CARE HOMES FOR OLDER PEOPLE
Firth House 18 Firth Mews Millgate Selby North Yorkshire YO8 3FZ Lead Inspector
Anne Prankitt Unannounced Inspection 10th February 2006 09:30 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 Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Firth House Address 18 Firth Mews Millgate Selby North Yorkshire YO8 3FZ 01757 213546 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) margaret.millin@anchor.org Anchor Trust Margaret Meek Millin Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th May 2005 Brief Description of the Service: Firth House provides personal care and accommodation for up to 40 older people. The home is a purpose built two-storey property set in its own gardens near to the town centre of Selby. There is parking to the front of the home. The home is divided into four small living units. Two on the ground floor and two on the first floor. Each unit has it’s own dining room, with a small kitchen area attached. One large lounge on the ground floor is provided for all service users. All service users have a single en-suite room. The home is situated in a quite residential area and is in walking distance of shops and community facilities. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over six hours. Three hours preparation took place beforehand. The senior care assistant, Claire Sherwood, was in charge of the shift, and assisted throughout. The deputy manager was also available, and the registered manager, Pearl Millen, was available for the second half and at feedback. She was not however on duty. During the course of the inspection, some service users and staff were spoken with, and the general activity within the home was observed. Some records were looked at, including the accident book, some care plans, some records of monies kept on behalf of service users, and some staff training records. All communal areas of the home were inspected, and a number of private bedroom areas were seen. What the service does well:
The home provides a clean and pleasant environment for residents. The residents spoken with were happy with the care that staff provide. Comments included ‘I have no complaints’, ‘They look after us well’, ‘I think it’s one of the best’. ‘Staff are busy, but it’s not a problem. I want to be independent’. Residents said that the food is good and plentiful. One resident said ‘My only complaint is there is too much food!’ All residents have a care plan which explain what their needs are, and help staff to understand how they are to be met. Residents can make choices about their life, and can maintain their family relationships and links with the community. One resident stated ‘We can do what we like. Apart from mealtimes we are not tied’, ‘The routine is flexible enough’, ‘We can get up when we like’. Staff receive training to help them in the work that they do at the home, and the care that they provide. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 6 Staff can look after residents’ personal monies if they wish them to do so. Residents can be assured that their monies will be handled competently. 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. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 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 Firth House DS0000007957.V280304.R01.S.doc Version 5.1 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): EVIDENCE: None of the standards were assessed at this inspection. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 9 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 and 10 The care plans contain sufficient information to help staff understand the needs of service users and how they are to be met, and assist in ensuring that advice is sought from other professionals where required. EVIDENCE: Care plans seen were of good quality, and were reviewed on a monthly basis. Additional reviews take place on a six monthly basis. The plans included risk assessments where risk had been identified. They were based on an ‘Individual Lifestyle Agreement’. A senior member of staff audits them. The registered manager stated that one care plan seen where the needs of the service user had changed, would be reviewed by the key worker that night, and areas where update was needed had already been identified. Information was provided where outside professionals, for example the district nurse, had been involved in the care of the service user. The carers spoken with demonstrated a good understanding of individuals’ needs, and of the input that has been provided where action and medical investigation has been required, for instance, in the case of multiple falls. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 10 Service users were satisfied that staff met their care needs. They felt that their privacy was respected, and this was reflected within observations made during the course of the inspection. Some service users require assistance with their personal care. This was carried out in private, and service users seen looked comfortable and well cared for. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 11 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 and 14 Service users are afforded choice, benefit from a range of activities, and can maintain relationships with family and friends, which may contribute towards maintaining their quality of life. EVIDENCE: There is a range of activities from which service users can choose over a seven day period. There is no dedicated activities organiser, so staff work together to ensure that the activities programme is made available, for those who wish to become involved. A weekly activities sheet is posted around the home. Some service users explained how they enjoy activities outside of the home, which they are able to organise independently. They have the opportunity to discuss within regular meetings what activities they would like. The most recent was attended by sixteen service users, and discussed the possibility of outings away from the home. Communion takes place on a monthly basis, to assist in meeting service users’ spiritual needs. Service users were satisfied that they were able to make choices in their lives, and agreed that the routine was flexible to incorporate individual needs and wishes. They have recently chosen the new carpeting for the communal sitting area, and new tiling for two bathroom areas. Staff receive training in ‘rights
Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 12 and responsibilities’, which discusses how service users can continue to make choices in their everyday life. Bedrooms were individualised, containing personal belongings. Each room has a doorbell and letterbox. Service users agreed that visitors were welcomed at the home at any time. The home has a guest room so that service users have the option of their relatives to stay if they do not live locally. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 13 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): 18 Matters that affect the vulnerability of service users are reported appropriately in order that appropriate support can be provided and action taken. EVIDENCE: There has been one matter referred correctly by the home to the local authority using the vulnerable adults procedure. The matter has been dealt with through the multi disciplinary process, and is now concluded. Staff spoken to were clear about the need to report any matter of concern regarding the vulnerability of service users. Training is being provided in abuse awareness. It was confirmed that this has been received by half of the staff, with training planned for the remainder. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: None of the standards were assessed at this inspection. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 15 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 and 30 Service users are cared for by sufficient staff who are provided with training to assist them in providing a safe and caring environment. EVIDENCE: On the day of the inspection, the staff team was depleted due to sickness. The team had been reorganised by the senior carer, in order that there was sufficient staff to provide a care and cleaning service to the home. The staff rotas seen confirmed the assurance given by the management that this was in fact a ‘one off’ situation, which could not have been foreseen. There were three supernumerary staff available in order to absorb the workload, and service users spoken with were generally happy that there were sufficient staff available to meet their needs. The home does not use agency staff. An additional member of staff is being introduced at night, to increase the staffing levels from two to three staff members. Staff undertake a range of training at the home. Each staff member has a training and development record. Newly recruited staff undergo a period of induction. Staff undertake statutory training, as well as NVQ training which is now up and running. Four staff have completed NVQ Level 3, four have completed level 2, with a further four staff who are nearly ready to have their work verified. In addition, seven staff have been newly registered. Approximately half of the staff have received training in the protection of vulnerable adults. Further training has been planned for the remainder of the staff.
Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 16 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, 35 and 38 The management systems seen appear to be run in the interests of the service users. The removal of the door wedge from the bedroom fire door will ensure that all service users are better protected from the risk of fire. EVIDENCE: The registered manager has completed the Registered Manager’s Award since the last inspection. She was previously deputy manager of the home, and became registered manager two years ago. Staff spoken with stated that she was supportive. One service user confirmed that she visits them on a regular basis. The home does not act as appointee for any of the service users. Service users are able to manage their own finances if this is their choice. One service user chooses to collect their own pension. Three service users are assisted by advocates to handle their affairs. However, the home is able to manage
Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 17 personal allowances on behalf of service users. Two staff sign where transactions are made on behalf of the service user, and the records kept could be reconciled with the total amount of money held. One bedroom fire door was wedged open by unauthorised means despite being fitted with an automatic closer. This means that, should the fire alarm sound, the door would not close automatically. Staff were instructed to remove the wedge. Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 18 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 1 Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO 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 OP38 Regulation 13,23 Requirement Fire doors must not be held open by unauthorised means. Timescale for action 10/03/06 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 Firth House DS0000007957.V280304.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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