled drugs were satisfactory. All four relatives who responded to the survey stated that the home always keeps them up to date with important issues affecting their relative. The two residents who responded to the “Have your Say“ survey stated that the staff listen and act on what they say. One relative commented that the home “creates an atmosphere of friendliness, care and gentle prompting. They added, “It appears that everybody gives time.” Another commented that their relative needs more support with personal hygiene, when going to the toilet, in terms of prompting and checking by staff. All four relatives who responded to the survey stated that the home always supports people live the life they choose. Three indicated that the home usually meets the needs of different people; one indicated that it always does. The AQAA stated that End of Life care been a focus for 2006/07 and that staff had been trained and changes implemented. It noted that facilities were in place for relatives of residents to stay with them. Staff spoken with confirmed that this was the case. Two residents had recently died on one of the units. A certificate with a picture of flowers and a poem was in place in remembrance of each of them. End of life wishes are now discussed as part of the pre admission inspection. Firs Residential Home, The DS0000024387.V350874.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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy a good quality of daily life whereby they are encouraged to maintain independence. EVIDENCE: One of the two residents who responded to the “Have your Say“ survey stated that they always like the meals at the home; another stated that they usually do. Written menu boards were on display on the individual units; in the AQAA the home identified the introduction of picture menu boards as an improvement it will make in the next twelve months. One relative commented, “I find I have to say to the carers if (……..) will eat (their) food if it is cut up, (they) have arthritis in (their) hands and I think they should notice if (they) struggle, not wait for me to prompt them.” One relative commented that they thought the food should be more old fashioned, like the sort of thing that the residents used to cook when they were in their own homes. The menus seen showed a good range of home cooked meals, and there were plentiful supplies of food in the home. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 15 Residents can have snacks on the units whenever they wish. Residents have kitchenettes within the individual units and those that are assessed to be able to do so are encouraged to make use of these. A recommendation was made at the last key inspection that the weekly activity programme should be reviewed, in the light of the input care staff are able to provide. In response to the enquiry, “Are there activities arranged by the home that you can take part in?” both residents responded that there sometimes were. One added, “ We know this is being addressed.” A relative commented, “A lot of the activities and days out for residents seem to have dropped off.” The AQAA stated “We will be looking at the role of Activity Co-ordinator within the home with the view to making it a full time role. We will be exploring the use of community groups to supplement the opportunities for interaction offered within the home.” There had previously been an activities coordinator, and staff confirmed the home was in the process of appointing a new one, for 20 hours. The relative suggested some afternoon sessions of reminiscence would be appreciated. Another relative stated that the residents need more stimulation. Another stated that it would be good to have a selection of audio books or information on how these could be accessed for when a resident finds it hard to hold their concentration to physically read a book. The AQAA states that the home currently accesses five local churches to provide he regular Sunday service. One relative commented that the religious services were excellent. The notes of a relatives’ and residents’ meeting held in April were seen; these included details of a number of outings, and events. The events listed included a gourmet evening for residents families and friends, a beach hut trip, a garden party and an art exhibition. Residents spoken with advised that they could make choices about their daily lives, and get up and retire to bed when they wanted to do so. Firs Residential Home, The DS0000024387.V350874.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): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have access to a good complaints procedure and for complaints to be responded to properly. They can also expect staff to have an understanding of their vulnerabilities, and for any concerns about their treatment to be recognised and responded to properly. EVIDENCE: One of the two residents who responded to the “Have your Say“ survey stated that they knew how to make a complaint and also that they always knew who to speak to if they were not happy. The other stated that they did not know how to make a complaint and that they sometimes knew who to speak to if they were not happy. One resident stated that they had never had reason to complain. The home’s complaints policy was on display in the home. Anchor homes complaints policy directs complaints to a Business Services Team in Bradford, and does not specify a named person to complain to. Given that this may be a barrier for residents wishing to make a formal complaint, the home had developed a process for handling informal complaints, directing them to the Registered Manager. This was also on display. A resident spoken with in their room confirmed that they had been given a Service User Guide, and they kept it on their windowsill. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 17 At the random inspection it was found that the complaints log had been organised and was complete. This was also the case on this occasion. The AQAA stated that three complaints had been received by the home in the last 12 months, that one had been upheld and one was still awaiting an outcome. This had taken longer than 28 day as after establishing an item had been lost from the laundry, the home then reimbursed the cost of the item once a new one was purchased. The regulation 26 visit report for July 2007 reported, properly, that there had been one complaint that was being responded to. The complaints log showed that the third complaint had been withdrawn as missing items were found during a room check. All of the four relatives who responded to the survey stated that they knew how to make a complaint; three indicated that when they or their relative had raised a concern, the home had always responded appropriately, the fourth stated that the home had usually responded appropriately. The AQAA stated that Alert Training (POVA training) for all staff has taken place. Records inspected showed that the majority of staff had undertaken Safeguarding training. In response to the survey enquiry, “Do you know about the procedure for safeguarding adults, sometimes known as PoVA?”(Protection of Vulnerable Adults), both staff members responding indicated that they did, and one stated on their survey form that that they had received PoVA training. A member of care staff spoken with at the inspection demonstrated a good understanding and was aware of steps that should be taken if they suspected abuse. Since the last inspection the Registered Manager had made one safeguarding referral to Social Care Services; the incident had also been reported to the CSCI by the home, and appropriate immediate action was taken to ensure that the resident was at no further risk until investigation took place. Firs Residential Home, The DS0000024387.V350874.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): 19,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy small group living in an attractive home that is well maintained. EVIDENCE: The home is purpose built and offers a high standard of accommodation on two floors. The general standard of the environment is very good, having been recently refurbished. The home is welcoming and provides a homely environment, with, for example, fresh flowers in communal areas. The main door into the rest of the home and the home’s lobby opens on a keypad system. A key fob system is in place in the units on the two first floor dementia care units, to offer protection form the staircases. Willow, which is downstairs which is used for older people or people with dementia has a key Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 19 fob system in place but the door is permanently open on a mag-lock attached to the fire system. One resident had a key fob, staff have advised that these can be given to residents without dementia so that they can enter the home without ringing the bell, or to a person with dementia if they are assessed as being safe to use it to come and go freely. All residents have access to the enclosed garden, those living upstairs can access this via the lift. Fencing in the garden had been completed since the last inspection. Communal lounge/ dining rooms have facilities for tea making and micro waving meals; the electricity for these facilities is on an override switch, so that they do not pose a risk to residents, but staff advised that they assist residents make tea in these areas. This facility adds to the homeliness of The Firs, and supports the encouragement of residents’ independence. All rooms have en-suite facilities. One relative who responded to the survey noted that staff were very helpful when the resident wanted to bring in furniture from home to personalise their room. Those individuals who had dementia had appropriate name/plates symbols on the doors to their individual rooms. Individual rooms seen were personalised and attractive, one resident who had a diagnosis of dementia had a large collection of soft toys in their room. However, one relative commented, “ We buy (…………….) plants for (their) room, (…………..) has dementia and forgets to water them, they don’t get watered. Plants should be maintained, as these are a sensory stimulation and can enhance the environment for those with dementia. One of the two residents who responded to the “Have your Say“ survey stated that the home s always fresh and clean, the other stated that it was sometimes fresh and clean. A relative who responded to the survey noted that, “ (………) is incontinent and when I complain that (their) room smells it is done immediately, but I should not have to bring this to their attention.” Another relative stated, “Most of the toilets could be cleaner”, and one stated that they thought the home would improve by having more housekeepers for cleaning rooms and bathrooms. A tour of the environment, including bathrooms was made and it was found to be very clean, however, one bathroom in an upstairs unit had a very strong unpleasant odour emanating from it. This was brought to the attention of a member of staff who advised, that it was coming form the bins in the bathrooms. In the bathroom was a metal frame, which held three differently coloured bags, for different kinds of waste. The member of staff stated, “I unusually close the door.” Pads were double bagged before being binned, however, the system is not satisfactory in respect of odour on one unit. A further relative commented, “………….the grounds are extremely well kept, as indeed is the general cleanliness and the laundry facilities.” Firs Residential Home, The DS0000024387.V350874.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): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a well-trained workforce. EVIDENCE: In response to the survey enquiry, “Do staffing levels on each shift give you enough time to meet the assessed needs of residents?” both members of staff responded, sometimes. One relative stated “Staff seem to be busy to a point where they are stretched.” The Service User Guide states that during the day the ratio of staffing on the two units where all of the residents have a dementia diagnosis is 1:5, and on the mainstream units it is 1:6. At night the ratio is 1:10 across the home, including a senior care assistant. Staff appeared to cope well with their duties on during the inspection, and call bells were answered promptly. One member of staff advised that if they felt stressed, they were encouraged to take a break. The AQAA stated that the home was introducing a new rota system and incentives for existing staff to ensure continuity without the use of agency Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 21 staff. The regulation 26 area manager visit report for July stated that the use of agency staff had been reduced. The AQAA stated that robust recruitment procedures are in place, supported by a recruitment team. It also stated that staff are provided with induction training that meets the minimum standards. Two staff files inspected supported this, apropriate records were on file. These staff had eveidence of induction training on file. The training is supported by Anchor homes, who review completed documentation. The AQAA stated that 27 of care staff hold NVQ2 or above. Twelve carers were either undertaking or lined up to undertake NVQ 2. The home had two NVQ assessors and two were awaiting accreditation and certificates. An analysis of basic staff training, food hygiene, fire safety, PoVA, Induction, Manual Handling and Health and safety, completed and planned was provided for inspection. The schedule showed that most staff had received Food hygiene training; training was planned for the others during September and October 2007. Refresher training was scheduled at 3 yearly intervals, four had not had refresher training for a period longer than this; This was also planned for 2007. Records shown showed that most staff had attended sessions of manual handling training since the last inspection. This is intended to be done annually, but four staff had not had recent updates yet. Other training provided to some staff since the last inspection included Boots medication training and advanced care of medication, and End of Life training. The AQAA stated that staff had received further training in dementia. A member of staff spoken with advised that they had had dementia care training and that most other members of staff had received it. They advised that dementia care training was provided by a member of staff with NVQ 3 who had undertaken training in dementia mapping and who was undertaking Assessor training. They are supported by the Registered Manager who is a dementia care mapper. The Anchor workbook for this training, which focuses on privacy and dignity, was inspected. The course was provided over six sessions, after a basic training session. A record of dementia training given was provided for inspection. Thirty-four of the 57 care staff had received all seven sessions. Both members of staff who relied to the “Have Your Say” survey indicated that they are being given training that is relevant to their role, helps them understand and meets the individual needs of residents and keeps them up to date with new ways of working. The files of two longstanding members of staff were inspected and these contained certificates to support this information. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 22 Two of the relatives who responded to the survey stated that the care staff at the home always have the right skills and experience to look after their relative properly, two indicated that they usually have. One relative commented on their survey; “ Most staff are very caring and kind and take an interest in the residents interest and needs. Team leaders are very knowledgeable and the manager approachable.” Two residents spoken with confirmed this and spoke well of staff. Records maintained in the home showed that where there had been incidents of two staff not maintaining a good manner or conduct that these had been picked up and responded to appropriately by management. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 23 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a well managed home, where their health and safety is well protected. EVIDENCE: Since the last key inspection, the manager had been registered. Simon Manning was registered as manager on 10/11/2006. He holds a Diploma in Social Work, a Diploma in the Management of Care Services and D32/33 NVQ Assessors award. One relative who responded to the survey stated that they felt there was a problem in communication between the staff and the office. Another relative Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 24 commented, “The manager and the staff are excellent.” A carer spoken with in some depth explained that they thought the manager had a good understanding of their work, and was supportive. At the random inspection Regulation 26 reports for April, May, June and July 2006 had been provided to the CSCI prior to the inspection, establishing that these had taken place during this period. On this occasion the regulation 26 reports for May 2007, June 2007 and July 2007 were inspected. They were comprehensive reports. The AQAA stated that a Residents & Relatives committee had been introduced as a forum to influence service delivery. One relative commented that the relatives and residents meetings were very helpful as they allow for good communication between the home and relatives. This meets every two months. On the AQAA it stated that Anchor has commissioned a full Customer Engagement Project to determine how in 2007/08 we can increase the engagement of those who use our services. The AQAA stated that there are lockable storage facilities for all service users within their own flats. This was checked in two residents rooms and found to be the case. Residents’ finances are managed through the residents personal monies system within the trust. Some items are purchased on behalf of residents, and a requirement was made at the previous inspection that receipted should have two signatures, to verify that the actual expenditure was on behalf of the resident. Records were inspected at the random inspection and this was found to be in place. On this occasion, records were checked and found to be in order, but monies held were not held individually and so could not be checked against the records. The home holds a small float. The Service User Guide states that the facility is available for residents to have certain monies held within a resident’s accounts system. The home’s policy on Residents Property and personal monies was inspected. The policy states that each home will have a resident’s personal monies account which will be a non interest bearing current account, and a limit of £250.00 per resident is set. Internal records are to be maintained on the computerised system, which can provide individualised statements. The record sheet for the system requires two signatures to witness and evidence transactions. The responses of the two members of staff who relied to the “Have Your Say” survey, to the enquiry, “How does your manager give you support”, in indicated that they did not receive regular supervision in line with the standards. One responded, “I have one to one every few months”, the other responded, “ At staff meetings” and stated that their manager did not meet with them regularly. The AQAA stated that staff supervisions and Performance Development Discussions are in place. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 25 The AQAA stated that the home does not have a procedure, policy or code of practice for record keeping in place. A copy of the latest CSCI report was on display in the home. Hot water temperatures were taken in two bathrooms at all outlets and were found to be at approximately 43degrees Celsius. No health and safety requirements wee identified. Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 3 Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 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 OP1 Regulation 5 Requirement The Service User Guide must contain all information as is required under the revised regulation, including details of fees, so that prospective residents have all of the information they require to make an informed choice. Care plans must evidence they have been regularly and fully reviewed in line with the standard. This is a repeat requirement from the inspection of 28/12/2006. Care plans must be completed for residents within a short period of admittance, to ensure that complete information is available on all aspects of their care. The home must be kept clean and free from noxious odours so that a safe and pleasant environment is maintained at all times. The Registered Persons should ensure that staff receive appropriate formal one to one supervision, to ensure that all DS0000024387.V350874.R01.S.doc Timescale for action 30/11/07 2 OP7 15(2) (b)(c) 31/12/07 3 OP7 15(1) 30/11/07 4 OP26 16(2) 15/10/07 5. OP36 18(2) 31/12/07 Firs Residential Home, The Version 5.2 Page 28 aspects of work and performance are regularly monitored and that staff are properly supported. This is a repeat requirement from the inspection of 22/08/06. 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 Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Local Office Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Firs Residential Home, The DS0000024387.V350874.R01.S.doc Version 5.2 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!