Inspection on 21/05/07 for The Firs, Budleigh Salterton

This inspection was carried out on 21st May 2007.

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

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

Other inspections for this house

The Firs, Budleigh Salterton 04/08/08

The Firs, Budleigh Salterton 30/05/06

The Firs, Budleigh Salterton 31/10/05

The Firs, Budleigh Salterton 19/05/05

The Firs, Budleigh Salterton 21/10/04

The Firs, Budleigh Salterton 05/05/04

The Firs, Budleigh Salterton 03/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Firs, Budleigh Salterton The Firs 33 West Hill Budleigh Salterton Devon EX9 6AE Lead Inspector Michelle Oliver Key Unannounced Inspection 21st May 2007 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, Budleigh Salterton DS0000047358.V335629.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, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs, Budleigh Salterton Address The Firs 33 West Hill Budleigh Salterton Devon EX9 6AE 01395 443394 01395 443830 firscarehome@aol.com 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) Buckland Care Limited ** Post Vacant *** Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29) of places The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the new accommodation will not be brought into use until the Commission for Social Care Inspection has received written confirmation that Planning Department, Building Control, Environmental Health Department and Devon Fire and Rescue Service requirements have been met. That the new accommodation will not be brought into use until an inspector has visited to confirm that the extension is ready for occupation and has been built according to plans which have been agreed with the Commission. Potential users of the two first floor rooms in the extension completed during November 2005 must be made fully aware that there is a restricted view from the rooms due to the height of the window sills, and that there is limited natural light because of the windows’ size. Users who accept an offer of accommodation in either of the rooms must be given first refusal of any other bedroom that becomes available. The home must apply to East Devon District Council for planning consent to enable the two first floor rooms in the November 2005 extension to have their sills reduced in height to enable a user either seated or in their bed to have a reasonable view of the outside world in order to meet the terms of National Minimum Standard for Care Homes for Older People number 25(3). Once planning approval is granted no new service users are to be admitted to the two first floor November 2005 extension rooms until the terms of National Minimum Standard for Care Homes for Older People number 25(3) is met. The Statement of Purpose and Service Users Guide must clearly describe the restricted view and light in the first floor rooms in the 2005 extension until the windowsills have been lowered to meet the terms of the National Minimum Standard for Care Homes for Older People number 25(3). 2. 3. 4. 5. 6. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 5 Date of last inspection 22/02/07 Brief Description of the Service: The Firs is a large detached property situated a short distance from Budleigh Salterton town centre and the sea front. It has level access into the home but the lounge, dining room and some of the bedrooms are located on the ground floor, with steps to reach them. Other bedrooms on the first floor are reached by a passenger lift. There has been a recent addition of a second conservatory and a new bedroom, and there are other building works at this time. The gardens are of a good size and have ample room for sitting out. There are three summerhouses, which service users may also use. The home provides personal care for up to 25 older people who may have dementia. The local community nursing team supports the home. A comprehensive statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is made available to all potential residents before they make a decision about living at The Firs. A copy of the most recent inspection report is available on request. Information received from the home indicates that the current fees are £400£500 weekly. Services not included in this fee are hairdressing, theatre tickets, and meals out, some activities, for example pottery, painting, labelling of clothes, papers, magazines, wine at meals and chiropody. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Several weeks before this inspection began the Commission asked the providers to complete a pre-inspection document. Questionnaires were sent to all of the residents, their relatives and the staff team. Questionnaires have also been sent to GP’s and District Nurses. This inspection began at 8.45am and finished at 6.45 pm. During the day we spoke to 9 residents, 3 care staff and the manager. To date we have received completed questionnaires from 8 residents, 4 staff, 1 doctor, and 2 relatives. Their comments have helped form the judgements reached during this inspection. During the day a tour of the premises took place. The procedures for storage and administration of medicines were checked and we watched the evening medicines being administered. The records of residents admitted since the last inspection, and records of staff recruited since the last inspection were checked to ensure safe procedures are being followed. Other records seen include cash held by the home on behalf of residents, staff training records, the accident book, the record of complaints, and the fire log book. What the service does well: We looked at the way the people who recently moved into the home were helped to decide if The Firs was right for them. People told us they had been made to feel welcomed when they and their relatives and friends visited. We saw information that had been gathered by the home to help them assess the person’s needs and decide if they have the skills and facilities to meet the those needs. This information has been used as the basis to draw up and agree a plan of how the staff will care for the person. An activities person is employed to provide a range of individual and group activities enjoyed by many of the residents. People told us that they are generally able to lead their lives as they wish, and have choice and control over their daily lives. Residents are offered a balanced and varied diet and people told us that they always enjoy the meals, “ food is always good”, “ beautifully presented” and “ nice to all meet up for lunch”. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Although there has been an improvement in the information gathered before someone moves in, there are not always good care plans in place. This puts people at risk of their care, health and welfare needs not being met. We saw several incidents of where no risk assessments had been completed for people possibly placing them at risk of harm or lack of care. Care planning and assessments of peoples risks must be undertaken to ensure that people receive a good standard of care delivered in an individual way, are kept safe but do not have their freedom restricted and are involved in all aspects of their daily lives at the home. Staff and some residents said that although arrangements for group activities are well managed arrangements for individual social interests or going out is not so well managed. The reason for this was thought to be the number of staff on duty is not sufficient to allow for this. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 8 Two rooms in a recently built extension have windows, which due to the height of the sills, people are unable to see out of when either sitting in the room or are in bed. At the time of this inspection one of these rooms was vacant which allows for the work to be undertaken. The home was generally fresh and clean however one room was not. The manager is aware of associated problems with maintaining the freshness of this room and will look in to ways of remedying the situation. The home is not providing structured induction or foundation training to newly recruited staff, to ensure that people living at the home are cared for by competent, well trained staff at all times. Currently only two members of staff have received first aid training. This puts people at risk of not being cared for, at all times, by appropriately trained staff who are able to deal with accidents and health emergencies The home does not currently have a system for reviewing and improving services at the home involving residents or their representatives. A system must be established to ensure that people have a say in the running of their home. The home has not always notified the Commission of serious adverse events that occur at the home. Details about events such as accidents, deaths or outbreaks of infectious illnesses are kept by the Commission and help us to monitor care at the home. 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, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides clear, detailed information to people considering moving in. People can be confident that they will receive the care and support they need if they do move into the home. EVIDENCE: During this inspection we looked at the admission records of four people, two of whom have moved into the home within the last three months. We talked to them about how they chose the home, about the information that was shared, and about the discussions and agreements that were reached on the care they need. We found that the manager had visited them to carry out an assessment of their health and social care needs and to give them information about The Firs. The assessment records showed that sufficient information had been gathered to form the basis of a plan of care to enable care staff to know how the person wants to be looked after. All prospective residents and/or The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 11 their family or representatives are encouraged to visit The Firs, meet other residents and have a meal if they choose before the decision is made to make it their home. All of the people living at The Firs were sent a questionnaire before this inspection to help gather information about their life at the home. Twelve were returned all of which confirmed they had received enough information about the home before they moved in. The home does not provide intermediate care. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,&10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvement is needed in the care planning process to ensure that staff are aware of how residents want their care to be delivered and to enable staff to meet residents’ health and social care needs. Despite some improvements in the way the home delivers personal and health care to residents, some people may continue to be at risk of harm due to their health and welfare needs not being met. Medications are generally well managed, but improvements are needed in the way some processes are recorded. EVIDENCE: At the last inspection we were concerned about the lack of information included in peoples’ plans of care, the extent to which people were included in the writing and reviews of their individual plans and the lack of relevant The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 13 assessments of risks. Since that inspection meetings have taken place with social services and health professionals to discuss and monitor the care provided at the home. Four care plans were looked at in detail during this inspection and discussed with the people concerned to check that they had been involved in the drawing-up and review of their individual plan. In some cases the residents had agreed that a relative should be involved on their behalf and the plans included signatures to confirm that either the resident or their representative have agreed the content. However, there was no evidence to suggest that residents or their representatives had been involved when their care plans were reviewed or being told of any changes to their care. We found the level of detail included in peoples’ plans of care was not sufficient for staff to be aware at all times of how to meet individual health and social care needs. Care plans outlined residents’ general care needs, such as personal care but did not always provide enough detail about communication needs, mobility and certain behaviour. For example, a resident injured their ankle recently after falling at the home. This injury has affected their mobility and continues to cause them discomfort. Staff confirmed that the residents’ mobility had decreased. Walking and putting any weight on the injured ankle was causing the person discomfort and so a wheelchair was being used to take the person to the lounge and dining room. We looked through a daily report for the resident which included details of disturbed sleep because of pain in their ankle and medication records confirmed that pain relief tablets were needed and being given every 4 hours. No details of how care staff should be caring for the resident or how this injury should be monitored and reviewed had been recorded. Risk assessments relating to the resident’s mobility did not include current changes to their ability to walk. The resident confirmed that they were in pain. Staff were very aware of the resident’s needs but records did not reflect the care to be given. This was discussed with the manager who spoke to the resident and an agreement was made that a doctor would be asked to visit to review the injury. We had been informed before this inspection that another resident had fallen and injured their wrist. There were no details recorded in their plan of care to inform care staff how to meet their needs following this incident. Another person was described as “aggressive” but no detail of whether verbal or physical aggression was present. The home monitors peoples’ dental and optician checks and chiropodists are used according to people’s needs. Since the last inspection the home has introduced ‘handover’ sessions between each shift to ensure that staff are given clear verbal instructions on any The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 14 changes to the care needs of each resident. The care staff said they feel this is a great improvement, and now feel more confident that they know what to do. On the whole existing staff appeared to have an understanding of people’s needs. However, the lack of up to date written information may compromise continuity of care when relying on individual staff knowledge. The manager said that since the last inspection all care plans had been reviewed and updated. Two of the plans looked at during this visit had not been reviewed since October 2006. This potentially puts people at risk of not receiving the care that is needed. The home’s procedure for undertaking assessments of risks to people living at the home consists of a check list of “potential” risks including those associated with, for example, sight/hearing difficulties, diabetes and taking too much or too little medication. However, this is not always being used. It was not always clear whether an assessment had been carried out for individual residents as no level of the potential risk had been recorded and no strategies for minimising risks had been undertaken. For example, there was no evidence of an assessment of a person’s risk of falling had been undertaken despite an entry in their daily report that the person was “ very unsteady on feet” or for the person who had fallen and injured their ankle. No assessments of peoples’ nutritional needs had been undertaken putting vulnerable people at risk of their dietary needs not being met. Another person who had recently fallen and injured themselves, was sitting in their room with a table pushed up against them. We looked at this persons care plan. The only information relating to this was an entry in the person’s daily report, “ Staff to make sure [their] table is in front of [them] and when mobile staff need to be with [them]”. Another had a gate across the entrance to their room. When asked why, the manager said that another resident kept wandering into the room and annoying the person. No assessment of risks associated with these actions, which effectively restrains them, or review of one person’s mobility had been undertaken. The lack of a comprehensive assessment and strategies for minimising risks potentially puts people’s health and safety at risk Due to their condition some people living at the home do not have an understanding of personal boundaries and space. An incident involving two residents were seen to encroach on others in the dining room when it had been recorded that one had thrown objects at another. Care plans and risk assessments did not give clear guidance with regards to the strategy for managing residents who may pose a risk to others. For example, residents who wander into other resident’s rooms or who may be aggressive towards others. People living at The Firs at the time of this inspection generally had low dependency needs. Those residents who were spoken to expressed satisfaction with the care they received. We received eleven questionnaires from people who live at The Firs before this inspection and all confirmed that The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 15 they always or usually received the care and support they need. One questionnaire completed by a relative commented, “we are pleased with the care and attention they receive”. It was noted at the last inspection that the home did not have an effective procedure for making sure that people did not go for any amount of time without their prescribed medicine. We noted that this has now been resolved and there was good evidence of a robust procedure for chasing up the delivery of medicines. The procedures for the storage and administration of medicines were checked. Unused or unwanted medicines are disposed of correctly. We watched a member of staff giving out the evening medicines, and checked the recording procedures. All staff who deal with peoples medicines have received ‘in house’ training on medicine administration, and have also completed a more in-depth training to a nationally agreed standard, and their competency has been checked. We found that medicines are generally stored and administered satisfactorily apart from one area of concern where prescribed cream had not been recorded either when received at the home or when applied. In one case pre admission details confirmed that a prescribed cream was to be applied, there was no record of receipt of the cream, no record of it being applied and no care plan relating to the health care to inform staff. This was discussed with staff at the home and it was found that the prescribed cream was not available, and we were told that the person refused to have cream applied anyway. There was no plan of care to inform staff of the care needs other than “cream to be applied” or anything recorded to support this had been carried out. One person living at the home chooses to look after their own medication and staff support them to do so. Lockable facilities are provided in their room and they order and collect their own medicines. However, a record of their medicines is not kept when received at the home, no assessment of their ability to undertake this safely has been undertaken; for example, are they able to read instructions, do they know any consequences associated with not complying with instructions or are they able to open the containers. All people living at the home who were spoken to during this inspection or who responded to questionnaires confirmed that they are treated respectfully and their privacy and dignity is upheld. They said staff call them by their preferred name and knock and wait to be invited in before entering their rooms. Staff were heard speaking kindly to people and seen to be patient and understanding. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social care, including activities, could be improved with meaningful care planning to ensure that residents’ individual preferences, potential and diverse needs are met. Residents benefit from the good relationships the home has developed with their relatives and representatives. A number of residents’ could be more enabled to make daily choices and retain some control over their lives. Residents receive a varied and balanced diet. EVIDENCE: All who responded to questionnaires said there were activities arranged by the home that they could take part in. The home has a dedicated activities The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 17 organiser who provides a range of activities mainly suited to groups rather than individuals. Some of the residents told us that they enjoy outings, including shopping trips or going out to lunch. However, the outings are dependent largely on the availability of willing “off duty” staff to accompany them. One person said they would like to go out more often but couldn’t because of the limited number of staff on duty during the afternoons. Residents benefit from the good relationships the home has developed with their relatives and representatives. A number of residents’ could be more enabled to make daily choices and retain some control over their lives. People who do not wish, or are unable, to take part in group activities were seen sitting in their rooms watching TV, listening to music or sitting in one of the lounges. We discussed how individual interests were met at the home. Peoples’ hobbies and interests had been briefly explored but little detail of how to meet social needs was described in care plans. For example in one care plan it stated that the person “ would like to do some knitting and have library books” but no other information regarding how this would be achieved. During the inspection this person spent varying periods of time unoccupied apart from when receiving care. The activities person told us that this is something which needs to be developed but that currently she tries to visit people individually and spend time speaking to them. Throughout the day we saw people moving freely around the home, going outside, walking or sitting in the garden and going out with friends or relatives. Some people spoken to said that they could do ‘what they liked when they liked’ at The Firs. Plans of care were looked at for those people who were not able to express their opinions as to whether their lifestyle at the home was flexible or not. When walking around the home we noted several people who were dressed, some sitting in chairs in their room, and some who were in bed, asleep. Two people had breakfast trays beside them but cereals and tea were cold. Details in their daily report stated that they had been “got up, washed and dressed by night staff. Slept most of the morning”. This was discussed with the manager who told us that night staff attended to people who were incontinent. We were concerned about this practice and asked whether people needed to be actually dressed and got out of bed and whether breakfast trays should be given when they were asleep. The manager agreed that this needed to be improved and that she was planning to employ a person to deal with breakfasts so that care staff could concentrate on caring. We were told that a person had once asked to have lunch in their room. Staff disagreed with this decision, brought them to the dining room, which upset the person and resulted in staff taking them back to their room. This is not allowing people to take decisions about their lives and puts them at risk of the choices being The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 18 restricted. Where residents lack capacity and have difficulty expressing their wishes clearly agreed routines and preferences would be useful to guide staff. Friends and families are encouraged to visit the Firs whenever they want. Relatives who completed questionnaires or who talked to us said they were completely satisfied with the way the home keeps in contact with them, and the way they are always welcomed when they visit. We looked at the visitors’ book and noted that several visitors came to the home each day. We noted that the manager had signed on behalf of some people who were unable to take part in drawing up their individual plans of care. This was discussed with the manager who said that these people had no family of representatives to involve. We discussed arrangements at the home for arranging advocates, who will act in the their interests of people who have no family or do not wish to involve them. At this time the manager was not familiar with contacting outside agencies and was unaware of how these could be contacted. This potentially puts some people at risk of not being helped to exercise choice and control over their lives. People told us that they enjoy the meals at The Firs. The chef preparing the meal during this inspection had been recently recruited and this was their first day of working unsupervised. The meal looked appetising and well presented. A choice of meal is not offered and a menu is not available to people at the home. Meals are taken in the home’s pleasant dining room and meals were seen being taken to people in their rooms. The chef told us that there were no special diets to be catered for at the time of this inspection. However, when discussing the lack of detail in a persons care plan it was noted that this person needed a liquidised diet. A member of staff had ensured that this had been provided at lunchtime by liquidising the meal themselves. We were concerned that the chef had not been informed of this need or that this information had not been recorded. The menus which we received before this inspection are varied and balanced but were not being followed during this visit and no menus were available at the home. Fresh fruit and vegetables in abundance were seen in the well organised food storage room. All who responded to questionnaires confirmed they always or usually liked the meals served at the home and comments included “ The meals are very good. Different menus” “Sometimes not a lot of choice” and “ well cooked and presented”. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure and there are systems in place to ensure that investigations are undertaken. Minor adjustments are needed to make sure that information included is up to date. Staff have a general understanding of the protection of vulnerable adults meaning that residents are protected from harm. EVIDENCE: A serious complaint was received by the Commission during February 2007 in relation to the quality of care being provided at the home. This complaint lead to a number of Vulnerable Adult Strategy meetings being held attended by professionals from the Police, Social Services and the Commission and is currently ongoing. All people who responded to questionnaires confirmed that they knew how to make a complaint, who to speak with if they were not happy and that staff listen and act on what they say. One commented, “No complaints. Quite pleased”. Since the last inspection a record has been kept of nine complaints made by people living at the home. These included complaints relating to cleanliness, choice and quality of food, the manner in which a person was The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 20 spoken to by a member of staff and one request that people living at the home be included in fire drills. The manager had looked into all issues and recorded outcomes and responses to all except one, although it had been dealt with. The home’s complaint procedure is included in their statement of Purpose and Service User’s Guide. However, the Commissions’ contact address and telephone number is out of date and need to be corrected to enable people to contact us if they wish. The majority of staff responding to questionnaires confirmed that they were aware of procedures to protect residents from harm. Training records showed that not all staff had undertaken training in relation to adult protection issues but staff spoken with had received training and had a good understanding of their responsibilities. All said that they would not hesitate to report any suspicion of poor practice. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good providing residents with a safe, attractive, clean and homely place to live. EVIDENCE: The home is extremely clean and well maintained both inside and outside the building. One person living at the home commented, “The home is very well looked after. The windows are open; we get plenty of fresh air passing through. It is very well cleaned”. It was noted that one room had an unpleasant odour. The manager said that they are dealing with the problem but have not yet resolved it. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 22 The home has an open, welcoming reception area. Décor is of a good standard, and refurbishment and redecoration is on- going to ensure the home remains comfortable and homely. On the ground floor there is a large lounge and adjoining conservatory, a smaller “quiet lounge” a separate dining room, which can accommodate most residents with a conservatory. The home has two rooms on the first floor that do not meet the required standard. The windowsills are too high for people to see out when they are either in bed or sitting in the room. The home was required to remedy this situation when either of the rooms became vacant or when another room became vacant, and with their consent, the current occupants could move whilst the work was being undertaken. At the time of this inspection one room was vacant which would allow for this work to be undertaken. [Please see standard 38] All bedrooms visited had been personalised with items such as pictures, photographs and various pieces of furniture. A passenger lift ensures that all areas of the home are accessible to residents. Staff had knowledge of infection control issues and there was evidence of good practice, for example the manager will liaise with other health professionals to ensure that practice is up to date. There are gloves, paper towels and liquid soap around the home, to promote good basic hygiene. The laundry is well equipped and appeared to be well organised. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers are generally sufficient to ensure peoples’ general care needs can be met but not always sufficient to ensure welfare and social care needs are met. Residents are protected by the home’s recruitment practice. Induction training for some new staff is limited which puts people at risk. EVIDENCE: Eight people responding to questionnaires said that staff were “always” available when needed and three felt that staff were “usually” available when needed. One person commented “ not very good at one to one”. We noted that during the day there were periods (up to 20 or 30 minutes) when people in the ground floor lounge were unsupervised. The manager is aware that with current staffing levels there is not always enough time to spend with individual people or to take them out when they want. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 24 People spoken with during the inspection said that staff were “kind” and “lovely”. One relative wrote, “ staff are excellent, I find not enough of them to look after the amount of people here. They are such a caring staff and I feel most residents suffer from dementia; there should be an increase of staff. What would we do without these carers”, another, ” It is hard sometimes when staff have English as their second language as they do not always understand what you say”. Four staff recruitment files were looked at. The home had received references, Protection of Vulnerable Adult (POVA) checks and Criminal Record Bureau (CRB) checks for these people prior to them starting work at the home. This robust recruitment procedure protects people living at the home. Details included in a pre inspection questionnaire received before this inspection told us that training provided for staff during last 12 months included Prevention of Abuse to Vulnerable Adults, medication, dementia, fire training, moving and handling, food hygiene, infection control, eye care and induction training for new staff. Training in risk assessment and first aid is planned for the next 12 months. We received three completed questionnaires from staff before this inspection. One had been working at The Firs for between 6 –12 months and was dissatisfied with a number of issues. These included their induction training, introduction to and understanding some policies and procedures followed at the home and introduction to people living at the home or when admitted to the home. Another, who had been working at the home for more than 2 years, was very satisfied with their recruitment and training. Two felt that there was not enough time to provide the required care for people and one “does not feel well supported to do job well, again no time is put aside, although training is provided. I don’t doubt that I am doing the job to the best of my ability”. Another member of staff commented they would like “More staffing” to improve the home. One commented that what the home does well is; “Makes the clients feel comfortable as if they are in their own home, relaxed atmosphere”. During this inspection staff were seen to be busy but answered people requests promptly in a friendly kind manner. However, it was noted that most of the time staff were carrying out “ task orientated” duties rather than person centred care, and little time was available for spending time simply talking to people. Residents and staff responses were discussed with the manager who said that recently she has not been able to spend as much time undertaking management and generally supervising staff. This situation will hopefully be The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 25 resolved and she will note the comments made by residents and staff and work towards residents needs being consistently met by the number of staff on duty at any time. The home currently employs 22 members of staff, 3 of which are undertaking, and one already holds, a nationally recognised qualification [NVQ]. Two care staff have been trained in First Aid which means that there is not always a relevantly trained person on duty. All staff, when spoken to were clear about their role and what is expected of them. People living at the home said that staff knew what they were doing and that they felt safe being cared for by them. The manager said all newly employed staff undergo a period of training when they start working at the home to enable them to get to know the residents, the home’s philosophy of care, safety procedure, care procedures, and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. Three members of staff are currently undertaking this training. Newly recruited staff are given an induction handbook, which allows for both the trainer and the staff member to sign and agree that training has been given and that the staff member is competent. We asked to look at records of three recently employed staff. One was not available and two showed that training was inadequate. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home has improved but further developments at the home will ensure standards continue to improve. People living at the home have limited opportunity to be involved in their care or running of the home. Systems are in place to ensure that residents’ personal monies are correctly managed. Arrangements for meeting with the manager and for formal supervision for all staff will improve care practice. Health and safety of the building is good, but some practices do not promote good health, safety and welfare for residents and staff. EVIDENCE: The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 27 The current manager has been employed since November 2006 and is currently in the process of applying to be registered with the Commission for Social Care Inspection. They are experienced in care of the elderly and in managerial positions, have attained a nationally recognised qualification [NVQ] at level 4 and hold a Certificate in Management Studies. There have been some improvements in the running of the home since the last inspection such as information gathered before people move to the home, management of medication and staff handover sessions. Two of the three responses to questionnaires received from staff confirmed they feel they have enough support from the manager but do not meet with the manager regularly or have supervision sessions. Staff comments included “ they do not allow enough time, their reason, as always is that they have a shortage of staff”. Formal supervision when undertaken will give staff an opportunity to review targets and training, and access improvements and achievements. Observational supervision will allow the manager to identify where staff may need support. Staff spoken to during this inspection felt that the manager is approachable and helpful although they feel that she has “ too much to do in the time she has”. The home encourages family or legal advisors to assist residents manage their finances. The manager is currently assisting some residents with finances. Good systems are in place to ensure that monies are managed appropriately. Fire safety appeared to be well managed; records showed that fire equipment is serviced and maintained regularly and that staff receive training and a risk assessment for the building had been completed. During this inspection a door leading to a cupboard where cleaning chemicals were stored was not locked although it was clearly marked. This practice puts peoples’ health and safety at risk. This was pointed out to the manager who immediately arranged for it to be locked. Staff do not currently receive consistent induction or foundation training. People said that the manager usually visits them daily and they are asked whether they are happy and comfortable and whether there is anything they want. No clear process has been developed to show how residents or their representatives, staff and visiting professionals have been consulted or their views sought in order to check the home is meeting their needs or of any improvements being made as a result. Serious events that happen at the home are not always reported to the Commission. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 28 The kitchen has recently been completely refurbished with easily cleanable surfaces and up to date equipment, and was generally clean and well organised. Regular fridge temperatures are recorded to ensure safe storage and foods stored in freezers and fridges were labelled and dated. Since the last inspection valves have been fitted to all bath taps to ensure that it does not put people at risk of scalds. The pre-inspection questionnaire showed regular maintenance of equipment and water, gas and electrical systems to ensure that people’s health and safety is important and respected at The Firs. The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 x 3 2 X 1 The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 [2][a, b, c &d] Requirement Care plans must include enough detail to inform staff how to meet residents’ individual needs. Care plans must be reviewed and updated regularly and residents must be included in the reviews. If a resident is not able or does not wish to be involved in reviewing their plans of care they must be told of any changes made. This is to ensure that residents’ health and social care needs are kept up to date and that they are given choice in the way they wish their care to be delivered. The previous timescale of 22/03/07 has not been fully met. 3. OP8 12[1][a] Arrangements must be made to promote and make proper arrangements to meet peoples’ health and welfare needs at the home. All people who choose to look after their own medication should be assessed as being able DS0000047358.V335629.R01.S.doc Timescale for action 30/06/07 30/06/07 4. OP9 13[2] 30/06/07 The Firs, Budleigh Salterton Version 5.2 Page 31 to do so. This is to ensure that people are able to safely take responsibility for their own medicines. 5. OP12 12[2] Residents must be encouraged and supported to make decisions about the care they receive and their health and welfare. This is to ensure that life at the home meets their expectations and not the routines of the home. 5. OP25 24 Care standards Act 2000 The providers must inform the Commission of how they plan to lower the windowsills in two rooms to meet recognised environmental standards. This relates to two rooms where residents are unable to look out of the window when sitting or in bed. The previous timescale of 24/06/06 has not been met. 6. OP26 16[2] [k] The home must be kept fresh with no unpleasant odours. The previous timescale of 24/06/06 has not been met. 7. OP27 18[[1][a] There must be enough staff on duty to meet peoples’ individual social needs. All newly employed staff must receive structured induction training. This is to ensure that people living at the home are cared for by competent, well trained staff The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 32 30/06/07 30/06/07 30/08/07 30/06/07 8. OP30 18[1] [c] [1] 30/06/07 at all times. The previous timescale of 22/03/07 has not been met. 9. OP33 24 The home must establish and maintain a system for reviewing and improving services at the home involving residents and / or their representatives. A report of any review undertaken by the provider must be to sent to the Commission. A copy of the report must also be made available to residents. This is to ensure that residents have a say in the running of their home. 9. OP38 13[4][c] Suitable arrangements must be made for staff to be trained in first aid. This is to ensure that residents are cared for by appropriately trained staff who are able to deal with accidents and health emergencies. Any serious injury to a resident must be reported to the Commission. This is to ensure that we are kept up to date. These details form part of our pre inspection information. The previous timescale of 22/03/07 has not been met. 30/07/07 30/08/07 10. OP38 37 30/06/07 The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 33 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 OP7 Good Practice Recommendations The home’s procedure for recording personal care carried out should be consistent. Nutritional assessment should be undertaken for all residents who are identified as being at risk. On any occasion a persons freedom to move around the home is restricted this should only be undertaken following an assessment of the risk associated with the restriction. This is to ensure that people have access to all parts of the home and are not restricted. 3. 4. 5. OP9 OP12 OP14 A record should be kept of the administration of creams and ointments Residents who do not wish to take part in group activities should be encouraged and supported, if they wish, to enjoy activities of their choice. The home should have up to date information about how residents may contact people who could act in their interests. This is to ensure that residents are helped to exercise choice and control over their lives. 6. OP15 Residents should be offered a menu to enable them to know what they will be served and to make a choice if they do not want what is on the menu. Individual likes and dislikes should be recorded, and the home aware of all dietary requirements This is to ensure that residents’ nutritional needs are met and that they are encouraged and supported to exercise choice. 7. OP16 The home’s complaint procedure should be updated to DS0000047358.V335629.R01.S.doc Version 5.2 Page 34 2. OP8 The Firs, Budleigh Salterton include the current address of the Commission. To enable people to contact us if they wish. A record should be kept of outcomes/responses to complaints made by residents or relatives/ representatives. This is to ensure that all complaints are taken seriously and acted upon. 8. OP28 Staff should be encouraged and supported to undertake a Nationally recognised qualification to ensure that residents are cared for by well trained staff at all times. Staff should receive formal supervision, covering all aspects of practice, philosophy of the home and career development needs at least 6 times a year. A qualified first aider should be on duty at all times to ensure that residents receive appropriate treatment. 9. OP36 10. OP38 The Firs, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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, Budleigh Salterton DS0000047358.V335629.R01.S.doc Version 5.2 Page 36 - 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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