Inspection on 09/02/09 for The Firs

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Adequate 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 05/09/08

The Firs 18/03/08

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE The Firs 186c Dodworth Road Barnsley South Yorkshire S70 6PD Lead Inspector Jayne White Key Unannounced Inspection 9th February 2009 10:00 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.V374133.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.V374133.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 Mr Azar Younis Manager post vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2008 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 and people’s bedrooms. The manager identified the fee as £351.50 per week. 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.V374133.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 1 star. This means that the people who use this service experience adequate quality outcomes. Jayne White, link inspector visited the home on the 9 February 2009 between 09:15 and 17:15 without giving them any notice. Karen Westhead, regulation inspector with the regional enforcement team and Steve Baker, regional lead pharmacy inspector also conducted a random inspection on 8 December 2008. This was to check compliance with statutory requirement notices issued after the last inspection on 5 September 2008 in respect of risk assessments and medication. An additional random inspection took place on 12 December 2008 by Steve Baker to check compliance with agreed follow up requests on the visit made on 8 December 2008. Before the visit we took into consideration other information the Commission for Social Care Inspection (CSCI) had received. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the 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. Adult safeguarding investigations. Surveys that were sent to people living at the home, asking them about the home. Nine were returned (90 ). Surveys sent to staff working at the home, asking them about working at the home. Two were returned (40 ). • • • • During the visit we spoke with the owner, the manager, people that lived there, staff, a representative of someone living there, looked round parts of the building and read some records. We would like to thank the people, staff and the owner for their time and cooperation throughout the inspection process. What the service does well: The manager was working hard to achieve the requirements of the management and administration of the home. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 6 In general, when we spoke to people and looked at the surveys they returned, they were satisfied with the health and personal care they received. They said, “my mother has received good care and support”, “if my mother has needed medical attention the doctor has been to visit urgently if needed. Her medical needs have been attended by the nurse as needed” and “doctors are requested and hospital A & E used if necessary”. People told us they were able to make some choices and decisions about their life style, where this was possible. People were protected from abuse and had their rights protected. What has improved since the last inspection? Audits of medication were much easier because the amount of medicines remaining from one month to the next was being recorded on the current medication administration record. The complaints procedure included up to date information of the name, address and telephone number of the Commission, so that people were fully aware of how and where their concerns may be raised. The leaking roof of the conservatory had been repaired to make it a safer and more comfortable environment for people to use. The AQAA told us on-going improvements to the environment included new armchairs and carpets in communal areas (not the conservatory), carpets in corridor areas and a number of peoples’ bedrooms. The staff rota was being kept up to date, which demonstrated and verified sufficient staff were on duty at all times. The recruitment procedure being followed was safeguarding people better through the service receiving two references and having satisfactory written explanation of any gaps in employment prior to new employees commencing duty. Staff training was demonstrated and verified through staff files having the relevant documentary evidence in place. Staff had undertaken training in respect of safe food handling, to make sure they were up to date with current good practice. The acting manager had submitted an application to be registered and enrolled on a NVQ level 4 in management and care to provide her with further knowledge, skills and competence required for managing a care home. Quality assurance systems were being established to prepare an annual development plan to improve the quality of the service provided and monitor compliance with regulatory duties. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 7 Records being completed were being signed and dated accurately to show the date the record was completed and by whom. 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 DS0000018252.V374133.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.V374133.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 outcome for standard 1 was inspected. We did not assess outcome area 3 as because of a safeguarding investigation and the previous key unannounced inspection, when statutory requirement notices were served on the service the owner had agreed to suspend admissions pending the outcome of the investigation. The outcome for standard 6 is not applicable as the home does not provide an intermediate care service. People who use the service experience adequate quality outcomes in this area. People who are looking to move into the home may not have all the information they need to make an informed choice about where to live. EVIDENCE: Surveys returned by people told us they did receive a contract. However, a comment made by someone needs to be acted on by the service, so that people are satisfied with the billing and receipting system operated by the service for fees that have been paid. The comment was “on being admitted to the home I received a contract, but more information could have been given. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 10 Typed receipts for fees paid could be made more readily available, so could the statements for fees paid. A more suitable billing arrangement could be acted upon”. In respect of previous admissions all people returning their survey stated they received sufficient information about the service before they moved in, so that they knew if the home was right for them. Comments included, “I am ticking yes because I looked round the home at the bedrooms etc. Also, the lounge and conservatory. My mother was invited to have her tea as well, so it looked like she would settle right from the start” and “a day visit was offered which was very helpful”. On the visit we saw that the certificate identifying the services registration information was from 2002. This was out of date. It is an offence not to display the current registration certificate and the manager was told to obtain the most recent certificate and display it. We received notification of changes in the statement of purpose and service user guide. These were assessed against the information that needed to be included, identified in the Care Home Regulations 2001. Omissions were noted. These were identified to the manager, so that she could update the documents and meet Care Home Regulations. The Firs DS0000018252.V374133.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 health and personal care that people received was based on their individual needs, but the plan did not always ensure people were sufficiently protected. People could not always be confident they were treated with respect by staff, because they did not always attend to their toileting and personal care needs when they needed it. EVIDENCE: On the whole, when we spoke to people they were happy with the way that most staff looked after them and respected their dignity. The surveys that were returned also told us that on the whole, people were satisfied with the personal and medical care they received. Comments included, “My mother has received good care and support”, “If my mother has needed medical attention the doctor has been to visit urgently if needed. Her medical needs have been attended by the nurse as needed. Unfortunately her medical requirements The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 12 aren’t discussed unless enquired about” and “Doctors are requested and hospital A & E used if necessary”. The manager needs to make sure that medical requirements are discussed with families, if it has been established during the assessment process that this is the wish of the person they are caring for. In general, when we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind manner. Staff made efforts to include people in conversation and day-to-day life. However, we did see that staff did not always act appropriately when people had been incontinent and needed the toilet or their continence wear needed attending to. This meant respect for people’s dignity was compromised as they remained in soiled clothing and consequently they smelt. A friend that was visiting someone confirmed this. They said, “there’s always an odour, but now there’s new chairs and carpets, so it must be the people. They don’t seem to have a toileting ‘regime’”. Six care plans were looked at as part of the random inspection to check that compliance was met with the Statutory Requirement Notice in relation to Regulation 13(4)(c) and 14(2)(a)(b) about risk assessments. The statutory requirement had been met as people were being assessed and where there was an identified risk an action plan was being put in place to make sure staff knew how to minimise this. Care plans were being reviewed, but documents needed dating properly and signing by the person completing the record. On this visit we looked at two care plans. On the whole, documents were being dated and signed properly. However, where the care plan identified the action to be taken to reduce the risk for people with epilepsy this contradicted what was in place and was insufficient to safeguard people. This was because there was not a ‘first aider’ on shift, which had been identified in the plan to minimise the risk to the person with epilepsy by taking the correct action should they have a seizure. The generic risk assessment for helping people in the event of an accident/incident also identified staff should be trained in first aid (see management and administration). In addition, care plans for some people with diabetes and the action taken by staff to monitor this was insufficient to protect them. The specific concern was there was no identified action to be taken in the care plan should raised blood sugars occur. This had happened for one person and there was no evidence of any monitoring by staff. The district nurse visited to administer insulin, but discussions with them and staff highlighted there was no communication between them about what action needed to be taken to reduce raised blood sugars. In addition, the content in the daily report about the person’s diet when there was raised blood sugars contradicted with what had happened in practice. These shortfalls placed the person at risk. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 13 These risks were highlighted when in a staff survey one commented, “not all information etc is passed when a new service user is admitted to night staff. If the relevant paperwork has not been submitted, we are unaware of their needs etc”. People had access to health care services. Where people were unable to access local services, health care professionals visited them at the home. There was some 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. The random inspections in December 2008 by the regional lead pharmacy inspector told us the systems for the recording, handling, safekeeping and safe administration of medication were now in operation at The Firs and that compliance had been reached with the Statutory Requirement Notice in relation to Regulation 13(2). A random sample of two people’s medication was checked on this inspection. Medicines continued to be stored securely under conditions recommended by the manufacturer. No gaps were found on the medication administration records (MARs). This meant there was a record of people receiving their medication correctly as prescribed. One error was found where the balance of medicines remaining on the MAR did not match with the actual medication that was left and this was identified to the manager for her to address. The Firs DS0000018252.V374133.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 some choices and decisions about their life style, where this was possible. Social and recreational activities available could be improved to meet all people’s expectations. Meals could be more appealing for people and drinks and snacks provided made more enjoyable and less of a risk to people by providing plates and sufficient occasional tables to put them on. EVIDENCE: The AQAA told us an activities co-ordinator had been appointed for 20 hours a week, with plans to increase the flexibility of the hours over the next 12 months. When I spoke with the activities co-ordinator she had only started the previous week and told us she was working 15 hours at this service. She has previous experience and says her responsibility is to organise all activities, fund raise, organise entertainers and shopping trips. We observed the activity co-ordinator inviting everyone to take part in dominoes in the conservatory lounge, but in the main lounge, no-one wanted to or were willing to move. A The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 15 friend of someone who was visiting said, “They’re too frightened to lose their chairs”. Four people in the conservatory took part and were enjoying it. We looked at the activity book the co-ordinator was keeping to demonstrate the activities she undertook. The activities had included bingo and dominoes and the participants had been the same. A record was kept of those that had refused and this was discussed with the co-ordinator and manager, as it was not a true reflection and inappropriate for some people. We also discussed having a more person-centred approach to activities to make them suitable for everyone, as the notice board in the entrance that told people of up and coming activities and activities for the week did not include time for this. When we spoke to people there was a varying response in regard to activities. One said they would like to join in, but can’t always as they can’t get there without ‘bothering staff’. Another said, “it’s enough to send you to sleep in here”. A friend that was visiting said, “there’s nothing usually going off and I visit at different times”. The surveys returned by people told us 7 usually and 2 sometimes felt there were activities arranged by the home that they could take part in. Their comments included, “at times more entertainment could be provided. I mean more one to one personal contact with either simple exercise or music or games etc to keep mental exercise”, “my mother was escorted on an outing once, but this isn’t happening very often. Now she is not able to take part. There could be an effort to hold more coffee mornings or similar more often”, “the home could have more services available, such as a hairdressing service. Most of the residents are sat for long periods in hard leather chairs without comfortable cushions” and “… makes it difficult to join in some activities”. These give good feedback to the manager on how people and their families feel activities could be improved and how important this is. When we looked at care plans there was some attempt to identify peoples’ preferences in respect of activities to engage them in meaningful daytime activities of their own choice, interests and capabilities to enhance their wellbeing. However, this was minimal and needed further work to make social stimulation a meaningful daytime activity for people. When we spoke to people they described how they maintained links with their family and friends and that their families could visit ‘at anytime’. When we spoke to one of the representatives they said they were neither made welcome or not. This could be because a tray with drinks was not provided when they visited. As they said, “This is what would normally happen if you visited someone at home”. The dining room was welcoming, being bright and clean. The menu for the day was displayed outside the kitchen, so people knew what the meal would be. An idea might be to put individual menus on tables for people who might have difficulty seeing the notice board. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 16 Overall, the surveys and discussions with people told us people liked the meals at the home. One commented, “the meals are of a good standard. More variation could be achieved for the person, if they are on soft diets”. Meals were also discussed at service user meetings, but all of the outcomes hadn’t been implemented. So that there is proper choice is available for people at meal times the outcomes from the meetings need to be implemented (see management and administration section). We saw the lunchtime meal being served. It was a leisurely and relaxed time for people. Staff were patient and helpful and allowed people time to finish their meal comfortably. Carers were attentive to people. However, the meal itself did not look very appetising. It was cold beef, mash or chips and peas. Desert was rice pudding or trifle. Looking at daily reports people had also been given trifle the day before. The meal therefore indicated a lack of thought in the variety of foods being served. It was pleasing to see fruit was served with morning drinks. However, people were not offered a serviette or plate to place it on and there were insufficient occasional tables to place drinks on whilst eating their fruit. This made the experience not as enjoyable as it could have been. Three ladies were trying to balance the two, which presented a risk of scalding to them from the hot drinks. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 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 and their representatives were able to express their concerns and had access to a complaints procedure, but they could not always be confident their complaint to the service would be acted on. They were protected from abuse and had their rights protected. EVIDENCE: Surveys and discussions with people told us people knew how to complain and that the majority would know who to complaint to. Comments included, “I would speak to the assistant manager or my mother’s care assistant”, “at times I have asked about my mothers care management. If I have had need to question this, my concerns have been acted upon” and “when I have made a complaint on my mother’s behalf, they have been acted upon straight away”. Surveys and discussions with staff told us they knew what to do should a person or their representative raise a complaint about the service. One said, “I’d find out what it was and that they could trust me. I’d go to Leanne and if I couldn’t go to Leanne I would speak to Social Services or the Commission for Social Care Inspection”. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 18 People could access the complaints procedure because it was displayed on the notice board outside the dining room/lounge for them should they wish to make a complaint. It was clearly written, easy to understand and explained what the procedure was and how long the process would take. The manager was asked to update the procedure, because it stated if people’s complaint cannot be resolved in-house it will be referred to CSCI and it is not the regulatory duties of CSCI to resolve complaints on behalf of providers. The procedure was also available in the service user guide that was available for people in the entrance hall and their bedrooms. One complaint had been received by CSCI. It was in respect of the cancellation of first aid training at short notice, the owner not responding to her in respect of negotiation of payment and the owner providing her documentation to CSCI as proof of the training to be carried out. The provider was asked to respond to the complaint. They did and although the outcome was unsatisfactory for the complainant, will not be pursued by CSCI as there is now no breach of regulations. Two complaints had been received directly by the service. These included a complaint about the attitude of a member of staff and from a GP, because the service had requested further information about ‘as required’ medication. The manager had acted on both the complaints and taken action where required. There were adult safeguarding policies and procedures in place that promoted the protection of people from harm and abuse and the service had worked hard at improving previous shortfalls, so that people weren’t placed at risk. The manager had completed a two day investigator training course for allegations of harm that may be made and was clear of the action she would take should any allegation be made. One allegation had been made alleging financial abuse (not by the service) and an adult safeguarding referral had been made. When we spoke with other staff they also confirmed they’d had adult safeguarding training and were clear of the action they would take should an allegation be made. The way financial transactions were dealt with by the service, did not fully safeguard people (see management and administration). The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for 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. There was an adequately maintained and comfortable environment for people to live, but some improvements were still needed. The home did not give the impression of cleanliness, because of an unpleasant odour that was present all day. EVIDENCE: There was a selection of communal areas, which meant people had a choice of where to sit, meet with family, sit quietly or engage with other people that lived there. It also provided sufficient space for the number of people that used them. Access around the home was good. There were sufficient toilets for people that were appropriately located and easily accessible. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 20 The AQAA told us of improvements that had been made to people’s living environment. The improvements included new armchairs and carpets in communal areas and carpets in corridors and a number of people’s bedrooms. This did improve the environment for people. The owner had repaired the leaks to the conservatory and the refurbishments identified earlier did not apply to this communal area. The reason was alterations to the environment were currently on-going. The owner was made aware of the need to apply for a variation in registration for this and of the sizes and space required for the rooms, including referring him to the information in the National Minimum Standards for Older People. On the whole, when we spoke to people they said they thought their home was comfortable. One said, “room’s good – just had to buy another wardrobe”. Others agreed they had a comfortable bedroom, which they had personalised with pieces of their own furniture and possessions. Some people had en-suite facilities. The surveys returned by people told us that on the whole, they usually thought the home was kept clean. A relative commented where they had filled the survey in of behalf of someone, “my mother’s bed is always clean including her bedding. This is kept to a good standard. Her room is tidied, but could be hoovered more often. The décor of her room is poor as is her room furniture. No clean towels are provided in her room”. This is something the owner and manager need to act on, perhaps, initially by conducting an audit of people’s rooms. The AQAA stated over the past 4 months the home had implemented a cleaning schedule for specific areas around the home to combat odours and control risk of infection. Night staff carried this out due to the areas cleaned being communal and the areas not being vacant during the day. However, there remained an intense odour in the dining room, main lounge and conservatory and the environment was unpleasant all day and the majority of people were sitting in those areas. When we spoke with a visitor they said, “it’s always like this – today’s better than usual” (also see health and personal care). The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 21 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 standard 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. Generally, staff had received training to provide them with the skills and knowledge to support people who use the service and were in sufficient numbers to support the smooth running of the service. EVIDENCE: When we spoke to people and looked at their surveys it told us that on the whole staff listened and acted on what they said and their was usually enough staff available to meet their needs. When we spoke to staff and looked at their surveys they confirmed this. One said, “there’s enough staff on shift” and “we’re working ‘proper’ shifts now”. We observed how staff worked during the visit. This told us there were good relationships between staff and people. 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. When we looked at three staff files it confirmed the procedure was followed in The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 22 practice. We discussed with the manager that where staff are employed when there is a conviction/caution on their CRB, a risk assessment should be completed to demonstrate their decision making process, that the member of staff is suitable to work with vulnerable people. The AQAA told us fourteen staff were trained in the prevention and control of infection, two catering and fourteen care staff had received training in safe food handling and 71 of care staff hold NVQ Level 2 in Care. A discussion with the manager told us she planned to arrange training in malnutrition care and assistance with eating as currently no-one was trained in these subjects. When we spoke to staff and looked at training records it confirmed to us there was a training programme and they had received training that included tissue viability, record keeping, NVQ 2’s and 3’s in Care, moving and handling, infection control, emergency aid, health and safety, dementia, fire safety, food hygiene, awareness of the Mental Capacity Act, falls awareness and Parkinson’s Disease. New employees commenced the Skills for Care Induction programme. The manager told us she was not happy with the quality and content of the training most recently provided to new staff and was in the process of complaining to the training company. This tells us the content and quality of training courses is evaluated, which is good practice. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 23 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although further improvements are needed, the manager was working hard in the management and administration of the home. Quality assurance systems were being established to assess the quality of the service provided and improve these as required and monitor compliance with regulatory duties. EVIDENCE: The manager, Leanne Smith appointed on 08.09.08 remained at the home. She had eleven years experience working in a care and held NVQ Level 3 in care. She had submitted an application to be registered and enrolled on an NVQ level 4 in Management and Care to provide her with further knowledge, The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 24 skills and competence for managing a care home. Since her appointment, there was more organisation within the service and staff knew where information could be found. In addition, she was completing information required by the regulations. The AQAA was submitted as requested, prior to the inspection. This meant the CSCI had information on how well the service felt they meeting outcomes for people using the service. It also gave us some numerical information about the service. Notifiables were also being sent in, with the action taken as a result of these, to demonstrate action to reduce a reoccurrence. Although the manager is available most days, a comment by someone in their surveys should be listened to, so that an inclusive atmosphere is promoted and people feel they can speak to her at any time as they said, “you do need to make an appointment to meet the owner and manager”. There was a mixed response from staff about whether information passed between staff about people worked well. In surveys staff comments included, “due to time restrictions and workload, not all information is passed at the time of reports. Some information has to be taken from the care plan rather than verbally passed between the staff” and “the morale of the staff is low, which I am sure is picked up by the service user. This is I feel, is caused by the workload and the attitude of the manager towards the staff. Although the current manager is doing a reasonable job, I feel that her constant implementation of rules and regulations is in some parts unnecessary and others trivial”. In contrast, when we spoke to staff they said, “Leanne is making a massive difference – she can see job dissatisfaction, gets things done, listens and explains, gives more advice and explanations”, “I’m happy”, “it’s better lately”, “help and support from Mrs Steeples’ is good” and “brilliant manager – she’s got discipline – she tells you the right way to go about things – she deals with things”. The manager had implemented some quality audits to assess and improve the quality of the service provided. Three service user meetings had been held. We saw that some of the outcomes of these had been implemented, for example, jaffa cakes instead of biscuits, however, the meetings had identified people didn’t like sausage, but this continued to be served as an alternative to the main meal. Clearly, it isn’t an alternative if people don’t like it and should be addressed to give people confidence their views are being listened to. When we spoke to staff they told us they had started to have staff meetings and supervision. We saw some records of these. Audits were also taking place of care plans and medication. We looked at the financial transactions made on behalf of someone that lived there. We raised some concerns about this with the manager and owner as the owner was not routinely paying personal allowances to the person. The last entry for personal allowances was one amount for previous fifteen weeks. This The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 25 meant the person couldn’t have access to this money and the way it was being handled could give the impression of financial misuse. This was made worse as the person said, “I didn’t want any dealings with my money, because it gets me all worked up – the office deal with it”. This meant they had no-one overseeing their finances and that they were being dealt with properly. In addition, paying money in such large sums, meant that all monies held for safekeeping on behalf of people meant all the money would not be insured in the event of it being stolen, because of the limit on the insurance. Receipts for transactions were in place, but a second signatory being consistently obtained for each transaction, would improve safeguards for people. We looked at a sample of maintenance and service records. These were up to date and current to the services provided. We checked to see if a risk assessment was in place to assess whether staff had sufficient training in first aid to help people should an accident/incident occur. A risk assessment had been completed and the outcome was for staff to be trained in first aid. They hadn’t received this, but had done emergency aid. The manager stated a first aid certificated course would be identified (also see health and personal care). The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 26 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X 2 The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 27 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 OP8 OP28 OP30 OP38 Regulation 13 (4) (c) & 18 (1) (a) Requirement There must be a trained ‘first aider’ on each shift, so that the action identified in the care plan, to meet the needs of people with epilepsy, should they have a seizure, are met. In addition, that staff are sufficiently trained to provide assistance to people in the event of an accident/incident. So that people with diabetes receive appropriate care to meet their needs, the care plan must identify the action to be taken by staff should people have raised blood sugars. Where people have an identified need in respect of diabetes, they must receive an appropriate diet to make sure their diabetes remains stable and they are not placed at risk of a hypo or hyperglycaemic attack. So that respect for peoples’ dignity is maintained, staff must take people to the toilet when needed and make sure that their continence wear is securely in place. DS0000018252.V374133.R01.S.doc Timescale for action 31/07/09 2. OP7 OP8 13 (4) (c) 31/05/09 3. OP7 OP8 13 (4) (b) 31/05/09 4. OP10 OP26 12 (4) (a) 31/05/09 The Firs Version 5.2 Page 28 5. OP16 22 (3) & (4) So that complainants can be 31/05/09 confident the service will investigate and respond to complaints, the registered provider must investigate any complaint that is made under the complaints procedure. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations So that people have sufficient information about the home, so that they can make an informed decision about where to live, the statement of purpose and service user guide should contain all the information required in the Care Home Regulations 2001. So that people know the conditions under which the service is registered, the most up to date certificate should be displayed. The plan of care should be expanded and demonstrate consultation with people and a plan 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 and would provide a more person centred way of achieving people’s expectations in regard to their social and recreational interests. Plates and occasional tables should be provided for people when they are given drinks and snacks, so they can take their time enjoying them and reduce the risk of them spilling the hot drinks and scalding themselves. Where staff are employed when there is a conviction/caution on their CRB, a risk assessment should be completed to demonstrate their decision making process that the member of staff is suitable to work with vulnerable people. To negate the impression of financial misuse and so that peoples’ money is being dealt with properly, personal allowances should be paid to people, at the most in monthly intervals. To safeguard people’s finances, money should only be kept DS0000018252.V374133.R01.S.doc Version 5.2 Page 29 2. 3. OP1 OP12 4. OP15 5. OP29 6. OP35 OP18 7. The Firs OP35 8. OP35 in the safe if it is insured. To safeguard people’s financial interests, a second signatory should be obtained on all financial transactions. The Firs DS0000018252.V374133.R01.S.doc Version 5.2 Page 30 Care Quality Commission North Eastern Region PO Box 1255 Newcastle upon Tyne NE99 5AS National Enquiry Line: Telephone: 03000 61 61 61 Fax: 03000 61 61 71 Email: enquiries.northeastern@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.V374133.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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