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Inspection on 22/08/06 for The Firs Residential Home

Also see our care home review for The Firs Residential Home for more information

This inspection was carried out on 22nd August 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides residents with a good standard of accommodation which is spacious but gives them the opportunity to live in small homely living units. It is furnished and decorated to a very high standard. Staff have formed good working relationships with residents and a mutual respect exists between both parties. The quality of daily life is good and relatives are welcomed into the home.

What has improved since the last inspection?

The administration of medicines had improved significantly since the last inspection when a large number of requirements and recommendations had been made. Residents` files inspected contained a written assessment in relation to mobility and any risk involved in their care. There were satisfactory written references on staff files.

What the care home could do better:

A requirement made at the last inspection that wardrobes in resident bedrooms be made stable so that they could not be pulled away from the wall had not been met and still needs to be addressed. Whilst care plans have improved there were still some omissions, and some entries not dated. Areas not completed on plans were not linked to the general risk assessment to indicate that this had been determined not necessary. The complaints policy must be reviewed, and the home must keep a complete record of complaints dealt with and their outcomes. Staff training and supervision do not meet the standards. Financial transactions made on behalf of residents require two signatures. One health and safety requirement, made at the last inspection needs to be actioned.

CARE HOMES FOR OLDER PEOPLE Firs Residential Home, The 186 Grange Road Felixstowe Suffolk IP11 8QF Lead Inspector Mary Jeffries Unannounced Inspection 10:30 22 August 2006 nd 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.V305392.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.V305392.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs Residential Home, The Address 186 Grange Road Felixstowe Suffolk IP11 8QF 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 sharon.blackwell@anchor.org Anchor Trust Post Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Firs Residential Home, The DS0000024387.V305392.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 20 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. 9th November 2005 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 residents, 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. The home is owned and administered by Anchor Homes Trust, a non-profit making organisation which 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 home charges £556 per week for frail elderly residents and £674.10 per week for residents with dementia. Hairdressing, private chiropody, newspapers, toiletries and private transport are not included. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place during August 2006 and took nine hours. This inspection focused on the Care Standards for older people and the report has been written using accumulated evidence gained prior to and during the inspection. A major variation application that has been submitted to he CSCI was also considered and discussed on this occasion. A pre inspection questionnaire was returned by the home, four residents returned “Have your Say” comments cards to the CSCI, and eight relatives returned pre inspection comments. One of the senior carers on duty facilitated the inspection, the other gave assistance. The acting manager attended when advised that the inspection was occurring. They particularly wished to discuss a major variation application that had been submitted in respect of the home, but also contributed to the rest of the inspection. A district nurse attending the home also contributed. A number of carers and the activities worker also contributed to the inspection. Four residents were tracked. These were all spoken with. What the service does well: What has improved since the last inspection? The administration of medicines had improved significantly since the last inspection when a large number of requirements and recommendations had been made. Residents’ files inspected contained a written assessment in relation to mobility and any risk involved in their care. There were satisfactory written references on staff files. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents can expect to be able to visit the home prior to admission, and to be assessed prior to going to live at the home. However, despite this, they cannot be assured that the home can meet their needs, as the home is currently accommodating one resident who falls outside of its category of registration. EVIDENCE: A copy of the Service User Guide was displayed on each unit. A resident advised that they did not get one each. The manager acknowledged that this was currently the case, as the guide was being reprinted. Two residents were spoken with about how they knew the home would be suitable for them. One advised that they had visited a friend at the home for some time before coming in them self, another explained that they came from hospital but had the opportunity to visit a couple of times. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 9 Three recently admitted residents both had social care service assessments, dated prior to admission on file. One resident’s assessment showed that they were subject of an order under section 117 of the Mental Health Act. The resident was spoken with and they were very happy with their placement; they detailed practical assistance as the major form of support received. The manager confirmed that the home did not provide intermediate care. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents are likely to find that the administration of medicine is to a good standard, although the current quality control employed does not ensure this. Residents cannot yet be assured that their care plans are clear or complete. EVIDENCE: As found at the last inspection, when a complaint was investigated, care plans were not all detailed, up to date and fully informative. The home’s care planning format is an Independent Lifestyle Agreement. Care plans of four residents inspected on this occasion showed that some of the Independent Lifestyle Agreement templates, were not used to their full potential and required completion. The resident catering questionnaire had not been completed in the care plan of one resident who had been in the home for a month. Also, in this file, the skin assessment section and the moving and handling risk assessment were blank. The senior advised that the skin assessment section and the moving and handling risk assessment were not Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 11 completed routinely. Residents’ files inspected did contain a written assessment in relation to mobility and any risk involved in their care. A requirement was made at the last inspection that a care plan is produced for each resident where the management of pressure areas is required, and a that a clear audit of the treatment of pressure areas should be available. The acting manager advised that none of the current residents had pressure sores. A district nurse who was attending the home on the day of the inspection confirmed this. They advised that a resident who had arrived at the home in June with a grade 2 pressure sore had been treated and no longer had a sore. The District Nurse described how they communicated with the home in records and verbally in respect of treatments, and the on going log was seen. Care plans for residents with pressure areas were not inspected on this occasion. Nutritional risk assessments had been completed on only one of the four files of residents tracked, no risk was identified for that resident. The acting manager subsequently advised that nutritional risk assessments are maintained in a separate file, maintained by two seniors. These will be inspected at the next inspection. A falls risk assessment on one plan inspected was not dated. A resident who had recently had two falls, which had been recorded in the accident book, did have a recent falls risk assessment on file. Records available at the home evidenced that care plans were reviewed at a minimum frequency of once a month. Two of the four residents’ files inspected did not have any funeral details recorded, although it had been recommended at the last inspection that this be done. There were no residents receiving palliative care at the time of the inspection. It was not therefore possible to establish whether a recommendation that a care plan addressing palliative care needs be produced for any terminally ill resident had been acted on. This will be considered again at the next inspection. The Inspector was advised that the organisation is undertaking a process of care plan improvement to be rolled out to all of its homes in the very near future, and that is not appropriate to conduct such an exercise within the home in advance of this. One resident spoken with, who was slow to engage but responded with encouragement, spoke, sadly, of wanting to die. They said that they didn’t enjoy very much at all. They commented, “The biggest thing about being here is that no one seems to care.” They explained that people walked past and said, “how are you”, but that they felt that there was no thought behind it. The resident was not aware of having a key worker. The resident presented as being accepting of this, rather than complaining, they said that they had had Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 12 their day and were of no use to anyone. They said, “ I don’t think anyone is interested in what I have to say. There was no psychological assessment on this resident’s care plan. Another resident spoken with was very happy with their care and enjoying life. They commented, “ I wouldn’t swap this”. This resident knew who their key worker was. The resident considered one carer to have made a thoughtless comment, once, that hurt their feelings, but otherwise had a very good opinion of all of the carers; “They are really nice, not a nasty one about. We respect them and they respect us.” They confirmed that carers always knocked on their doors before entering. A resident recently admitted onto the special needs unit was able to explain that they felt frightened, but didn’t know why; they said that “everything is so nice, and the staff are very good.” A resident spoken with advised that if you wanted to see a doctor you could, all you had to do was ask. They spoke of an occasion when they needed to see a doctor. A senior spoken with confirmed that if a resident requests to see a G.P., a G.P. is called. The G.P. visited one of the residents tracked on the day of the inspection. The senior carer had suggested this as the resident had been feeling weak and had needed assisting to the floor on a two occasions the previous day. This was recorded in the resident’s care notes, as were a series of other medical appointments. It was noted that a urine sample had already been taken for analysis, and that the G.P. was going to speak with the psychogeriatrician. This resident was seen sitting in a wheelchair. A carer explained that this was unusual, but that the resident was back and forward to the toilet very frequently at the moment. The resident was seen speaking with the carer about how they felt about their falls, and appeared comforted by this. The arrangements for the storage of medicines had been reviewed and rationalised, and there was central storage of all medicines including medicine trolleys. Metal trolleys had been obtained, however, one had been delivered without a key and one trolley was being used for two units on the top floor pending arrival of another trolley. Two small fridges were in this room, and the senior advised that medicines requiring refrigeration were clearly and separately identified at the time of delivery. The carer and acting manager explained the changes that had been made to the security for the keys to the storage of controlled drugs. These were satisfactory. A copy of the RPSGB guidelines The Administration and Control of Medicines in Care Homes and Children’s Homes June 2003 was available in the room where medicines were kept. Medicine administration records (MAR sheets) for the residents with special needs were inspected. One MAR sheet was handwritten, each entry on this had Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 13 been signed by two members of staff. All had photographs of residents, and quantities of medicines received in were recorded on each. The senior carer administering the medicines advised that the acting manager had recently audited the medication system, and that they did this at regular intervals, they thought monthly. No errors were found on this occasion. All entries were correct and the senior was asked what action they would take if they noticed that an entry was missing. They advised that they would establish whether the medication had been given, and ask the person responsible for that round of medication about it when they could. They were asked whether this was their duty, and they advised that they guessed that it was. Although no errors were found on the day, this system does not ensure that errors are immediately responded to and addressed. The controlled drugs book and stock were checked and found to be in order. The senior carer advised that further training had been arranged, but not yet undertaken for all authorised members of care staff on medication in line with National Minimum Standard 9.7. The improvements the home had made were discussed; the senior thought that this was in part due to the fact that the new medication system had started just prior to the previous inspection, and they were not used to working with it at that time. Three of the eight relatives who returned inspection comments gave very positive additional comments about care at The Firs.“ I have great regard for the fine work done at The Firs to make …… feel as comfortable and happy as possible. ”One relative commented, “I couldn’t have hoped for better care and support, for my (spouse) and for me too. Firs Residential Home, The DS0000024387.V305392.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents can expect to be treated with dignity and respect, and to be able to exercise choice in their daily routines. Some residents may find that the social and activities programme is not as full as they would wish. EVIDENCE: The home had a warm and relaxed atmosphere. A carer spoken with advised that some residents liked to get up early, and that the night staff assisted get a couple of the residents on their unit get up. The carer advised that residents have a choice. They advised that residents were usually in bed by ten o’clock, and that there were a couple on this unit who stayed up until then, including one resident whose relative visited late in the evening. A carer advised that the home does have an activities worker, and that carers also did activities, mainly in the afternoons, as they were very busy in the mornings. She advised that they did manicures, which they believed the residents really enjoyed. She advised that that no major outings were arranged for residents, although the acting manager confirmed that residents are taken out locally, on an individual basis, for example to the sea front. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 15 A church service is held at the home each week; four different churches attend the home once a month. One relative reported visiting three days a week, and having their dinner with their spouse which they considered very good. Another relative was concerned that food quality was variable, and sometimes processed foods without fresh vegetables were served. Residents spoken with, and those providing surveys, indicated a high degree of satisfaction with the food. A menu which was provided contained a good range of meals. Dining tables on each unit were attractively set; they had had fresh flowers and tablemats. Staff and residents were observed to interact well, and residents confirmed that they were treated with respect and dignity. Firs Residential Home, The DS0000024387.V305392.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents may not find it easy to make a formal complaint, and cannot be assured that all complaints are followed up and acted on. The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: At the time of the last inspection CSCI were investigating a complaint which had originally been referred through the PoVA procedure; a strategy meeting had been held. Two elements of the complaint were unresolved, two were upheld. Five immediate requirements and three recommendations were made as a consequence of this, which were followed up at this inspection. Copies of Anchor homes complaints leaflets were also available in the hall. These include a form that can be completed, and sent to a Business Services Team in Bradford; there is no named person to complain to specified on it. This may be a barrier for residents wishing to make a formal complaint, and whilst there were a number of “informal” complaints the process by which these had been handled was not clear. The home had a complaints log which contained paper work relating to a number of complaints. Complete paper work was not available for all Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 17 complaints within the log provided on request, there was no summary to indicate that this was a full record of complaints received, and no clear statement of the outcome of the complaints. There was no paper work in the log relating to the complaints investigation undertaken by the CSCI in February 2006. One resident advised that if they are not happy with anything they “walk down to the office and they are very helpful”. Another said that they would go to a senior, explaining that they knew she would listen to them. Staff spoken with were aware of how they should respond in the event of suspicion of abuse. The training analysis provided showed that PoVA training occurred in house. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents users can expect to live in a very comfortable and attractive home, that is well maintained. EVIDENCE: One resident spoken with said, “My room is kept beautiful.” A number of residents’ rooms were seen and were well decorated and personalised, with all appropriate equipment and furniture. A matter concerning a need to fix wardrobes to the wall is reported under standard 38. The whole of the home had been recently refurbished to a high standard, and residents spoken with expressed their appreciation of this. Each unit was Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 19 colour coded, skirting board were all white, bathroom doors all blue, and there were significant identifying pictures on most bedroom doors. The home was clean throughout, although towels were seen stored in a communal bathroom. This poses an unnecessary risk of cross infection. One resident advised that they were concerned that their shower room floor was slippery when wet. The flooring was an appropriate surface for a shower room. The acting manager was asked whether they had similar floor in others and whether there had been any accidents relating to this. They advised that all floors were similar and that there had not been any accidents, but agreed to look into this concern that had not been previously expressed to them. The accident book, which was inspected, supported this advice. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents can expect to have sufficient staff on duty, and that that these staff have been employed using correct procedures which offer them protection from abuse. They cannot be assured that all staff have received all of the training they require to do their work. EVIDENCE: Two seniors were on duty on the day of the inspection; they each had responsibility for a floor of the home. The Staffing Rota correctly reflected the names and numbers of staff on duty. During the morning there were two carers on each of the special needs units, one carer on each frail elderly unit, and a float. Another carer was present to assist with the breakfast time routine between 8am and 11.30am. Each unit also had a housekeeper on duty between 8am and 5 Monday to Friday, and at the weekend for a couple of hours each day. A housekeeper spoken with advised that they liked the fact that their job gave them time to speak with residents during the day. The home also employs someone to do laundry and a handy man. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 21 Staff files inspected contained two satisfactory written references gained prior to staff members commencing employment, and all other information required. A training analysis was provided. This supported advice given in the pre inspection questionnaire that only 30 of staff had NVQ2. Manual handling training was out of date for a number of carers, one had not received it since 2002. The manager advised that this training had been scheduled for the following week. Six sessions of person-centred training is provided in house for staff, and as part of the training staff are then asked to do a life history with a resident. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents cannot be assured that the home’s own Quality assurance systems will pick up on areas that residents consider need improvement. Residents cannot be assured that staff are receiving adequate supervision. EVIDENCE: The Registered Manager’s post has been vacant since January 2006. An acting manager has been appointed. No response or action plan was received in respect of the last key inspection or in respect of the complaint investigation. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 23 The report of the last inspection was not on display in the foyer, although the previous one was. The senior on duty was unable to locate the report, but it was found by the acting manager when they attended. The homes certificate of Registration and public Liability insurance were correctly displayed. Copies of Anchor home’s relatives and residents’ survey, 2006 were available in the reception hall. It is not possible, from this document to know anything specific about the Firs, only about the group of homes owned by Anchor. The acting manager advised that no other form of QA which formally elicited resident’s views within this home was in place. No reports of regulation 26 monthly reports had been received by the CSCI since February 2006, however they had been undertaken. Residents’ finances are managed through the residents personal monies system within the trust. Items purchased on behalf of residents were receipted and recorded, but did not have two signatures to validate that the actual expenditure was on behalf of the resident. A carer spoken with advised that their supervision had not taken place recently. Four staff files were inspected and it was found that for two of them, there was no record of formal supervision for over five months. A recent Environmental Health report of food hygiene standards noted that a good standard had been met, and no follow up action was required. A resident spoken with confirmed that they heard the fire alarm tested at intervals. A requirement was made at the last inspection that the Registered Persons ensure that all wardrobes provided in resident bedrooms are stable and cannot be pulled away from the wall. Two wardrobes checked had not been secured. It was a fairly lightweight wardrobe, and the handles to the doors were prominent, such that they could possibly be grabbed by a resident who felt unsteady. Were this to occur, it could pull the wardrobe over. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 24 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 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 X 2 2 X 2 Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 25 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(2) Requirement A copy of the Service User’s Guide must be provided to each resident. The home is operating outside of its category of Registration and must immediately apply for a variation in respect of a resident who is subject of an order under section 117 of the Mental Health Act. The Registered Persons must ensure that a detailed, up to date and informative care plan is provided for each individual resident. This is a repeat requirement from a complaint investigation undertaken by the CSCI in February 2006. The home must keep a complete record of complaints received; this should include outcomes. The complaints policy must be accessible and suitable for the needs of the residents. Towels must not be stored in communal bathrooms, to reduce an unnecessary risk of cross DS0000024387.V305392.R01.S.doc Timescale for action 15/10/06 2. OP4 CSA regs 2001 22/08/06 3. OP7 15(1) 15/10/06 4. 5. 6. OP16 OP16 OP26 22(8) 22(2) 13(4)(c) 30/09/06 30/10/06 22/08/06 Firs Residential Home, The Version 5.2 Page 26 7. 8. 9. 10. 11. OP30 OP28 OP33 OP35 OP36 18(1)(c)(i ) 18( c)(i) 24(2) 13(6) 18(2) 12. OP38 13(4)(a) infection. All staff must receive appropriate Manual Handling update training. The home must develop the percentage of staff with NVQ2. Regulation 26 reports for the period March 2006 to July 2006 must be forwarded to the CSCI. Two signatures must be acquired to evidence transactions made on behalf of residents. The Registered Persons should ensure that staff receive appropriate formal one to one supervision. The Registered Persons must ensure that all wardrobes provided in resident bedrooms are stable and cannot be pulled away from the wall. This is a repeat requirement from the last inspection. 30/11/06 30/03/07 15/10/06 01/10/06 31/10/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that where the general risk assessment shows there to be no significant risk in a particular area of need, that this be noted on the care plan, rather than a blank space being left. It is recommended that responsibility for responding to a missed entry on MAR sheets is clarified and allocated, and a protocol for responding to this in a timely way is established. Funeral arrangements should be documented as part of the care plan. The weekly activity programme should be reviewed, in the light of the input care staff are able to provide. Results of Quality Assurance that reflect the strengths and needs of this home as perceived by residents should be DS0000024387.V305392.R01.S.doc Version 5.2 Page 27 2. OP9 3. 4. 5. OP11 OP12 OP33 Firs Residential Home, The 6. OP37 available. The Registered Persons should ensure that all records and documentation produced in relation to the individual care needs of residents are dated. Firs Residential Home, The DS0000024387.V305392.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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