Inspection on 01/10/07 for Firtree House Nursing Home

This inspection was carried out on 1st October 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Firtree House Nursing Home 30/10/08

Firtree House Nursing Home 23/01/06

Firtree House Nursing Home 23/08/05

Firtree House Nursing Home 07/10/04

Firtree House Nursing Home 04/05/04

Firtree House Nursing Home 31/10/03

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

CARE HOMES FOR OLDER PEOPLE Firtree House Nursing Home 30 St James` Road Tunbridge Wells Kent TN1 2JZ Lead Inspector Ruth Burnham Key Unannounced Inspection 9:30 1st October 2007 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 Firtree House Nursing Home DS0000026166.V348439.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. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firtree House Nursing Home Address 30 St James` Road Tunbridge Wells Kent TN1 2JZ 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) 01892 523954 01892 545241 Firtree Care Limited Mrs Catherine Ellen Brewster Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 50 beds registered, 5 may be used for care without nursing. Of the 50 beds registered, 2 may be used to provide intermediate care. 19th December 2006 Date of last inspection Brief Description of the Service: Firtree House Nursing Home provides nursing care and accommodation for 50 older people. Firtree Care Limited owns and operates the Home. Firtree House is located in a residential area of Tunbridge Wells with shops, public transport and other usual town amenities being approximately ½ mile away. Firtree House Nursing Home consists of a detached property and garden with car parking facilities at the front of the building. There is accommodation on 3 floors in the newer part of the building and on 2 floors in the older part of the Home. The Home has two shaft lifts. There is a staff call system with various television and telephone points throughout the Home. The Home employs care and nursing staff, working a roster, which gives 24-hour cover. The Home also employs other staff for catering and domestic duties. Fees range from 365 to 895 pounds Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was conducted on 1 October 2007 by Ruth Burnham, Regulatory Inspector, who was in Firtree House from 9.30 a.m. until 4.30 pm. The report also contains information gathered at the random unannounced visit which took place on 18 December 2006. During these visits residents, visitors, staff, the head of care, the area manager and the registered manager were spoken to. Parts of the Home and some records were inspected. The owning organisation’s area manager was in the home during the visits. A number of surveys were sent out before the last visit to residents, their relatives and social and healthcare professionals. No responses were received from residents or relatives. Five health and social care professionals responded to the survey, all were positive about the home. Comments included • • • ‘Residents are treated as individuals providing tailored care to their needs. From a GP point of view Firtree is well organised and easy to work with’ ‘very few if any complaints, none in the past 5 years. Good communication when problems arise. No problems, excellent and well run home’ ‘Service more than satisfactory. Their approach has been caring and kind and in the best interest of my client. They are providing excellent nursing care. The staff are patient and caring in their dealings with my client. The home is clean and airy and bright. The atmosphere is friendly and staff are helpful and approachable.’ ‘Good communication. Always meet the care needs of clients. Privacy and dignity always observed. Staff have right skill and experience. Communicate clearly with other agencies, relatives and residents. Flexible approach. Professional and understanding. Treat people as individuals and make them feel at home.’ • • The Management and staff gave their full co-operation throughout the visits. What the service does well: The management operates a good pre-admission assessment process and are helpful in assisting residents to settle in to the Home. Firtree House provided a comfortable, well maintained, well decorated and homely environment for the people who live there. General health needs are well recognised and managed. The majority of people said they enjoyed the food. There are safe systems for giving medicines to protect residents. Robust staff recruitment Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 6 systems ensure only appropriate people work at the Home. There is ongoing training for staff in safe working practices and staff are supervised regularly. What has improved since the last inspection? What they could do better: Care planning must be person centred so staff know how to support each person appropriately with understanding and sensitivity. Social care plans should be developed to contain significant information and individual wishes and preferences. A review of the daily notes recorded by all staff should take place to ensure that all relevant and specific information is being recorded for any one shift. Care plan reviews should be recorded in detail. Care should be provided in a way which upholds peoples’ dignity. When agency staff are employed they must treat people with respect, ensuring that they communicate with them properly before moving them around and attend to their personal needs without undue delay. There should be sufficient, trained staff on duty to ensure the social, emotional and personal care needs of the people who live in the home are met. There should be sufficient qualified nurses on duty in the home to ensure that peoples’ health is promoted and there are adequate supplies of syringes for flushing feeds. Agency staff should be supervised effectively to ensure they respect peoples dignity at all times. A full programme of activities should be in place in line with the wishes and preferences of the people who live in the home. All complaints should be recorded to ensure that action is taken where necessary to protect people from risk of harm. The call bell panel should be located away from areas where people are constantly annoyed and disturbed by the noise. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 7 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 be made available in other formats on request. Firtree House Nursing Home DS0000026166.V348439.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 Firtree House Nursing Home DS0000026166.V348439.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): 1–6 Quality in this outcome area is good. People who are considering moving into the home are provided with good information about what life is like there. They can be confident that the home will be able to meet their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who are considering moving into the home are provided with good information about what life is like there. The written information includes a statement of purpose and service user guide, These and other useful information including a copy of the contract are contained within the welcome pack that is placed in each person’s room. People can be confident that the home will be able to meet their needs. There is a thorough assessment process carried out before a place is offered. This includes a visit to the prospective resident, detailed information is recorded at this stage in consultation with the residents and their relatives. Information is Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 10 also obtained from health and social care professionals. People are also able to visit the home to meet staff and other residents and experience what life is like there for themselves. An initial plan of care is drawn up following the assessment. A health care professional who was contacted before the visit and has recently supported a client to move into the home had this to say: ‘The service is more than satisfactory. Their approach has been caring and kind and in the best interest of my client. The manager is in the process of developing more specialist services for people who are experiencing dementia, including additional staff training in this area. The home is registered to provide intermediate care however this is not happening currently. Firtree House Nursing Home DS0000026166.V348439.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 – 11 Quality in this outcome area is adequate. People who live in the home can be confident that their healthcare needs will be met. However emotional, social and spiritual needs may not be met and staff shortages are undermining their personhood and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home can be confident that their healthcare needs will be met. Individual care plans contain good information about peoples’ physical healthcare needs. The home maintains good working relationships with the specialist and local health care professionals to support people with their health care needs. Healthcare professionals who were surveyed before the visit were very positive in their comments about the home. These included: ‘Residents are treated as individuals providing tailored care to their needs. From a GP point of view Firtree is well organised and easy to work with.’ ‘There is good communication when problems arise.’ Records seen show that people are supported to attend appointments and access health care professionals where needed. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 12 The manager is making improvements in the care planning to introduce a more person centred approach. Some work has already been done to develop individualised documents which include people’s social needs, wishes and preferences. A written plan of care for each resident is prepared from the preadmission assessment. These do not currently provide staff with information that will help them to understand peoples’ individual choices and preferences. Care plans seen did not contain any social history. They are drawn up using a generic pre-recorded template; this has resulted in inaccuracies where some information on individual care plans has no relevance to the person at all. There is little if any information about people’s social, emotional or spiritual needs. Daily notes are written however these are very brief and focus on people’s physical needs. Records show that care plans are reviewed regularly however those seen recorded, ‘no change’ with little additional detail to show whether people have been involved in their review or how they are feeling about the care they are receiving. Some risk assessments are in place however these do not cover all aspects of the daily lives of people who live in the home. People are protected from harm through safe handling, storage and administration of medication. There was some concern however about the maintenance of adequate stocks of medical equipment. A relative was seen to make a complaint to the nurse on duty about a syringe used for peg feeding. It was alleged that this had not been replaced in spite of requests. It was impossible to clean the syringe effectively which could place the person at risk of harm. People are not always treated with respect for their dignity. It is clear that standards have deteriorated in this area due to the use of agency staff to cover some shifts. Examples of poor practice were observed where people were moved around without asking their permission or offering explanation or reassurance. Agency staff talked to each other over the head of a resident they were hoisting whilst ignoring the person. A member of agency staff moved 2 people from the lounge to the dining room without even speaking to them. One person was asking for the toilet repeatedly for 45 minutes before staff were free to attend to her needs. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 13 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 – 15 Quality in this outcome area is adequate. People who live in the home are not always finding the lifestyle in the home satisfies their social cultural and recreational needs and interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are not always finding the lifestyle in the home satisfies their social cultural and recreational needs and interests. Care plans do not contain information about peoples’ interests to help staff provide appropriate leisure activities. The current recruitment position meant that staff have little or no time to stop and chat or offer adequate emotional support where needed. People were saying how bored they were with nothing to do at the moment. There have been staff changes and a new activities coordinator was starting in post on the day of the visit. This member of staff is keen and enthusiastic and was already talking to people about what they would like to do. It was encouraging to hear the manager talk with knowledge and enthusiasm about plans to provide more specialist support for people who are experiencing Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 14 memory loss, dementia and other impairments. The management team acknowledged that this would only be possible with additional staff training. Visitors are welcome in the home and feel comfortable approaching staff and management with any concerns they may have. A lot of people choose to have their meals in their rooms. There is a lot of pressure on staff at mealtimes and is resulting in some poor practice. They were rushing and meals were placed in front of people without speaking. Some people who needed help with eating had to wait a long time for a member of staff. It was good to see the way in which a member of staff helped one person with their meal in an unhurried and sensitive manner. There are 2 dining areas, People in the second dining area had to wait a long time for their food to arrive, when it did they were served with the main meal and pudding at the same time which meant that the hot pudding was getting cold by the time they were ready for it. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 15 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 adequate. People who live in the home are listened to and protected from abuse. Where complaints are not recorded people may be put at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are free to offer comment or complaint. Numerous cards of appreciation and thanks have been received. A complaints procedure is available to residents and their relatives and visitors. Some records of complaints are kept and these include details of investigation and action taken. Discussion took place about the need to record all complaints to ensure that action is taken quickly when issues are raised, for example the need to obtain additional medical supplies. People are protected from abuse through good staff training, policies and procedures and robust recruitment procedures that include criminal record checks on all staff before they are appointed. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 16 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. The bright, clean, well equipped and homely environment enhances the quality of life of people who live in the home. Resiting the call bell panel will improve the quality of life for some of the people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The bright, airy, clean and homely environment enhances the quality of life of people who live in the home. At the time of the visit all areas of the home were clean and free from unpleasant odours. Bedrooms seen have been personalised with the occupants’ personal effects and reflect their individual tastes and interests. The home is attractively decorated throughout and there is an ongoing programme of redecoration and maintenance. The majority of bedrooms have ensuite facilities, there are 3 shared bedrooms. Communal areas are comfortably furnished, there are 2 lounges, a small dining room and a spacious conservatory. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 17 People who are experiencing mobility difficulties benefit from access to a range of equipment and adaptations provided throughout the home. Equipment seen, including hoists, shower chairs and wheelchairs, appeared clean and well maintained. All floors are accessed by a lift. A staff call system is available. The location of this, just outside the small lounge/dining room, is causing a great deal of annoyance to people who use this room. The constant bleeping noise is very intrusive. This was discussed with the management team who said no-one had ever raised this with them before, they agreed to explore the possibility of moving the panel to a more suitable location. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 18 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 – 30 Quality in this outcome area is adequate. People who live in the home benefit from the support of well trained staff. However in low levels of permanent staff are currently having a negative impact on their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current low levels of permanent staff are adversely affecting people who live in the home. On the day of the visit there were only 5 members of permanent care staff on duty supplemented by 2 agency staff. There was only 1 qualified nurse on duty in addition to the registered manager who is also a qualified nurse. The manager said that they had recently lost a number of staff and were having trouble recruiting. There are currently 5 vacancies. This situation is having a negative effect on peoples’ lives in a number of ways: Staff are too busy to spend time with them; they have to wait for extended periods of time for help with personal care; mealtimes are stressful; there has been no activities programme for a while or any outings. In addition to nurses and carers, the home also employs staff for catering, laundry and domestic duties. People benefit from the support of well trained staff, it was unfortunate that the practice of agency staff observed during the visit was poor. The regional manager said that since the last inspection, the organisation has obtained it’s own training company. In addition the head of care is trained to provide courses. All new staff are required to undertake an Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 19 induction programme. It was said that the home provides an ongoing rolling training programme and that the majority of courses are up to date. Staff are tested for competency following all courses. People are protected trough the robust recruitment procedures. All applicants complete a detailed application form and supply 2 written references.. Further checks are carried out through the criminal records bureau before they are appointed. Records seen were up to date and well maintained. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 20 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 – 38 Quality in this outcome area is adequate. People who live in the home benefit from the support of a well qualified management team who are working to provide a quality service. People are protected by safe working practices however their welfare is not being promoted where agency staff are not being supervised effectively or working effectively on shift to meet people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the support of a well qualified management team who are committed to their best interests. The registered manager is a registered nurse and has many years experience in the care of older people. Throughout the inspection, the manager and senior staff demonstrated a commendable commitment to a high quality service, they were aware of the current shortfalls brought about by inadequate staffing levels and Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 21 are in communication with the owners to ensure that recruitment and retention of staff improves. Staff receive regular supervision to monitor their performance and identify any training needs. Agency staff who’s practice was undermining the dignity of people were not being supervised effectively. Some discussion took place about how to improve the homes’ internal quality assurance system to ensure that issues, which have a detrimental effect on people who live in the home, are picked up and addressed quickly. Residents meetings are held regularly and minuted, people who use the service also complete questionnaires. The manager is in process of completing the Annual Quality Assurance Assessment for the Commission. People are protected through good policies and procedures, these are reviewed regularly and staff are trained in safe working practices. The manager said that all necessary fire safety checks have been undertaken and the fire officer has visited the home and is happy with fire prevention measures. An external agency has undertaken a fire risk assessment for the home in November 2006. Staff have training and regular updates including moving and handling. Kitchen staff are trained in food hygiene; food hygiene courses are provided by the organisation for all staff. A staff member trained in first aid is available on every shift. Fire training is provided for staff every two months, which includes night staff. Four individuals are trained as Fire Marshals; there is one available on every shift. Infection control training is provided by the organisation, which includes the storage and use of hazardous substances. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 3 3 3 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 x 2 3 2 Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(2) Requirement The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. So far as practicable ascertain and take into account their wishes and feelings. In that care plans should be accurate and person centred. Social care plans for all residents should be developed to contain significant information and individual wishes and preferences. A review of the daily notes recorded by all staff should take place to ensure that all relevant and specific information is being recorded for any one shift. Care plan reviews should be recorded in detail. 2 OP10 12(4) The registered person shall make 30/10/07 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users; DS0000026166.V348439.R01.S.doc Version 5.2 Page 24 Timescale for action 30/11/07 Firtree House Nursing Home In that all staff including agency staff should treat people with respect, ensuring that they communicate with them properly before moving them around. Personal care needs should be met without undue delay. 3 OP9 13(4) The registered person shall 30/10/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In that there should be adequate stocks of medical equipment to ensure that feeding syringes are replaced at regular intervals. The registered person shall 30/11/07 consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. In that A full programme of activities should be in place in line with the wishes and preferences of the people who live in the home. 5 OP16 22(3) The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. In that any complaint brought to the attention of staff should be recorded and followed up. 6 OP27 18(1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure DS0000026166.V348439.R01.S.doc 4 OP12 16(2)(n) 30/10/07 30/11/07 Firtree House Nursing Home Version 5.2 Page 25 that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that there should be sufficient, trained staff on duty to ensure the social, emotional and personal care needs of the people who live in the home are met. There should be sufficient qualified nurses on duty in the home to ensure that peoples’ health is promoted and there are adequate supplies of medical equipment. 7 OP36 18(2) The registered person shall ensure that persons working at the care home are appropriately supervised. In that agency staff must be adequately supervised to ensure that they care for people with respect for their dignity. 30/10/07 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 OP19 Good Practice Recommendations Excessive disturbance and disruption caused by noise from the call bell system should be eliminated. Firtree House Nursing Home DS0000026166.V348439.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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