Inspection on 20/06/07 for Firwood House

This inspection was carried out on 20th June 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

Firwood House 16/03/07

Firwood House 03/02/06

Firwood House 21/09/05

Firwood House 03/11/04

Firwood House 04/06/04

Firwood House 11/02/04

Similar services:

Chirnside House

Emmaus House

East Croft Grange

Craignair

Croston Park Nursing Home

Conifers Nursing Home

Cloisters

Elmsdene Care Home

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

CARE HOMES FOR OLDER PEOPLE Firwood House Crompton Way Bolton BL2 2PE Lead Inspector Sarah Tomlinson Unannounced Inspection 20th June 2007 07:15 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 Firwood House DS0000030981.V337059.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. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firwood House Address Crompton Way Bolton BL2 2PE 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) 01204 337770 01204 337772 rob.rimmer@bolton.gov.uk Bolton Metropolitan Borough Council (vacant) Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered for a maximum of 27 service-users to include: *Up to 27 service-users in the category of DE (E) (Dementia over 65 years of age). 16th March 2007 Date of last inspection Brief Description of the Service: Firwood House is owned by Bolton Council and is run by their Social Services department. It provides specialist care for older people with confusion (personal care only). Up to 27 people can live there. At the present time there are 17 short term care (respite) places, 1 emergency place, 3 long term care places and 6 new, intermediate care (rehabilitation) places. A separate day centre is also based in the home and is open seven days a week (this is for older people with confusion and is run jointly with local mental health services). Bolton Social Services and the local Primary Care Trust jointly provide the intermediate care service. On site care is provided to these residents by the home’s care staff and by three specialist support staff (assistant practitioners). Nursing, physiotherapy and occupational therapy staff, plus social workers and medical staff visit on a regular basis. Firwood House is in a residential area of Bolton (off Crompton Way), and is close to bus services. The home is purpose built and is on two floors, with a passenger lift. There are 27 single bedrooms, all with wash hand basins (no en-suite facilities are available). The building is divided into five wings – Fern, Lilac and Rose on the ground floor, Magnolia and Primrose on the first floor. Each wing has its own small dining room and lounge area, plus bathroom and toilet facilities. The building is surrounded by gardens and there is parking at the rear (accessed via Tintern Avenue/Glaisdale Close). Other community services run by Bolton Social Services are also based in the building. Their offices and entrance are separate. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit, which the home was not told about beforehand, lasted just over 11 hours. Two inspectors were involved. The main inspector was there for the whole visit and talked to 3 residents, 1 visitor, the manager, 2 care supervisors, 4 day carers, 2 night carers, 2 specialist carers, a cook, 3 domestics and the laundry assistant. We also watched how staff cared for residents, looked around parts of the building and at some of the home’s paperwork. The second inspector was a pharmacy inspector, who came for part of the visit and looked at how medicines were organised. Eight relatives had previously returned comment cards to us about the home. Their views are also included in the report. What the service does well: What has improved since the last inspection? The home had a new, permanent manager, Mr Rob Rimmer. Staff talked about the new manager in a very encouraging way. One carer said things now felt “completely different, much better…[that the new manager was] getting things in order” another said he was “absolutely brilliant”. Staff felt the new manager would listen to any worries or problems they had and sort them out. The home has started to have a face-lift, with new curtains and blinds being bought, and a lounge and dining area being redecorated and refurbished. Further work is planned, including a completely new reception area and more ornaments and pictures. A new receptionist job has been created. This will be a huge help for care staff, who at the moment have to answer the telephone, greet callers and carry out administration tasks. Firwood House DS0000030981.V337059.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. The summary of this inspection report can be made available in other formats on request. Firwood House DS0000030981.V337059.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 Firwood House DS0000030981.V337059.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To ensure the safety and well being of ‘short term care residents’, the home needs to be in control of their referral and admission process. A review of the general admission process should improve the experience for all residents and their relatives. EVIDENCE: The home was currently registered to provide accommodation for up to 27 older people with confusion - 17 short term care places; 1 emergency place, 6 intermediate care places and 3 long term care places. The intermediate care provision was new, with places only provided since April 2007 (having ‘transferred’ from another Bolton Council home). We had Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 9 concerns immediately prior to this inspection as the home had been admitting residents to these places outside their legal registration category (of elderly people with confusion). This had been resolved, with only elderly people with confusion now being admitted. The home has now applied to us to change its registration – requesting that the six intermediate care places be for older people in general, who would have no confusion or only a mild level of cognitive impairment. We will respond to this request separately to this inspection report. Residents admitted for intermediate care stayed on Rose wing, which had become a dedicated wing for this service. A specialised rehabilitation programme was provided for these residents, including exercises, washing and dressing practice and home visits (from a multidisciplinary team of assistant practitioners, carers, nurses, physiotherapists, occupational therapists, medical staff and social workers). The aim was to help these residents regain their independence after a period of incapacity or illness and so return to live at home. There was no charge to people receiving this service, which was provided for a maximum of six weeks. All new residents were initially welcomed and admitted by a care supervisor (‘short term care residents’) or an assistant practitioner (‘intermediate care residents’ only) before being taken to one of the wings, where they were then looked after and settled in by a carer. We looked at care files for three residents who had recently moved in, all contained assessment information received prior to admission. However, we were greatly concerned over the referral and admission procedure for ‘short term care residents’. This concern was shared by the new (acting) manager, who had inherited the current system and by the staff team, one of whom said “it’s been horrendous”. The problem was a computer-based bed booking system was used, of which the home had no direct control. Social work team leaders booked a specific bed for a named person for a set time. Only then was assessment information received by the home (contract and assessment details arrived together). And only then did the home staff have the opportunity to assess whether they could meet the referred person’s needs (applications for admission were initially being agreed without consultation with the home). The majority of referrals were for known residents who stayed on a regular basis (‘rolling respite’), and therefore their needs were generally known. However, some were new referrals, placing the home in the position of having to refuse an agreed admission if they felt they could not safely meet their needs. The other major concern was residents regularly had to change bedrooms during their stay. A resident’s length of stay was often extended (e.g. two weeks of planned respite becoming three due to the resident’s own personal family carer (e.g. husband or wife) still being unwell). However, their bed would often already be booked out to another person. Consequently, a confused, vulnerable resident was required Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 10 to move bedrooms, often to another wing in the home to enable the next new person to move in. The new (acting) manager agreed the above practices were unacceptable and had been taking active steps to address them. He was aware control for the booking of short stay care places needed to lie with the home. Whilst an appropriate computer system was being sourced, the home was now actively looking at all referrals, with all unfamiliar people being fully discussed with the referring social worker. We also discussed Bolton council’s future plans to widen the admission criteria for ‘short term care residents’, to include older people with other mental health needs such as anxiety or depression (as well as confusion). We advised any such change would require the home to submit another application to vary its registration (requiring the category of ‘older people with a mental disorder’ (OP (MD) to be agreed and added). We raised concerns of trying to safely and competently accommodate such diverse needs within one home, particularly until the concerns regarding admission planning detailed above had been fully resolved. Due to the respite and intermediate care services provided, the home was always very busy; with a frequently changing resident population. However, three ‘permanent residents’ lived at the home and done so for a number of years. The new (acting) manager was aware of the need to safeguard the interest of this particularly vulnerable group of residents. All three residents had lived on separate wings, although one resident had to recently move from Rose wing due to the introduction of intermediate care there and now lived on the same wing as the second ‘permanent resident’. The third ‘permanent resident’ lived on another wing. Staff were aware of trying to keep disruption for these three residents to a minimum. However, this was difficult due to the nature of services now provided in the home. Due to their frailty, one resident spent time each day in their room resting. The other two residents also spent time in their bedrooms, e.g. eating meals there. Continuity of staff was limited as staff were rotaed to work throughout the whole home. However, good practice was noted, as each ‘permanent resident’ kept their personal (key) worker. To promote further stability and staff continuity, these personal workers could be rotaed to work more regularly on the wing where ‘their’ resident lived. Written information about the home was in the process of being updated. As its Service User’s Guide (brochure) was intended for older people with confusion, its style and format should be reviewed to make it as accessible as possible, e.g. use of photographs, larger print, plainer English (advice could be sought from the Plain English and Alzheimer’s societies, plus feedback from residents’ surveys). It would also be helpful to add page numbers and the names of the different wings (including whether they are on the ground or first floor and on which intermediate care is based). The exact numbers of short Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 11 term, emergency and long term care places also need to be added to the Statement of Purpose. A copy of the home’s current Service User’s Guide and Statement of Purpose were kept in bedrooms. We advised the Statement of Purpose did not need to be displayed and was not meant for residents, as it was a more ‘technical’ document, intended for contract and referral purposes. A relative on the intermediate care wing said they were given a leaflet about the service in hospital but this had not mentioned Firwood House. We showed them the Service User’s Guide in ‘their’ resident’s bedroom. Neither the relative nor the resident could remember being shown or told about it. We advised the new (acting) manager that all care staff should receive training about the home’s Service User’s Guide (so they can feel confident in helping residents and their families understand and use it). An admission checklist was on use in the intermediate wing. We advised introducing a similar checklist for residents admitted for short term care. This would guide staff, particularly if the admission was interrupted (e.g. due to mealtimes). We discussed how overwhelming the admission process could be for residents, whether arriving for intermediate or short term care (all experiencing possible short term memory loss and disorientation). We discussed practical ways of trying to minimise this. For example, having a brief reminder session a couple of days after admission where (some of) the ‘welcome’ information was repeated with residents and their families; more helpful name badges, rather than identity badges (in clearer, larger print); a uniform board/chart to explain the different staff groups; ways of helping residents remember their room. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care records did not generally match the good standard of care being given, placing residents at risk of their needs not being fully understood or met. EVIDENCE: We looked at four care files. With regard to residents receiving short and long term care, information about their needs was in place. However, we were concerned, as the information for ‘short term care residents’ was not up to date. Where known residents were returning for subsequent visits (‘rolling respite’), previous care information was not being formally reviewed or updated (e.g. a current resident admitted on 19/6/07 had a care plan dated 27/6/06). It was not clear what care needs and risk issues were still current. For example, across several admissions, checks showed one resident losing weight. Staff were aware of this. However, the resident’s dietary care plan Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 13 had not been updated (since 3/4/06) and it was unclear what action had been taken and what help staff should be currently providing (e.g. ‘to encourage additional finger foods’). To track care needs at different admissions, we advised a simple record of admission and discharge dates should also be kept in files of residents receiving short term care. Relatives felt they were kept informed of their relative’s health and welfare. However, care plan and risk assessment records need to show how residents (or their relatives) have been involved in their initial drafting or any subsequent review. This is particularly important as most residents would only be staying for a short time; would probably have communication difficulties; and would have family carers who were very knowledgeable about how they liked to be cared for. Nutrition and moving and handling assessments were generally in place. However, as with care plans, those for residents receiving short term care were not being updated or reviewed on admission. Also, although staff explained pressure areas were informally checked, with appropriate action taken if necessary, care records contained no details of any formal assessment being made. The risk of possible physical aggression was noted in care files. However, there was no information about what kind of aggressive behaviour had occurred before (if known, including the frequency and most recent incident), nor any practical guidance for staff about how to reduce or manage this risk. Incidents of physical aggression were being noted in daily records but these did not contain enough detail about what had actually taken place (to provide evidence of possible triggers) (e.g. “been aggressive this evening”; “was aggressive earlier in the shift”). Notifications about serious incidents of aggression were also not being sent to us. With regard to the intermediate care service, a ‘skills plan’ was used as the main care document. This was a brief summary of the resident’s abilities and care needs. It was produced by Primary Care Trust staff and reviewed at a weekly multi-disciplinary team meeting, with an up to date copy displayed in the resident’s bedroom. A range of risk assessments was completed on admission, although a tissue viability assessment was missing for one resident. This assessment was the responsibility of nursing staff and had been missed due to problems with organising nurse cover. This had apparently been resolved, with the day before the inspection, a rota of available nursing staff being provided. With regard to being kept informed, one relative (and resident) said when they asked, staff told them about their relative’s progress, but they had not been told who they should speak to about such matters. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 14 The home had experienced three lengthy outbreaks of vomiting and diarrhoea over winter and spring. The community infection control nurse, who had been involved in monitoring and guiding staff in their management of these, was satisfied with how the home had responded. As part of their regular refresher training, she recommended all care and domestic staff now received infection control training (which she is able to provide free of charge). Domestic staff confirmed they had received additional support at the time of the outbreaks to implement the necessary infection control procedures. Further good practice was noted, as before the home re-opened to admissions and discharges, all carpets had been steam cleaned to remove any remaining traces of the virus. Most residents were unable to tell us what it was like to live in the home. However, we were able to speak with three residents, who were very positive about how staff looked after them, confirming they were treated gently and kindly and that staff were “very nice” and “very helpful and approachable”. We spoke with staff who had a good understanding of residents’ individual needs, working hard to meet these in a busy and frequently changing environment. We also observed staff, including domestic staff, keeping residents safe and interacting with them in a warm, caring and competent manner. Good practice was noted, as the home allocated a ‘personal worker’ (key worker) to each resident, who was then responsible for assisting ‘their’ resident to bathe (helping to maintain their privacy and dignity). The pharmacist inspector looked at the way medication was handled during this inspection. The medication policies were implemented earlier this year and provided a safe framework for medication handling. Medicines handling could be made safer if staff had good practical procedures to follow for some aspects of medication handling. Most of the staff administering medicines had had medication training in January 2007. The staff in the home completed most records regarding medication to a good standard. However, the records of disposal of medicines were not available during the inspection, which meant that some medicines were unaccounted for. The information the home received regarding the medicines a respite care resident was prescribed was not always up to date and it is recommended that the staff in the home find out exactly what medication the resident is prescribed by their doctor prior to admission. The medication administration records showed that most residents were given their medicines as prescribed by the doctor. However, it was seen during the inspection that three residents had not been given their medicines properly, one resident’s medication had run out and for the other two residents staff had signed that medicines had been given but the stock level indicated that the medicines had not been administered. It is important that residents are given their medicines as prescribed to make sure their health is not at risk. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision of regular therapeutic activities, which meet the specialised needs of the mixed resident groups, would ensure their social needs were met. EVIDENCE: When time permitted, care staff carried out social activities during an afternoon (an activities co-ordinator was not employed). We advised a range of suitable activities needs to be regularly provided. These need to take account of the diverse, specialised needs in the home – residents with confusion; residents receiving long term care; residents receiving intermediate and short term care. Those receiving intermediate care may feel after rehabilitation exercises and visitors, they wished to rest (e.g. reading; watching television). Although, resident surveys would need to ask specific questions to confirm this. For short and long term care residents, we advised a weekly programme of activities should be developed for the former, and three, individual weekly programmes for the latter. The new (acting) manager Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 16 was aware of the lack of social activities and had already planned to meet with the craft instructor from the day centre for advice. If social activities are to be the responsibility of care staff, they need to be suitably trained (to meet residents’ specialised needs). They also need to have time to carry them out, with their provision being seen as an integral part of their role and not an ‘extra’ if they have time - particularly for the three residents receiving long term care. Records needed to be kept to show when activities were being carried out. As part of the home’s quality assurance framework, different individual and group activities could be trialled and their success monitored. Residents receiving long term care were supported to personalise their bedrooms. Visitors felt they were made welcome and could see their relative in private. On the day of the inspection, three residents were up when we arrived. Night staff confirmed they were under no pressure to get people up, with residents being able to choose what time they got up. With regard to food, positive comments were received from several residents and visitors. Once visitor said food was “very nice”. The full time cook was about to return following a period of sick leave, with a peripatetic cook from Bolton council covering in her absence. Residents ate in one of the small lounge/dining areas on the wings, with a hot trolley serving each. The new (acting) manager had introduced paper napkins, with the use of tablemats being planned (and possibly table cloths). Residents’ likes and dislikes and dietary needs were known by care staff and were also written in the kitchen. No pureed meals were currently being provided, although the cook confirmed each item would be kept separate (to maintain taste, texture and appearance). Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 17 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, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for protecting residents from abuse or harm and for taking any concerns seriously were in place. Reminders and encouragement to residents and relatives about how to complain should strengthen this system. EVIDENCE: The right to complain was detailed in the Service User’s Guide. However, as detailed earlier in the report, some residents and their families were unfamiliar with the Guide and several relatives also said they did not know how to complain. The new (acting) manager was intending to display details about welcoming comments, concerns and complaints in the home’s entrance. We advised brief details of informal as well as formal complaints were kept (including action taken and outcome). This would enable any issues and patterns to be monitored over time, whilst also providing evidence of the home’s openness and its ability to put things right where necessary. Records were seen of action already taken by the new (acting) manager regarding two serious concerns. Several staff said they felt very confident that the new (acting) manager would act on any concerns they had - “he’d deal with it”. During the inspection, a relative discussed a minor issue with us regarding a Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 18 resident’s laundry. With their agreement this was passed to the manager to follow up. We discussed the recent introduction of the Mental Capacity Act 2005 and its impact of care practices in the home. The new (acting) manager was due to shortly attend training on the Act. The importance of documenting the actions of the ‘decision maker’ was discussed – from minor everyday decisions (e.g. for a resident who lacks capacity to choose what clothes to wear) to major decisions such as moving to new accommodation. The latter issue was discussed in relation to the provision of long term care in the home. We advised the manager to consider whether the involvement of the new Independent Mental Capacity Advocate would be appropriate. Staff received abuse awareness training during their induction and when undertaking the NVQ award. Refresher training for those staff not undertaking the award should be considered. Good practice was noted, as the home was arranging for domestic staff to also receive abuse awareness training. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 19 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, 22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided residents with a comfortable and safe place to live. The current and planned improvements should make the building more attractive. EVIDENCE: The home was divided into five wings – Fern, Lilac and Rose on the ground floor, Magnolia and Primrose on the first floor. Intermediate care was provided on Rose wing. Each wing has its own small dining room and lounge area, plus bathroom and toilet facilities. There was a large, enclosed garden, most of which was grassed, with some mature trees. There was a small patio area with garden furniture. Push button key-pads were used on all main entrances, plus on the entrance to Rose wing. Other Bolton council domiciliary care Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 20 offices were also based in the building (on the first floor). Although a meeting room was shared, their offices and entrance were separate, with their staff not needing to access any residential areas. Although the entrance was rather dark and unwelcoming, Firwood House was comfortable, clean and tidy with an acceptable standard of décor. Good practice was noted, as wallpaper was used in corridors, lounge/dining areas and bedrooms, helping the building appear more homely and comfortable. However, the new (acting) manager agreed that much of the home seemed rather uncared for, with a lack of pictures and ornaments (although many of these had been removed as part of recent infection control measures), missing lampshades and mismatched curtains. Bathrooms also appeared rather stark and clinical. Wall tiles were missing from some bathrooms and toilets, although as replacements were no longer available, complete redecoration would be required. The wallpaper border in Rose dining room had also been torn away. We discussed the need for large, domestic style clocks and calendars to meet the specialised orientation needs of residents. New curtains had been ordered for all lounges and dining areas, with delivery now due. The lounge and dining area on Magnolia wing had just been redecorated and re-carpeted to a high standard, with new easy chairs, dining tables and dining chairs (with arm rests and glide rails) provided. Funding had been confirmed for this financial year for major improvements to the entrance area and Rose wing. We were impressed with the plans for the entrance, which included a new ceiling and lighting and the creation of a proper reception desk, where visitors could be greeted (as they often currently drifted into the main office, where care staff were working). A good standard of hygiene was found throughout the home, with no malodour, which visitors confirmed was usual. Liquid soap and paper towels were provided throughout the home. Good practice was noted, as the new (acting) manager had increased domestic staffing levels at the weekend. One concern was the start time of domestic staff (9am), which made it difficult to clean lounge areas (as residents were sitting in them when domestic staff came on duty). This concern was recognised by the domestic staff themselves, one of whom, in the short term, was willing to start earlier. A range of aids and equipment was available throughout the home (e.g. grab rails in corridors and toilets). In addition, a therapy room had been created and equipped on Rose wing. Following assessments from the visiting physiotherapists and occupational therapists, intermediate care residents were provided with equipment on an individual basis, whereby after they were trained to use it at Firwood House, they then took it home. The issue of residents smoking was discussed. Legislation comes into force on 1st July 2007, preventing smoking in public places. Whilst care homes are exempt (enabling them to have a designated room for residents to smoke in) Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 21 Bolton council had already introduced a borough wide no smoking policy. We were concerned as residents who smoked were still being admitted to the home. The home’s no smoking policy needs to be made clear with the resident and their family at the initial referral stage (and clearly detailed in the Service User’s Guide). Difficulties arose as some of these residents had been coming to Firwood House for respite care for some time. Although other placements might be available, these confused and vulnerable residents would be in completely unfamiliar surroundings, being cared for by people who were unfamiliar with their needs. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefited from good staffing levels provided by a generally experienced and competent care team. However, intermediate care training was needed to ensure new specialist care needs were met and a staffed reception to free up care staff. EVIDENCE: On the day of the inspection enough staff were on duty to meet the needs of the residents. Staff felt they had enough time to care for residents without feeling rushed. However, as occupancy was currently low, the need to ensure responsive staffing levels that met the needs of a very changeable resident population was discussed (e.g. additional staff that were familiar with the service that could work at short notice). There was a low staff turnover with the staff team remaining stable. Three carers and one care supervisor had recently joined the staff team through redeployment. There were vacancies for one day and one night carer. One carer was away on maternity leave. Existing care staff were working additional hours to cover this shortfall, with bank staff also being used. The new (acting) Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 23 manager had not used agency staff. Two carers were also doing additional hours as acting care supervisors. The need for a receptionist was discussed. Firwood House was a very busy home, with a high number of visitors and telephone callers. We were concerned with the current situation, whereby care staff had to deal with all calls and enquiries and had no on site administrative support. We advised a staffed reception was essential and it was not acceptable to rely on care staff to fulfil this function. This issue had already been recognised by Bolton council, whereby in addition to the planned new reception area, a receptionist post was also being created. We advised this should be filled as a matter of urgency (without waiting for the new reception to be built). With regard to NVQ training, good practice was noted as approximately 70 of the care staff had NVQ level 2 or above. We requested staff training records. However, the new (acting) manager had inherited a poor system, where no clear information was available regarding the training each staff member had completed. Staff spoken with felt they were generally up to date with their annual moving and handling and fire safety training and had received a range of specialist, service specific training regarding caring for people with confusion (e.g. dementia care awareness, working with challenging behaviour). However, due to the lack of records, it was unclear whether this was the case for all staff. The new (acting) manager was aware that individual training files were needed and had developed a training matrix for care supervisors, with one planned for carers. We were also concerned about the lack of preparation regarding the introduction of intermediate care to the home. No training had been provided, leaving some staff feeling “daunted…don’t know what I’m dealing with” and “terrified”. The new (acting) manager was aware issues of staff confidence and training needed about new systems and procedures, and was already in discussion with the Primary Care Trust team leader regarding in house training to address this. We could not assess Standard 29 as recruitment records were held centrally by Bolton Social Services. CSCI are due to inspect these records shortly. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new (acting) manager was working hard to improve the service, establishing systems to create a well managed and well organised home, with a culture of openness, involvement and respect. EVIDENCE: The management arrangements in the home had recently changed. The home had been without a permanent manager for several years. We had confirmed the previous acting manager (Alan Kirk), as the registered manager in October 2006. However, Mr Kirk was employed through an agency and did not have a Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 25 permanent employment contract with Bolton council. Mr Kirk’s post finished at the beginning of April 2007, with Mr Rob Rimmer becoming Firwood House’s new (acting) manager. Mr Rimmer is a permanent employee of Bolton council and transferred from another Bolton council older people’s home, where he was the registered manager. Mr Rimmer was in the process of submitting his application to us to become the new registered manager of Firwood House. Mr Rimmer has considerable professional experience of working with older people in short, long stay and rehabilitation care settings. Qualified as both a nurse and social worker, Mr Rimmer has worked in management positions for the last seventeen years. Mr Rimmer completed the Registered Managers Award in 2004. We were impressed with how the new (acting) manager had gained the confidence and support of staff. They felt they now had a permanent manager after a long time of temporary arrangements and that morale was improving. Staff spoke about Mr Rimmer very highly, “feels completely different, much better…getting things in order”; “absolutely brilliant, getting the shake up we need”. The new (acting) manager was creating an open and inclusive atmosphere, where staff felt “involved”. Mr Rimmer had already held two staff meetings for day staff; had come in early to meet night staff; and had introduced weekly management meetings with care supervisors. A range of changes was being introduced. For example, each care supervisor had been allocated an area of specific responsibility (e.g. supporting and managing domestic staff), and whilst formal, one to one supervision, had been taking place, the allocation of staff to supervisors had been improved. The home had an ongoing quality assurance programme. The new (acting) manager intended to review the current system. Money kept on residents’ behalf was being stored safely and securely, with appropriate records kept. Two balances were checked at random and found to be correct. The new (acting) manager had ‘inherited’ some unclaimed valuables left from previous residents. We advised the home needed to try and trace the owners by advertising both in the home and in local newspapers. If this was unsuccessful, we advised the items should be disposed of and the money raised donated to the home’s entertainment fund. We asked clear records be kept of these transactions and further guidance sought if any item of high value was identified. We advised the current system for recording when valuables were deposited for safekeeping (or found), be revised to prevent a re-occurrence. As detailed earlier, our checks showed that whilst records were generally up to date, there were gaps, e.g. in care plans and risk assessments for residents receiving short term care and individual staff training records. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 26 A sample of maintenance records was seen. These showed up to date safety checks had been carried out on hoists, the passenger lift and fire equipment, with the fire alarm being sounded weekly. Restrictors were fitted to ground and first floor windows. We were concerned about access to the first floor laundry when it was left unoccupied and advised a risk assessment be carried out to review current arrangements. The provision of additional mobile buzzers for the ‘nurse call’ system was also discussed. Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 27 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 X 2 2 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 28 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 OP4 Regulation 14 (1) (c) Requirement To ensure their needs can be safely met, referrals to the short-term care service must only be accepted and allocated a bed after full and appropriate consultation with the home. To ensure the safety of residents and staff, care plans and risk assessments must be kept up to date and be of sufficient detail. To ensure the safety of residents and staff, all serious incidents of physical aggression must be reported to CSCI. All medicines must be given in exact accordance with the prescribers’ directions, to ensure residents’ health is not at risk. To ensure the specialised social needs of residents are met, a range of appropriate activities must be regularly provided. To ensure residents’ safety, the review of annual moving and DS0000030981.V337059.R01.S.doc Timescale for action 31/07/07 2 OP7 OP8 15 (1) (2) (b) 31/07/07 3 OP7 OP8 37 (1) (c) (e) (2) 31/07/07 4 OP9 13(2) 31/07/07 5 OP12 12 (4) (b), 16 (2) (m) (n) 18 (1) (c) (i), 23 (4) 30/09/07 6 OP30 OP38 31/07/07 Firwood House Version 5.2 Page 29 (e) handling and fire safety training undertaken by staff must be completed, with action taken to address any shortfall. To ensure residents’ safety, all 30/09/07 staff working on the intermediate care unit must be appropriately trained. To ensure residents’ safety, access to the laundry when it is unoccupied must be reviewed, with any necessary action taken. 31/07/07 7 OP30 18 (1) (c) (i) 8 OP38 13 (4) (a) (c) 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 OP4 Good Practice Recommendations To ensure residents are treated respectfully and their confusion is not exacerbated, they should remain in the same bedroom throughout their stay. To avoid residents having to move bedrooms, responsibility for allocating places to the short term care service should lie with the home. 2 OP1 OP4 To improve the admission process: • an admission checklist for short term care should be introduced to guide staff • ways of helping residents (with possible short term memory loss and disorientation) settle into the home should be developed • all relevant staff should receive training about the home’s Service User’s Guide, so they can help residents and their families understand and use it. To ensure residents and/or their relatives views are taken into account, care plans should show their involvement (e.g. signatures; their content – using quotes/information DS0000030981.V337059.R01.S.doc Version 5.2 Page 30 3 OP7 Firwood House from the resident/relatives) 4 OP8 To ensure their needs are met, all residents receiving short and long term care should be formally assessed to identify those who have developed or are at risk of developing pressure sores (with any required intervention being recorded in their care records). To ensure residents safety, all care and domestic staff should receive infection control training. 1.It is recommended that written procedures regarding medicines handling be put in place in order to ensure residents’ safety is maintained when having medicines. 2.It is recommended that medication for residents is confirmed with the GP on or before admission and a written record of this should be obtained preferably by fax to make sure the residents are given the correct doses of their medication. 7 OP12 To ensure residents are involved in meaningful stimulation and social activities: • timetables of social activities should be developed for residents receiving both short and long term care • staff providing these specialist activities should be trained to do so • records should be kept of activities provided • the expectations of ‘intermediate care residents’ regarding the provision of social activities should be researched. To ensure understanding of the complaints procedure, it should be proactively discussed with all new residents and their families and also displayed around the home. The newly created receptionist post should be filled as soon as possible. As planned, to accurately monitor and respond to training needs, individual staff training records should be kept in the home. 5 6 OP8 OP9 8 OP16 9 10 OP27 OP30 Firwood House DS0000030981.V337059.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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