Inspection on 12/06/08 for The Firs

This inspection was carried out on 12th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Firs 23/05/07

The Firs 25/05/06

The Firs 09/02/05

The Firs 10/09/04

The Firs 05/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Firs 90 Glasshouse Hill Codnor Ripley Derbyshire Derbyshire DE5 9QT Lead Inspector Susan Richards Unannounced Inspection 12th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs DS0000002116.V366454.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. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Address 90 Glasshouse Hill Codnor Ripley Derbyshire Derbyshire DE5 9QT 01773 743810 01773 571531 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) www.ashmere.co.uk Ashmere Care Group Mr Gerald Poxton, Mrs Sandra R Poxton, Mrs Ann Theresa Poxton, Dr Michael G Poxton, Mr David A Poxton Mrs Pamela Mary Wood Care Home 42 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (30), Physical disability (2) The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ashmere Care Group is registered to provide at The Firs Nursing Home personal care with nursing for service users of both sexes whose primary needs fall within the following categories:Old age not falling within any other category (OP) (30) Physical Disabilities aged 50 years and over (PD) (2) 2. Dementia aged 55 years and over (DE) DE(E) 12 The maximum number of service users to be accommodated within The Firs Nursing Home is 42 23rd May 2007 Date of last inspection Brief Description of the Service: The Firs is a converted older property with later additional building extensions. It is situated in the village of Codnor, close to the market town of Ripley and all local amenities and is located on a direct bus route to giving access to local towns and villages. There are two units to the home. The main unit provides accommodation, personal and nursing care for up to thirty older people and including two people with physical disabilities aged fifty years and above. A separate/dedicated unit, known as the Extra Care Unit, provides accommodation and personal care for up to twelve people aged fifty-five years and above with dementia. This unit is accessed via the main unit, having an electronic keypad entry system and is purpose built, comprising of twelve bedrooms, each with it own en-suite facility and with separate lounge/dining facilities. There is level access throughout the home and a number of environmental aids and adaptations are provided to assist those who may have mobility problems. These include a shaft lift and an emergency call system throughout, together with well-maintained, landscaped gardens to all sides of the home, providing level access and seating areas for people. Each unit has a dedicated staff team comprising of registered nurses and care staff in the main unit, with care staff, including a unit manager for the Extra Care Unit. All staff is responsible to the registered manager for the service - a registered general nurse, who has support via external management arrangements. Hotel services are centralised. Fees charged per week range between £390.00 and £1,050 per week with no additional charges. Fees charged are determined in accordance with individual’s assessed needs, room type and provision and for those that are eligible, are inclusive of any agreed contribution to their funding via local The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 5 authority (for personal care and accommodation) or primary care trusts in respect of the free nursing care element of the fee as may be determined by them. For any person who is not eligible for such contribution(s), fees charged are by way of private contractual agreement between the individual and the home. The home also offers day care (for limited numbers), charged at £50 per day and a bathing service charged at £10 per session. A copy of the most recent inspection report is usually displayed in the main reception area of the home. Additional copies can be obtained from the registered manager’s office, also located off the main reception area. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star) This means the people who use this service experience adequate quality outcomes. For the purposes of this inspection we have taken account of the information we hold about this service. This includes our previous key inspection report of 04 June 2007, and our annual quality assurance assessment questionnaire (AQAA), which we asked the home to complete in order to provide us with key information about the service. At this inspection there were thirty-six people accommodated, including twenty- four on the main unit, twenty-two of whom receive nursing care and twelve on the Extra Care Unit (personal care only). We used case tracking as part of our methodology, where we looked more closely at the care and services that three of those people receive. We did this by talking with those people (in accordance with their given capacities), direct observation of staff interactions with them, looking at their written care plans and associated health and personal care records and we also looked at their private and communal accommodation. We also received survey returns from ten residents, one relative and ten staff before our visit to the home. Survey returns from eight of the ten residents were recorded as completed by staff in their assistance. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We spoke with the registered manager about her role and responsibilities for the management and administration of the home and examined associated records. We also met with the Extra Care Unit manager and external area management. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian based religion (either practising or non-practising). The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Care plan reviews are regularly recorded and, with the exception of one identified area concerned with storage, medicines practises comply with requirements made at our last inspection and with recognised guidance. There has been development to some extent in respect of people’s care records detailing their preferred daily living routines. Recorded risk assessments are in place in respect of the use of bed rails in the home. People are provided with accurate information as to how to contact the Commission should they choose to do so. Attention has been given to some areas of renewal and redecoration in the main unit and a programme for the purchase of adjustable beds has been commenced for the main nursing unit. A review of staffing arrangements has been undertaken in respect of ensuring more pro-active monitoring and management of staff sickness and absence. All information and documents that are required to be kept in respect of staff recruited to work at the home are in place. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 8 There are adequate facilities for the safe disposal of cigarettes by residents and a review of storage undertaken to ensure better environmental health and safety precautions. 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. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 9 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 The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 10 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): NMS 1 & 3. (NMS 6 is not applicable as the home does not provide for intermediate care) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current method of making key service information available and meaningful to people benefits the majority, but does not best promote equality of access and does not always meet with their diversity of need. Individual’s assessed needs are in mostly well accounted for, although their capacity and rights to make key decisions about their lives are not always best determined or recorded. EVIDENCE: At our last key inspection of this service we judged that people who may use the service and their advocates have the information they need to choose a home that will meet their needs. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 11 In our annual quality assurance questionnaire completed by the home, they say that they aim to provide a homely, warm and friendly atmosphere where people’s dignity, choice and right to respect are promoted. They did not make any reference to the national minimum standards in this outcome section where we asked them about improvements they had made and are seeking to make. Although they did refer to their aim in continuing to improve all documentation in home, which they said at our visit, includes individual’s needs assessment records, although specific improvements were not given. At this inspection people surveyed told us that they received enough information about the home to assist them in choosing to live there. The Statement of Purpose is displayed in the reception area and a copy of the service guide is routinely place in all bedrooms, which with the exception of not specifying fees charged and what they cover, provided all key service information. Two of the people we case tracked knew that this was provided, but said they were not able to access this due to their mobility problems and that no one had gone through this with them. We were unable to hold any meaningful discussions about service information with the third person due to their mental capacity. Some key service information is provided in large print formats, although there is no advice as to its availability in other alternative formats. People who were able told us that some of their needs are discussed with them on admission and their recorded needs assessment records that we looked at were fairly comprehensive, although they lacked clarity of information in respect of peoples’ capacity to consent and to make informed decisions. Discussions with one service user identified examples of clear differences in his expressed daily living choices to that either detailed in or omitted from his needs assessment and care planning information. We discussed this with the manager who advised that she had very recently attended training in respect of the Mental Capacity Act 2005 along with the area manager and that this was on their agenda as an area for development and improvement. The Firs DS0000002116.V366454.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): NMS 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s healthcare needs are being met and their dignity and privacy rights promoted. However, arrangements for the storage of people’s medicines (creams and lotions) do not accord with recognised safe practise guidance. EVIDENCE: At our last key inspection of this service we judged that people are involved in the planning of their care and have their health needs largely met, although errors in the management of medicines meant that their wellbeing was not fully safeguarded. We made a number of requirements about medicines practises with regard to receipts, storage, recording and administration. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 13 We also made two other requirements about ensuring timely care plan reviews and updates in response to people’s changing needs and to ensure that people’s feelings and wishes are respected concerning any planned alterations to the premises in which they live. In respect of the latter we have referred to this under the Environment section of this report. We asked to provider to include these in an improvement plan and tell us what action they intended to take to ensure these were achieved. The provider complied with this request and the information they gave us was satisfactory in principle. In our annual quality assurance questionnaire completed by the home, they say that they always aim to respect and meet people’s needs, including taking action, as may be necessary in respect of any changes in those needs. They also tell us that they have good working relationships with local General Medical Practitioners (GPs). They say that they have made key improvements over the last twelve months by engaging regular inputs from a physiotherapist for those with mobility problems and by ensuring a regular visiting chiropody service for people. They do not refer in the AQAA to any improvements they have made in respect of the requirements we made at our last key inspection with regard to care planning reviews and medicines practises. They feel they could improve their existing arrangements for people to access a local dentist and their stated aims for improvement over the coming twelve months relate to improving co-ordination of care and dissemination of key information between staff in the home in respect of to individual’s personal and healthcare arrangements. At this inspection the majority of people told us that they always or usually receive the care and support they need and that staff listen and act on what they say. And, in respect of both of these questions, two people said they usually do but at times have to wait for long periods and one person said they sometimes do. We discussed matters arising from the latter with the manager at our visit. People’s written care plans that we looked at were formulated in a framework of risk management and overall are reflective of recognised nursing and care practise concerned with older people. They also had regularly recorded reviews, although people’s agreement with them was not always evident. Arrangements for the management and administration of people’s medicines are largely satisfactory and we found that four of the five areas of requirement that we made about medicines at our last key inspection are complied with. However, during our tour of the environment we found people’s creams and lotions were left out around the main unit of the home, in bathrooms and in The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 14 their own rooms. People are not routine provided with lockable storage in their own rooms on the main unit. The manager removed those found in communal areas immediately. For two people whose medicines instructions were hand written onto their medicines administration record (MAR) sheet, these instructions were not signed, or dated by the person writing them or countersigned by a staff member witnessing these. The Firs DS0000002116.V366454.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): NMS 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s lifestyles at the home continue to meet with the expectations of the majority who live there. However focused development in this area for younger adults who may be placed at the home may better promote their personhood, independence, choice and sense of control over their lives. People are provided with food, which they usually enjoy and which accords with their assessed needs. EVIDENCE: At our last key inspection of this service we judged that people who use the service are able to make choices about their lifestyle and that recreational activities largely met people’s expectations. In our annual quality assurance questionnaire completed by the home, they say that they provide regular entertainment for people, access to movement and music sessions and always celebrate people’s birthdays with them. Also The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 16 that they provide people with information about any social events planned and promote regular fund-raising to support outings and presents for people at key celebrations. They say they have improved the variety of activities for people over the last twelve months, including more one to one time for people. And that they could improve further by establishing a relative committee/steering group and plan to provide dedicated staff hours to co-ordinate and implement an activities programme. At this inspection people told us that there are usually activities they can join in although some people said ‘sometimes.’ All people say they usually like the meals at the home, with two people saying they ‘sometimes do.’ Two people felt that improvement could be made in terms of the choice of food offered and also healthy eating better promoted. Dedicated staff hours had been introduced for each afternoon in order to organize and deliver social and recreational activities for people and with records kept in respect of these. People were engaged in a game of skittles during the afternoon of our visit, which they said they enjoyed. Two residents were engaged reading newspapers in a small seating area during the morning, and others watched TV in lounge areas or listened to music. One younger adult living at the home, that we case tracked expressed significant feelings of frustration in terms of their isolation in their room linked to their specialist mobility equipment needs and their occupation, social and leisure needs. With that person’s permission we raised the issues expressed by them with the manager, who agreed to discuss matters further with the individual concerned. People in the extra care unit had ‘life diaries’ recorded and in a simple/picture format, which continues to promote good practice. Records of their engagement in a range of activities organized both in and outside the home were kept within individual’s care records. Entertainers visit the whole home on a regular basis, including a visiting organist, accordionist and there are also weekly movement and music sessions. Information about activities and events are advertised, including social outings, although in our AQAA, the manager told us that interest in social outings is poor. Resident and relative meetings are held, again the uptake on these is said to be lacking. The manager advised that they are changing the format, dates and times of these in a bid to better promote them and engage people’s interest. Lunches served were reasonably well presented. People were offered ‘seconds’ and those who required were given assistance in a sensitive manner. The menu of the day was displayed in the dining room. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 17 The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 18 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): NMS 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People may be confident that the home will usually take any complaints and concerns they may have seriously and that they will be protected from abuse. EVIDENCE: At our last key inspection of this service we judged that people who live in the home are safeguarded and protected from abuse, although gaps in procedure and documentation leave them vulnerable. We also judged that people’s rights to make a complaint are upheld through the homes’ complaints procedure. We made a requirement to review and develop their safeguarding policy and procedures and specified areas to be included there. In our annual quality assurance questionnaire they say that they always fully respond to complaints within a twenty-eight day period and that the manager has an open door policy, whereby people can see her where possible without an appointment. They say they have improved by ensuring that all staff is aware of the whistleblowing policy and in encouraging staff to voice any issues/concerns they may The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 19 have. They do not refer to the requirements we made in our last key inspection report/improvements that we asked them to make. They say they could improve further by ensuring that all staff have undertaken safeguarding adults training, are conversant with the company’s policies and procedures for complaints and in ensuring that all incidents are reported to the right person in a timely manner. They say they aim to improve staff development in this area over the coming twelve months via training and staff appraisal. At this inspection people told us that they know how to complain, although four of the seven people who responded to our survey said they ‘sometimes’ know who to speak to if they are unhappy. One representative said that where concerns are raised, they felt the service is often slow to respond. Relevant information about how to complain is provided within the home’s service guide and also displayed in a large print format. There is no reference to it being made available in any other formats, such audio. The home usually keeps records of complaints they receive, including details of their investigations, outcomes and any action taken by them in respect of these. Since our last key inspection, the home has received five complaints, including two allegations of neglect, investigated via social services joint agency safeguarding adults’ procedures, one allegation of misconduct/failure to act by a senior person in response to changes in a person’s condition, one poor cleanliness levels in one person’s own room and one complaint referred via the Commission alleging insufficient staffing levels and management conflict. From the latter, the first part was not upheld and the second was partially upheld. Of those investigated via safeguarding procedures, one was partially upheld and the most recent of those is awaiting an outcome. The complaint regarding lack of cleanliness was upheld. Where necessary, the home has taken satisfactory action in respect of the findings of complaints investigations, including any shortcomings on their part. However, the home did not notify the Commission in writing as to one of these where an allegation of misconduct was made. We have discussed the latter with senior management for the company following our site visit to the home. (See also management section of this report) The Commission has also recently received anonymous concerns relating to environmental health and safety and alleged conflict arising from lack of clarity as to roles, relationships and responsibilities at management level. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 20 Where possible, we have looked at the latter via this inspection process in relation to our national minimum standards for older persons, under the relevant outcome sections of this report. Staff spoken to during our visit were mostly conversant with their roles and responsibilities in respect of handling complaints and responding to any allegation or suspicion of the abuse of any service user, with one recently appointed staff member awaiting training in this area. All staff confirmed that such training is provided as part of an ongoing rolling programme along with challenging behaviours/dealing with aggression and the AQAA tells us that they have reviewed their policy regarding dealing with aggression and challenging behaviours since our last key inspection. Given our requirement made at our last key inspection in March 2007 (detailed at the head of this section). At this visit we asked to see the home’s written policy guidance and procedures concerned with recognising abuse and procedures to follow. We were provided with a policy statement and managers were unable to locate the procedure for us to examine. However, information provided by the home in our AQAA return told us that the home’s policy for safeguarding adults and preventing abuse was last reviewed in September 2006. Some people we case tracked had bed rails fitted to their beds. Recorded risk assessments are in place in respect of these and people had signed their consent to their use. (The need to ensure suitable risk assessments and agreement in respect of such equipment was a recommendation at our last key inspection and is therefore achieved). The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Overall the home is clean and comfortable, although standards of décor and attention to repairs and equipment are variable between the two units. This continues to result in a much lesser quality of provision for people accommodated within the main building. EVIDENCE: At our last key inspection of this service we judged the physical design and layout of the home to be effective in ensuring people’s privacy, dignity and freedom of movement. However, poor standards of cleanliness and furnishings affected the quality of life for people in the main building. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 22 We made two requirements, that people must be provided with a good standard of furnishings with the lounge carpet and damaged chairs to be replaced. And that people must be provided with clean and reasonably decorated accommodation. In our annual quality assurance questionnaire completed by the home, they say that people’s health and safety is their prime concern and that they ensure individual’s safety and comfort is accounted for. They tell us that they have improved in the last twelve months by decorating the main lounge and dining room, providing new carpeting to the lounge and installing further en suite facilities to some bedrooms. They feel they could do better in terms of their monitoring of the environment and aim to commence formal monitoring of the building on a weekly basis. They also identify their plan to supply a new carpet to the reception area and a number of bedrooms and to carry out imminent repairs to a downstairs toilet. At this inspection people told us that the home is always or usually fresh and clean, although some people told us that the provision of essential equipment for the main unit, such as rise and fall beds and replacement of old equipment where necessary could be improved. We discussed this with the manager who advised that a bed replacement programme had commenced. Two of the people we case tracked had rise and fall profiling beds in accordance with their documented assessed needs. We will continue monitor progress with the bed replacement programme at our next inspection visit. The extra care unit is fresh and clean and furnished and equipped to a high standard. Suitable signing is provided there to assist people in their orientation. The main home was reasonably clean, although some parts of the main unit had stale odours and are tired and ready for upgrading, repair and renewal, including worn and stained corridor carpets. Bathrooms are very stark and uninviting and the flooring to one bathroom was badly damaged and lifting around the edges. However, replacement of this was included in the home’s maintenance programme. Lockable-storage facilities are not provided in those bedrooms seen, sink taps in some people’s rooms had the colour coded hot and cold-water indicator tops missing and in one room these were on the opposite taps, with very hot water emitted from what was perceived to be the cold tap. The latter was rectified from the maintenance person before the end of our inspection. We also observed linen trolleys in bathrooms, which were ready for replacement, with formica edging strips broken off missing. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 23 We tested hot water emissions from one bathing outlet. This was scalding hot and recorded above the maximum temperature range on the gauging device. The manager brought this to the attention of the maintenance person who adjusted these to within recognised safe limits. Records of hot water temperatures tested from bathing outlets were kept and indicated safe water temperatures from all bathing outlets tested the previous week. It was not clear at our visit as to whether the devices fitted to prevent risks from scalding are failsafe. The manager advised us that these would be reviewed as a priority. Work was being undertaken to provide additional en suite facilities in the main unit and a CCTV camera had been fitted in the main entrance area to the home. People were consulted regarding the building works being undertaken. However, anonymous concerns were raised with us before our inspection visit about the citing of the camera and the fact that people who like to sit in this area had not been consulted and were concerned that this may invade their privacy. We discussed this with the manager, who advised that the camera is set at a fixed position solely on the entrance door to the home with the reception area out of visibility range. The laundry was well organised and there are suitable arrangements for transporting soiled linen within the home. However, equipment provided consists of one commercial washer and one dryer to meet with the laundry requirements of a potential number of forty-two service users. We are advised that this affects the time taken for the processing of dirty linen, although it is managed fairly well with no known complaints made about the laundry service. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 24 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): NMS 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are usually met from a competent staff team that is effectively recruited, inducted and trained. EVIDENCE: At our last key inspection for this service we judged that People’s needs are met from competent and suitably qualified staff although gaps in staffing and recruitment systems mean their wellbeing is not fully safeguarded. We made two requirements about staffing arrangements, and including ensuring the provision of required information in respect of staff recruitment. These are complied with at this inspection. In our annual quality assurance questionnaire completed by the home, they say that they do well in ensuring continued staff development through training, including NVQ’s. They say they have improved over the last twelve months by ensuring better dissemination of information through staff meetings, which are more regularly held and better staff attendance at training provided. They also say they have The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 25 more flexible shift patterns for staff and an improved induction and mentorship programme. They say they need to improve the in terms of the records they keep in staff personal files and that this is now being addressed. For the next twelve months they intend to continue to improve by ensuring ongoing staff development and to cover shifts via an internal bank of staff rather than use agency staff. At this inspection people most people told us that they usually receive the care and support that they need and that staff usually listen and act on what they say. Staff also described satisfactory arrangements in respect of their recruitment, induction, training and deployment and examination of related records and discussions with the manager confirmed this. Although some comments were made regarding the impact of reduced staffing levels resulting from last minute sickness and absence. However, staff spoken with felt that this issue was being tackled by management and via personnel procedures. Discussions with the manager confirmed this to be so. We also discussed with the manager as to how staffing levels are determined. Individual’s assessed dependency needs are not formally used to determine these in accordance with recognised guidance. Data set information from the provider tells us that a total of twenty-nine people have achieved at least NVQ level 2 or above with four people undertaken these. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 26 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): NMS 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is reasonably well managed, usually in people’s best interests. Although it is not consistent in terms of monitoring it’s own practise to ensure that it always meets health and safety requirements in a timely manner. EVIDENCE: At our previous key inspection of this service we judged that the home is managed effectively although health and safety hazards create unnecessary risks to the welfare of residents. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 27 We made two requirements regarding environmental health and safety and the need for formal consultation with people as part of the monthly provider visits to the home. In our annual quality assurance questionnaire completed by the home, they say that they ensure that the home is well managed. They did not identify any key improvements made in relation to this outcome section over the last twelve months, nor refer to any progress they may have made with regard to the requirements we made at our last key inspection. They say they could improve further by ensuring that matters arising via the home’s internal service audits are all suitably acted on and that these are regularly reviewed. And that over the coming twelve months they intend to ensure ongoing monitoring of health and safety in the home. At this inspection the manager told us about her training and development over the last twelve months and we looked at the home’s quality assurance and monitoring systems. These consist of monthly home audits undertaken by the registered manager in conjunction with external management and include satisfaction survey questionnaires periodically sent out to service users, their representatives and also relevant care professionals. The results of these are not published or made available to service users or people completing them. There were no reports provided of monthly visits to the home by the provider or their representative to include formal direct consultation with residents and staff. We were advised that the home does not manage monies on behalf of any person except one. Satisfactory records are kept in respect of that person. However, people’s needs assessment information did provide for individual decision-making process in respect their finances and abilities and choices to manage these. We discussed the implications of the Mental Capacity Act with the manager who demonstrated her awareness of this as an area for attention and advised that she and the area manager were due to attend training in this area. In the Complaints section of this report we refer to complaints received by the home, including on allegation of misconduct/failure to act by a senior person in response to changes in a resident’s condition. The Commission has not been notified in writing about this, including the outcome. Staff told us about the arrangements for ensuring safe working practises at the home, including core health and safety training and provision of equipment. Overall these are satisfactory. During our tour of the building, we noted some potential hazards to people’s health and safety. These are referred to under the Environment section of this report. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 28 The home recently notified us of an electrical fire in the home and told us at our inspection that the fire alarm and emergency call system has been retested since then. Certificates for their maintenance and testing were not available for inspection. The manager advised that these had not been issued from the relevant contractor. We requested that copies of these be forwarded to us once received. We looked at the home’s last legionnellas testing certificate in respect of the home’s hot and cold water systems undertaken in September 2007. Although this was within safe range, it was noted by the testing agency to be high and they detailed action, which should be taken in respect of the hot and cold water, distribution systems. There was no evidence as to whether this work has been undertaken with no certificate in place with regard to hot and cold water system testing and chlorination. There are suitable systems and arrangements in place in respect of the reporting and recording of accidents and untoward occurrences in the home and staff spoken with is conversant with their responsibilities in dealing with these. The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X 2 2 The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP9 Regulation 5 13(2) Requirement The service user guide must specify the amount (range of fees charged). The arrangements for storage of medicines received into the home must accord with recognised guidance. People’s creams and lotions must be properly stored and must not be left out in communal areas or in people’s own rooms. Four of the five areas from the requirement in respect of medicines practises at the home made at our last key inspection are complied with. We agree an extended timescale for compliance within this area. The homes’ adult protection policy must include the following information Recognition that other people besides staff can be abusers. Timescales for when to inform Social Services and Commission for Social Care Inspection. The need to notify the The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 31 Timescale for action 12/08/08 31/08/08 3. OP18 13(6) 31/08/08 Commission for Social Care Inspection The need to ensure a joint decision with outside agencies is made about whom will investigate issues and the role of strategy meetings. So as to ensure residents are safeguarded against abuse. An extension to the original timescale of 31/07/07 is agreed. The provider (one of the directors, or a management representatives other than the registered manager) must provide reports of their monthly visit the home, which must be carried out in accordance with this regulation and include direct consultation with service users, their representatives and staff working at the home. Copies of those reports must be provided to the Commission and the registered manager at the home (and also other directors within the organisation). Copies of the most recent fire alarm and nurse call testing maintenance certificates must be provided and forwarded to the Commission. Written notification must be provided to the Commission, regarding any allegation of misconduct of a registered person or any person who works at the care home. This must be forwarded to the Commission. People’s health and safety must be ensured in the home by the effective regulation of water temperatures and design solutions to control: 4. OP33 26(2)-(5) 12/08/08 5. OP38 13(4)(a) & (c) 12/08/08 6. OP37 37(g) 12/08/08 7. OP38 13(4)(a) & (c) 12/08/08 The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 32 Risks of Legionella Risks from hot water 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. 2. Refer to Standard OP1 OP3 Good Practice Recommendations More innovative methods should be sought to ensure equality of access to key service information for people in accordance with their diversity of need. Peoples’ individual capacity and right to make informed choices and decisions about their lives should be accounted for within the home’s needs assessment and care planning records for each person in accordance with the Mental Capacity Act 2005. This should people’s capacity to exercise person autonomy and choice in respect of their financial affairs. People should be fully consulted and involved in the drawing up of their care plans in accordance with their given capacities, and their care plans determining their daily living choices and lifestyle preferences should be agreed with them. Hand written instructions on any person’s medicines administration record (MAR) sheet, should be signed and dated by the person writing them and countersigned and dated by the person witnessing this. The importance of enabling younger adults who may be placed in the home, to achieve their goals, follow their interests and be integrated into community life and leisure activities, should be recognised and developed in a way that is directed by the person using the service. The registered persons should seek to improve environmental standards, including the quality of furnishings, décor and equipment within the main unit for the benefit of people who accommodated there. Care staffing levels should be determined using recognised guidance from the Department of Health, such as the Residential staffing forum. 3. OP7 4. OP9 5. OP12 6. OP19 7. OP27 The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI The Firs DS0000002116.V366454.R01.S.doc Version 5.2 Page 34 - 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. 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