Inspection on 18/03/08 for The Firs

This inspection was carried out on 18th March 2008.

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

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

The Firs 09/02/09

The Firs 05/09/08

The Firs 14/03/07

The Firs 06/04/06

The Firs 19/10/05

The Firs 27/07/05

The Firs 21/01/05

The Firs 02/06/04

The Firs 09/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Firs 186c Dodworth Road Barnsley South Yorkshire S70 6PD Lead Inspector Mrs Jayne White Key Unannounced Inspection 18th March 2008 09:00 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 DS0000018252.V360881.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 DS0000018252.V360881.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Address 186c Dodworth Road Barnsley South Yorkshire S70 6PD 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) 01226 249623 F/P 01226 249623 none None Mr Azar Younis Mrs Susan Hunter Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2007 Brief Description of the Service: The Firs is a care home providing personal care and accommodation for up to 33 older people. The home is on the same site as its sister home, Dorothy House. Dorothy House is registered separately and not covered by this inspection report. The home is owned by Mr Azar Younis. The Firs is situated approximately one mile from Barnsley town centre in one direction and the M1 motorway in the other direction. A main bus route passes the bottom of the drive. The home is all on one level and has 25 single and four double bedrooms. There are three lounge areas. One is a separate small lounge, one a small lounge leading off the dining room and the other a conservatory. There is a lawned area and a small car parking area to the front. Information of the services and facilities the home offers, including the home’s statement of purpose and service user guide, including the CSCI inspection report is available in the entrance hall to the home. The manager identified the fee as £341.50. Additional charges are made for hairdressing, private chiropody, toiletries, papers and magazines. This fee was that applied at the time of inspection and people may wish to obtain more up to date information from the care home. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. We visited the home on the 18 March 2008 between 09:00 and 18:30 without giving them any notice. Before the visit we took into consideration other information the Commission for Social Care Inspection (CSCI) had received. This included: • An Annual Quality Assurance Assessment (AQAA). An AQAA is a document completed by providers. It gives them the opportunity to tell the CSCI how well they think they are meeting the needs of people using their service. Information contained in notifications from the home about any deaths, illnesses and other events, which affected the health and well being of people living there. A complaint that had been received by CSCI. Surveys that were sent to a range of people, asking them about the home. Two came back from people that lived there and one from staff. During the visit we spoke with people that lived there, relatives, staff, the manager, looked round parts of the building and read some records. • • • • We would like to thank the people, their relatives and friends, staff and the manager for their time and co-operation throughout the inspection process. What the service does well: What has improved since the last inspection? The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 6 Information provided to people and their families during the admission process in the service user guide. Also, information about the pressure area care for people in their plan of care. The records of the medication that was being given to people. In addition, a system was in place that identified the date when medication must be discarded. The temperature of the room where medication was kept was being monitored to make sure it was kept at the right temperature to store medication. There was an up to date list of staff authorised to administer medication. Some aspects of the environment, including the landscaping of the gardens, repairing windows, the redecoration of some rooms and the replacement of some carpets. Staff were not commencing work without a Criminal Record Bureau (CRB) or Protection of Vulnerable Adults (POVA) first check. What they could do better: Document information to support the care provided to people and the decisions made, including a comprehensive assessment and detailed care plan. Where information is documented, have satisfactory quality assurance systems in place to make sure the care identified is carried out. Similarly, document all concerns and complaints to demonstrate an open and transparent process. Where complaints are logged ensure it gives a full and comprehensive account with timescales, outcomes and actions being properly logged. Make sure there are sufficient staff trained to give medication, so people can have their medication when they need it. In respect of training in general, make sure staff undertake and are up to date with training to maintain their personal development. Ensure that where private matters of people are being discussed, they are done so in private, so that their confidentiality is maintained. Consult with people on an individual basis about their social and recreational expectations and identify ways of how these could be met. If necessary make adjustments in the routines of the care home so that people don’t feel they are ‘controlled’ and have “less freedom of speech”. In addition, review staffing levels to make sure staff are in sufficient numbers to support these activities. Change the way liquidised meals are served to people, so they are more attractive and look appetising to eat. Continue with the refurbishment programme to improve the living environment for people. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 7 Make sure appropriate aids and equipment are provided for people, so they are moved safely and they remain as independent as possible. Also, that people can have access to their money when they wish, to uphold their rights and maintain their independence. Work proactively in partnership with families or close friends keeping them informed about the care of their relative. 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 DS0000018252.V360881.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 1, 2, & 3 were inspected. The home did not provide an intermediate care service (standard 6). People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who used the service and their representatives had the information they needed to choose a home that would meet their needs. People moving into the home had their needs assessed to make sure the home was able to meet their health, social and care needs, but the documentation of this process was poor. EVIDENCE: The service had developed the service user’s guide, which provided information about the service. The guide was made available to people. The manager was given feedback on the omissions in the service user guide. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 10 The admission of new people included a visit by the manager to the person. This gave a personalised touch to the process with consideration being given to the person’s individual needs and to decide whether the home was able to meet their needs. Also, it gave the manager the opportunity to discuss any concerns and anxieties the person and their families may have about moving into the home. When we spoke to people and their relatives they said, “I didn’t know where I was going to. My granddaughter and grandson visited” and “when Sue visited she said straight away my relative would be suitable”. Evidence suggests that prospective people should have a needs assessment before they go to live at a home. We looked at three peoples’ files for this assessment. One of the assessments contained some information about the person; one very little information and the other only noted the next of kin and mobility information. This meant the service had insufficient documentation about the person’s needs to support their decision to accept their application for admission and offer a place to them. In addition, it did not provide the care staff with documented information about the particular needs of the person. This could lead to people not receiving the care they need. Where people had been placed through care management arrangements the services had received a copy of the summary, but this did not reflect information about their admission to residential care. When we spoke to people or their relatives they said they had a contract or knew what they had to pay. They were clear about what service they could expect from the fee they paid and what the terms and conditions of their occupancy was. This was supported by the information in surveys. However, when we looked at contracts in peoples’ files these were not fully completed and had not been signed or dated by any parties. The manager was told written information about the contract must be given to people and signed by them. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 7, 8, 9 & 10 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The personal care that people received was based on their individual needs, but documentation to support this was poor. There were aspects of upholding the principles of respect, dignity and privacy of people that needed to be improved. EVIDENCE: On the whole, when we spoke to people they were happy with the way that most staff delivered their care and respected their dignity. They said, “we’re looked after alright. Can’t complain about that”. Decisions on how personal care was delivered was not consistently recorded or carried out. For example, we looked at five care plans for people. Two did not have a plan of care. There was no documented risk assessment in any plan of their nutritional needs. In one instance, the plan of care identified two hourly The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 12 turning of a person for pressure area care, but there was no record of this and staff said they didn’t carry this out. When we spoke with people they said they had a bath, but the record didn’t confirm this was regular, with at least one bath a week. In one instance, the admission assessment had identified a bath every other day, the detail in the care plan just said ‘a bath’ and the record identified the person had received one bath in the last month. Despite this, people did look clean and when we spoke with staff they said most people had a bath once a week. When we spoke to staff they described how they would encourage people to be independent and to take responsibility for their own personal hygiene. For example, on a morning staff said people were offered a flannel to wash themselves if they couldn’t get to the sink. They said they didn’t offer people a bowl of water to do this themselves. A family member raised this, as their relative had said to them “they don’t get a proper wash on a morning and my hands don’t feel clean”. People had access to health care services. There was evidence in the care plan of health care treatment and intervention and a record of general health care information. There were some gaps in information, but when we spoke with staff they were able to give a verbal update. Staff received some training in the understanding of the safe handling of medication; however, this did not include an assessment of their competence to do this. There was not always a member of night staff on duty that was trained to administer medication. This meant if people needed medication during the night, there might not be someone available to give them this. The home had a medication policy which was accessible to staff. Medication records for people were generally up to date and medicines received, administered and disposed of were recorded. However, the stock of medication carried forward from one month to another was not recorded on the medication records we checked. Some medication was managed in a way that recognised choice and independence. This was illustrated when one person said, “I keep my own inhalers, one in my pocket and two upstairs. I take two on a morning and two at night. They’re there on the cupboard”. However, documentation to support the person’s capacity to manage their medication and keep it safe was not in place. Neither was there a record of what that medication was. The service understood the need to comply with the administration, safekeeping and disposal of controlled drugs. Staff were aware of the need to treat people with respect and to consider dignity when delivering personal care. However, this was not always upheld in practice. One relative said, “there have been blips when my relative has been The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 13 wearing other people’s clothing”. In addition, we saw discussions taking place with a person about their private affairs in the dining room, where people were sitting and an activity was taking place. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 14 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): The outcomes for standards 12, 13, 14 & 15 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People described how they were able to make choices and decisions about their life style, where this was possible, but at the same time that there was a controlling element to this. On the whole, social and recreational activities available met people’s expectations, but this could be improved by an individual approach. EVIDENCE: The opportunities available for people to take part in a variety of activities had developed. More outings were taking place, including a monthly visit to a club where people had a meal and there was entertainment. However, opportunities were limited and could be improved by a more individualised approach. For example, one person said, “my wife’s been in hospital 2 weeks, but I’ve not visited” and when a person asked about some slippers, the response was “someone will go and get you some”. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 15 When we spoke to people they gave mixed feelings about their lifestyle in the home. They said, “I just sit quiet and watch TV, that’s what I like doing”, “I have my old friends visit. The nuns from Holyrood come and give us blessings and a sermon” and “I can please myself what I do, read, walk round, have a shave”. At the same time, they said, “controlling”, “less freedom of speech”, “don’t like you talking about your past”, “the carers speak to you, but they don’t ask if you need anything”, “I want to carry out the instructions of the place” and “you can’t just please yourself, but they don’t get mad at you”. These comments gave the impression that people were trying to adapt to what can be seen as constraints as part of group living, rather than the service making adaptations to meet their individual needs. The atmosphere in the home was calm. There were some people sat enjoying the peace and quiet, some reading, others sleeping, one person was knitting and one was doing a word puzzle. During the morning five people enjoyed a game of snakes and ladders with the carers. This was the activity that was advertised to take place on a Tuesday in the hallway. People were able to bring personal items and furniture when they came to live at the home to personalise their rooms. There was no evidence in care plans that people were asked about how the home could work with them to provide a flexible lifestyle, that met their social and recreational needs. When we spoke to people they described how they maintained links with their family and friends and that their families could visit ‘at anytime’. Our observations and discussions with relatives during the day confirmed this. When we spoke to people they said, “ meals are alright”, “I always eat my meals. I don’t leave anything”, “simple stuff the best” and “better meal than at home”. The dining room was very welcoming, being bright and clean. The menu for the day was displayed outside the kitchen, so people knew what the meal would be. We saw the lunchtime meal being served and carers and kitchen staff were attentive to people, offering them different choices and asking if they would like some more. When the meal was served, it was leisurely and people were given sufficient time to eat. Where people needed a special diet this was provided. We saw that for people who had a normal diet, their meals were well presented. However, for people who needed their meal liquidised this was not the case. When we spoke to staff they said that people served liquidised meals had it all mixed together in a bowl. This does not look appetising and as one member of staff described “it doesn’t look pleasant. I’d call it brown slop really, but I don’t know what it tastes like”. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 16 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): The outcomes for 16 & 18 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were able to express their concerns and had access to a complaints procedure, but these were not always recorded or appropriately logged. People were protected from abuse and had their rights protected, but further training was needed for staff to update their knowledge. EVIDENCE: On the whole, when we spoke with people they said they were satisfied with the care they received and felt safe. The service had a complaints procedure that was displayed on the notice board, so people and their representatives had access to it, should they wish to make a complaint. The manager was asked to update the procedure, because of the new working and contact arrangements within CSCI. Surveys and discussions with people indicated people knew how to complain. However, it was apparent from conservations with people and their families they had raised concerns with the manager, but these were not recorded. This does not demonstrate an open and transparent process of managing complaints to improve the service. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 17 When we spoke to staff they were aware of the complaints procedure and were aware of the importance of listening to and then acting on people’s concerns. A complaint was received by CSCI, which was forwarded to the provider to investigate. This was logged in the complaints record but the record was incomplete, with timescales, outcomes and actions not being properly logged. The manager had obtained the updated local multi-agency policies and procedures for safeguarding people. Staff were able to access the procedure, but they were not familiar with the guidance, as the manager had not arranged any training or information for them. However, when we spoke to staff they were confident in when and how to use the policy and procedure. The service had not highlighted to staff the importance they gave to safeguarding adults, as when we spoke with staff about their knowledge and training in adult safeguarding this had not always been provided for them. This was confirmed when we looked at their training records. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 18 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): The outcomes for standards 19 & 26 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. On the whole, the building and its environment were clean, adequately decorated and adequately maintained. This meant people found the home comfortable, relaxing and to their satisfaction. EVIDENCE: When we spoke to people they all said they thought their home was comfortable. They said they had a comfortable bedroom, which they had personalised with pieces of their own furniture and possessions. They said, “I’ve a nice big room. Can’t complain about that”, “it’s warm and I’ve a clean bed” and “it’s ok”. They also said the home was ‘clean’ and ‘warm’. Some people had en-suite facilities. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 19 When we spoke to relatives they also felt the environment was comfortable, but said, “it could be improved”. Examples they gave were “the roof in the conservatory could do with painting”, “the carpet in the conservatory could do with replacing”, “the furniture in the conservatory could do with replacing” and “the furniture and furnishings in the bedrooms are basic and could be more luxurious”. There was a programme to improve the decoration, fixtures and fittings, but further work was needed. In the past, maintenance was reactive rather than proactive, which has resulted in a number of areas still requiring action. These areas were discussed with the provider and included replacing some of the chairs in the lounges because the seating had worn, replacing bedding and curtains as these were tired and worn and completely refurbishing the conservatory. In the conservatory the floor underneath the carpet was uneven and presented a tripping hazard to people, the carpet was stained and the roof unpleasant to look at. The furniture was also tired with tables with scratches and dints in them. We commented to the manager that where the table was placed in the conservatory was good, as this was where the flooring was at its worst. The manager said, “she had strategically placed it there”. When we looked round the home there were sufficient toilets for people that were appropriately located and easily accessible. The home was generally clean and tidy. The complaint made to the CSCI made reference to the lack of availability of gloves for staff that is never found because when a check is due everything is provided. The provider in his response said this was not the case although no evidence to support this was given. When we spoke to staff they said, “there are sufficient supplies of gloves and aprons, but sometimes we don’t have access to new supplies, which means we’re without”. Despite not all staff having training in infection control the staff could describe the procedures to follow for the control of infection and the shortfalls within the home to promote this, such as a sluice. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 20 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): The outcomes for standards 27, 28, 29 & 30 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. On the whole, staff were sufficiently skilled to support people, but further training was needed to up date and improve these skills. A review of staffing levels was needed to make sure staff were in sufficient numbers to respond to all peoples’ needs, including individualised social and recreational activities. EVIDENCE: On the whole, when we spoke to people they said there were enough staff available to meet their needs. They said that staff working with them knew what they were meant to do. One person said, “they work jolly hard”. We saw good relationships between staff and people and observed staff responding to assistance as required. Discussions with staff and the rotas identified there were three staff on duty in a morning and afternoon to support twenty nine people that currently lived there. Other staff included a cook and kitchen domestic, but these went off duty at 14:30. This meant the care staff on duty had additional duties to do at tea and suppertime. There was a cleaner on duty every day, but the laundry person only worked Monday – Friday. This meant care staff were again The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 21 responsible for doing other duties at those times. We spoke with the provider about staffing. We explained the number of staff on duty at certain times would be a barrier in providing an individualised approach in respect of people’s social and recreational activities. There was a mixed response from staff about whether the training they received fully equipped them for their role. When we spoke to staff and looked at their training records there were staff that had received appropriate training with updates. Equally there were staff that had not received any training or all of the recommended mandatory training to equip them with the knowledge and skills for their role. The training provided included health and safety, induction for care, dementia, emergency aid, moving and handling, managing abuse in a care environment, palliative care and bereavement in a care setting, managing challenging behaviour and dementia in a care setting, managing incontinence and fire. The training was limited with staff saying training consisted of ‘watching a video and answering questions on the video’. The AQAA stated 26 of staff hold NVQ Level 2 or above. This does not meet the recommended level of 50 . A good deal of the formal training that staff had received had been undertaken with their previous employer. Certificates to demonstrate qualifications and training of staff were in place. The service had a recruitment procedure that included prospective employees completing an application form, obtaining two written references, documentation of a full employment history and a CRB and POVA first check. However, the process was not always followed in practice as when we looked at one staff member’s file they had commenced work prior to the service receiving references. This meant the process was not sufficiently robust enough to protect people. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 22 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): The outcomes for standards 31, 33, 35 & 38 were inspected. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Documentation of information was poor which did not demonstrate the management and administration of the home was based on openness and respect. Effective quality assurance systems were not in place. EVIDENCE: The manager was qualified and had the necessary experience to run the home. She was aware of, but didn’t always meet the regulations and basic processes set out in the NMS. There were shortfalls in the training and development of staff to ensure they were up to date with the knowledge and skills to care for people. When we The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 23 spoke to staff there was a mixed response about whether they received supervision. The service focused on the person, taking into account equality and diversity issues, but social and recreational activities needed to be developed and more staffing provided to be more individualised. One relative said, “we don’t get informed if there’s been an incident, such as a fall or a hospital visit. They just fill you in when it seems convenient or appropriate, such as when our relative tells us or we ask”. This was observed to happen on the inspection. This highlighted the service was not always proactive in working in partnership with families or close friends, as appropriate. The manager had not made any improvements in developing systems that monitored practice and compliance with the plans and the policies and procedures of the home. More work is needed in this area. The manager yet again said she had commenced a quality assurance and monitoring system involving stakeholders of the service. However, when we asked to look at this she had not yet collated the information to provide a report of the action to be taken to improve the service. The provider had provided a more consistent report of his opinion of the quality of the service. However, this could be in more detail and relate more to how requirements, regulations and NMS are being met. In addition, the action that he has taken to address the shortfalls within the manager’s responsibilities. The AQAA was poorly completed and the information did not give any indication of the current situation within the service. There was little evidence to illustrate what the service had done in the last year or how it was planning to improve. For approximately three months, the manager had not responded to numerous requests for further information from two notifiable incidents that had been submitted. The manager was aware of the need to promote safeguarding and there was a health and safety policy that generally met health and safety requirements and legislation. However, we did see a person being moved in a hoist and it did not look safe. The manager said, “it was because it wasn’t a small sling, as one was on order”. We explained this needed to be addressed immediately, so that the person had access to equipment they needed. In addition, the staff said the person did not have their own personalised wheelchair. We observed this, as when they were moved they had to go and look for a chair. Again, the manager was told to access an assessment for this. People or their families managed their own money where possible, which meant people’s independence was promoted. Investigation of the complaint received by CSCI highlighted people did not have access to the money when the manager was not on duty. Neither did they have access to sufficient funds The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 24 from the petty cash as a temporary arrangement. The manager said this arrangement was in place to safeguard people’s money. Whilst this is accepted, there needs to be a balance between this and promoting people’s rights. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 X X 2 The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1) Requirement All people must have a plan of care, so that the person and staff know how their needs in respect of their health and welfare are to be met. There must be sufficient staff trained in medication administration, so that people have access to their medication when they need it. A record must be maintained of all medication a person is prescribed. This includes medication that the person takes themselves. This will make sure the service knows what medication a person is prescribed to manage or monitor a person’s health in respect of this. Where people need their meals liquidising, this must be served properly so that it looks well presented and appetising to eat. The provider must monitor the manager’s effectiveness in meeting requirements, regulations and NMS. In addition, identify and take action DS0000018252.V360881.R01.S.doc Timescale for action 18/03/08 2. OP9 OP14 18 (1) (c) (i) 18/05/08 3. OP9 13 (2) 18/03/08 4. OP15 16(2) (i) 18/03/08 5. OP33 OP31 24 (1) 30/04/08 The Firs Version 5.2 Page 27 6. OP38 13 (5) to address the shortfalls within the manager’s responsibilities. Suitable aids and equipment must be provided for people to be moved safely. 18/03/08 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 OP3 OP7 OP8 Good Practice Recommendations The assessment should contain comprehensive information of all the areas identified in 3.3 of the NMS. A risk assessment of people’s nutritional needs should be recorded. Any action to be taken to meet those needs should be recorded in their plan of care. This would demonstrate what their needs were and the action to be carried out to meet their nutritional needs. A risk assessment of people’s capacity to manage their own medication should be recorded. This is so that there is a record of how this will be managed, so that the person gets and uses the medication they need and that the medication is stored safely. A bowl of water should be provided for people when assisting them with washing themselves to promote their independence. A record of all medication should be maintained by recording the amount of stock carried forward from one month to another. When people are discussing their private affairs they should be encouraged to use their own private space to maintain their confidentiality. The plan of care should demonstrate consultation with people about how their social and recreational needs are going to be met. This gives people an opportunity to discuss with the service their expectations in this respect, so they do not feel they live in a ‘controlled’ environment. All complaints should be recorded to demonstrate an open and transparent process in improving the service. Where complaints are recorded it should provide a comprehensive account of the outcomes, with actions to be taken and timescales. DS0000018252.V360881.R01.S.doc Version 5.2 Page 28 3. OP7 OP9 4. 5. 6. 7. OP8 OP10 OP9 OP10 OP12 OP14 OP31 8. OP16 The Firs 9. 10. 11. 12. 13. 14. OP18 OP19 OP26 OP26 OP27 OP12 OP14 OP28 OP30 OP31 OP33 OP29 OP31 OP31 OP31 OP33 OP35 15. 16. 17. 18. Adult safeguarding training should be provided to staff, so that they remain up to date with current practices and procedures in safeguarding adults. The refurbishment programme should continue to improve the living environment for people. A sluice should be installed so that waste can be disposed of in a more professional manner to control the spread of infection. Staff on duty should have access to gloves at all times to control the spread of infection. Staffing levels should be reviewed so there are sufficient staff on duty to meet the social and recreational needs of people. Quality assurance systems should be improved so that the training needs of staff are kept under review. This should ensure they receive appropriate training and remain up to date with their knowledge and skills. To make sure people are sufficiently safeguarded two references should be received prior to them commencing duty. To demonstrate a proactive approach, work in partnership with families or close friends of people so they are kept fully informed about their welfare. Quality assurance processes should be carried out to monitor practice and compliance with plans and the policies and procedures of the home to improve services. People should have access to their money, when they wish, promoting their rights. The Firs DS0000018252.V360881.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 DS0000018252.V360881.R01.S.doc Version 5.2 Page 30 - 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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