Inspection on 12/11/08 for Firtree House

This inspection was carried out on 12th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Dilston College Of Further Education

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Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Firtree House 37 Pease Street Darlington Durham DL1 4EX The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tanya Newton Date: 2 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 28 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Firtree House 37 Pease Street Darlington Durham DL1 4EX 01325389967 01325356360 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Potensial Limited Name of registered manager (if applicable) Mrs Alison Strickland Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 0 care home 10 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC; To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD, maximum number of places 10 The maximum number of service users who can be accommodated is: 10 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 28 How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out on the 12th and 21st November 2008. In line with current CSCI policy on Proportionality, the inspection focused upon a number of key standard outcomes for the people who use the service. The inspector looked around the building and a number of records were examined. The homes manager and staff were interviewed. Within the limits of their communication and understanding, the people who use the service were also spoken to. Feedback gained throughout the inspection has been included within the report. What the care home does well The home carries out assessments to make sure that it can meet the needs of the people placed there. Standards of care were said to be good with clear records to demonstrate how peoples needs should be met. People have the opportunity to participate in a range of social activities and are encouraged to maintain contact with families and friends. Food was said to be good. The home has clear policies for managing complaints. Comments about the staff were positive and people also felt that management arrangements within Care Homes for Adults (18-65 years) Page 7 of 28 the home were good. What has got better from the last inspection What the care home could do better A policy should be developed to reflect the minimum and maximum amounts of cash to be held on the premises for people living at the home. The gardens must be made safe and accessible to people so that they can used. Staffing numbers need to be kept under review to ensure that they meet the assessed needs of the people living at the home and the manager should be given super nummery hours so that management tasks can be completed. Care Homes for Adults (18-65 years) Page 8 of 28 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tanya Newton 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Admissions to the home are appropriately managed. Evidence: There is a statement of purpose and service users guide to the home. These documents provided people with information about the home. Both documents are also available in pictorial formats to make them more accessible to the people living there. People are assessed prior to moving into the home to make sure that it is the right place for them to live. There were some minor gaps in the recording of assessments but in the main they contained detailed information about how peoples needs would be met. Assessments form the basis from which the care plan will be written. Each person living at the home has a contract. Contracts tell people how much it costs to live at the home and what is included within their fees. Contracts had been updated to reflect the charges for transport. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The needs of the people who live at Firtree House are met. Wherever possible, they are offered choice. Decision-making is appropriately supported. Evidence: Care plans were detailed and written in a person centered way. They contained detailed information about the way in which peoples needs would be met. Care plans also contained risk assessments to show how risks could be minimised for people. People living at the home are offered choices. This included choices at meal times, participation in communal activities, day services and involvement in activities organised by the home. People can also choose to get up and go to bed when they want. People spoke about their interests, for example needlework, football etc. People who live at Firtree House can choose to spend time in their rooms if they want to and were observed to do this. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Activities are arranged and people live as part of the local community. Contact with family and friends is supported. Meals provided are wholesome and nutritious. Evidence: There are a range of social activities taking place and people said that they were able to go out. One person said, I went to see Joseph at the theatre last week, I go out shopping in town. On the day of the inspection a small group of people had gone Christmas shopping with the staff on duty. Another person said, I go out for a short walk each day. People access the local community using the local shops and pubs. Wherever possible, contact with family and friends is supported. People spoke about their family and friends visiting and the home supports people in doing this. Peoples rights to live how they choose are respected. Peoples bedrooms have been personalised. Responsibilities are also recognised. As part of their care planning Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: arrangements, bedroom management is diarised - with appropriate support provided by staff where required. One of the people living at the home said, I have a nice room, I like it. A wholesome and nutritious diet is provided. Where people who use the service require assistance with dining it is provided. Within the limits of their communication and understanding, people who use the service have chosen the meals they would prefer. Comments from people living at the home included, we have nice meals here and the food is alright, we can choose what we want. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Personal and health care needs are appropriately met. Medicines are dealt with correctly. Evidence: The inspector saw that the people who live at Firtree House are well supported, well cared for and comfortable in their home. Within the limits of their communication and understanding, their preferences are accommodated. From discussions with management and staff, where personal support is required it is provided appropriately. Care plans examined show that wherever possible, people who use the service are provided with guidance and encouragement to undertake their own self-care tasks, thus promoting independence in a dignified and respectful manner. Management and staff ensure that peoples health care needs are met. Records confirm that contact with GPs and other health professionals is maintained. Where specialist intervention is required it is sought. The care plans read by the inspector were seen to document personal and health care needs and other relevant information. Care plans record the care required and also inform the delivery of the care provided in the home. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Medication systems were looked at. Although none of the people who live at Firtree House retain, control or administer their own medication, because of their needs and dependency this is considered appropriate. All staff who administer medication have received training in the safe administration of medicines. The home uses a monitored dosage system for medicines. Policies, procedures and systems in place relating to the receipt, recording, storage, handling, administration and disposal of medicines are suitable. Care Homes for Adults (18-65 years) Page 16 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Complaints and adult protection systems in the home help to safeguard the people who use the service. Evidence: The home has detailed complaints and adult protection procedures. Information about complaints, how and who to make them to, is also provided in the homes Service Users Guide. One of the people living at the home said, I could talk to the staff if there was any problem. Systems to safeguard peoples monies were looked at. The home acts as an appointee for some of the people accommodated. It is recommended that the home develops a policy which stipulates the minimum/maximum amounts of cash to be held on the premises. Staff interviewed voiced a commitment to the people they work with and to upholding the rights of the people who use the service. Staff have received training specifically relating to adult protection. Policy and procedure documents relating to adult protection provide further information and guidance to staff. One of the staff members spoken to said, I would have no hesitation in whistle blowing, or raising any concerns. The home operates in a relaxed informal manner. There is good communication between staff. House meetings, serve as an additional forum to discuss concerns or Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: potential difficulties. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Firtree House is homely, clean, tidy and safe. The gardens must be maintained to make them accesible and safe to people living at the home. Evidence: Firtree House is a large, detached, converted and extended property, situated in the Eastbourne area of Darlington. Accommodation is provided in 1 double bedroom (now used as a single room) and 8 single bedrooms. 2 bedrooms (one of which has an ensuite facility) are located on the ground floor, with the remainder on the first floor of the premises. The home underwent a major refurbishment programme in 2007. The home was rewired and a new heating/hot water system was installed. A new kitchen with new appliances was also installed. All bathroom fittings were renewed. The home had been redecorated, refurbished, re carpeted and refurnished throughout. The home was clean and tidy and bedrooms were individually furnished and decorated to reflect individual choices for people living at the home. The gardens to the front and rear of the property need to be overhauled and made accessible to the people living at the home. Both staff and people living at the home raised dissatisfaction that they were unable to access the garden during the summer. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: The gardens need to be maintained so that they are safe and accessible to people living at the home. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staffing numbers need to be monitored to ensure that they meet the assessed needs of people living at the home. Evidence: Staffing rotas were looked at, the home has two staff on duty throughout the day. There are no super nummery hours allocated to the manager and people said that this did have an impact on the service being provided. The home does have 79 hours which are vacant, some of these hours are being filled by the use of agency staff. One member of staff raised concern, about the disturbances to the sleep over member of staff on duty and said that waking nights should be available. This was a recommendation made in the previous report for the home which has not yet been actioned. Comments from people living at the home include, the staff look after us well and the staff are alright. From staff files checked, recruitment procedures within the home are considered safe. CRB (Criminal Records Bureau) disclosure checks are carried out for all staff. Applicants for employment complete an application form and 2 references are obtained. One of which is a reference from the last employer. Each member of staff receives a contract of employment and a job description. All new staff are inducted. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: Staff training files were looked at. Although the majority of mandatory training was up to date some staff felt that issues with staffing numbers in the home also impacted on staff being able to attend training. One member of staff said, My training is up to date and I have an NVQ, we receive regular supervisions and staff meetings, we get well supported. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Management arrangements, quality assurance systems, working practices and the procedures of the home in the main support effective management and quality monitoring of the service. Evidence: The registered manager has a nursing qualification and has completed an NVQ Level 4 Registered Managers Award management training course. She has considerable management experience and is able to demonstrate that she has undertaken periodic relevant training. There are clear lines of accountability within Firtree House and the parent organisation. From discussions with people who use the service and staff, the homes manager is providing a clear sense of direction and leadership. Staff spoken to described the management arrangements for the home as professional and friendly, with a supportive atmosphere between colleagues and management. One staff member commented, the manager is fantastic, very supportive and approachable. Another said, the manager is one of the best I have worked for. Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: Policies and procedures in the home provide guidance to staff and serve to safeguard the rights and best interests of the people who use the service. The home, through its parent organisation Potens, has a system of quality assurance across a range of issues. Audits have been conducted to highlight repair works required and ways to improve care practices within the home. Feedback is encouraged through house meetings and ongoing contact with people who use the service, families and outside agencies. Questionnaires have been given out to people living at the home and to other stakeholders. Monthly visits and reports required under Regulation 26 of The Care Homes Regulations 2001 were not up to date, the last one carried out was dated June 2008. These visits must be conducted each month. Health and safety records were looked at. Weekly health and safety checks are carried out by the manager. Certificates viewed were up to date. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 24 23 The gardens need to be made safe and accesible to people living at the home. 30/04/2009 Premises must be kept safe inside and out. 2 33 18 Staffing numbers need to be 30/03/2009 monitored to ensure that they meet the assessed needs of people living at the home. Concerns raised by staff about the number of agency hours being used and the lack of management hours. 3 37 26 Monthly visits must be carried out by the provider and a written report of this visit is to be held in the home. 31/03/2009 Regulation 26 visits have not Care Homes for Adults (18-65 years) Page 26 of 28 been carried out since June. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 23 It is recommended that the home develops a policy which stipulates the minimum/maximum amounts of cash to be held on the premises. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!