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Inspection on 30/05/06 for The Firs, Budleigh Salterton

Also see our care home review for The Firs, Budleigh Salterton for more information

This inspection was carried out on 30th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All residents spoken with said they were very happy living at the home and the staff were helpful and kind. Residents said, "I am very happy living here" and "I made the right choice". Staff are keen to ensure the well-being and comfort of the residents and treat them with respect and kindness. A member of staff said that residents have more opportunity to go out and more entertainment is provided since the last inspection, all staff show great kindness and care to all residents and that the manager is very supportive and encourages staff to undertake training.

What has improved since the last inspection?

Some improvements have been made in the procedures to ensure that medication is handled safely at the home. Resident`s benefit from an improved procedure relating to fire safety at the home. Fire doors are no longer kept open at night and a door that did not close fully has been repaired. During the last inspection it was noted that items had been left on a corridor floor, increasing the risk of residents tripping. Attention has been paid to making sure the building is safe for residents to walk around by removing any hazards in corridors and by staff becoming more aware and alert to potential risks.

What the care home could do better:

Plans of care should be more comprehensive, clearly giving information about how residents` individual needs will be met. These must include assessments of potential risks, such as nutritional needs, involvement of the resident in the writing and review of their plan. Plans should also include details of how residents prefer their care to be given. This will further ensure that individual, person centred care is a priority at the home. Improvements must be made in relation to recording and administering medication at the home. At the time of this visit some medicines no longer prescribed for a resident were being kept in the home. Medications must be returned to a pharmacy when not required. A record must be kept of all medication when it is received at the home. The administration of medication must be safe. Medicines must not be dispensed by one member of staff and given by another at a later time. All staff who administer medication must receive suitable training. Hand washing facilities, although provided, are not currently accessible in the laundry room. Attention must be made to providing adequate hand washing facilities in the laundry to protect residents from the risk of cross infection. Staff, some of whom smoke, use the laundry room to take breaks. After being laundered residents` clothes are hung in the same room. Arrangements should be made to make sure that clothes are stored in a way that keeps them fresh. The owners must inform The Commission how they are going to comply with a condition made relating to a recent extension at the home. Two rooms were registered with the Condition that the home must apply to East Devon District Council for planning consent to enable the rooms to have their sills lowered to enable residents, when either seated or in their bed, to have a reasonable view of the outside world.

CARE HOMES FOR OLDER PEOPLE The Firs, Budleigh Salterton The Firs 33 West Hill Budleigh Salterton Devon EX9 6AE Lead Inspector Michelle Oliver Unannounced Inspection 30th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 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.V289742.R01.S.doc Version 5.1 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 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.V289742.R01.S.doc Version 5.1 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, which 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 window sills 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.V289742.R01.S.doc Version 5.1 Page 5 Date of last inspection 31st October 2005 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. Nametapes. papers, magazines, wine at meals. and chiropody. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Tuesday 30th May 2006 over a period of 8 hours. The manager was present throughout the inspection. Some positive informative discussion and exchange of information took place. Four members of staff and fifteen residents were observed, consulted with and their views on the home discussed. A number of questionnaires, seeking people’s views about the home were sent out by the inspector before the visit. One questionnaire completed by a resident, three from GP’s, six from health care professionals and six from members of staff were returned. A tour of the building was made and a number of records were inspected. This included resident plans of care, fire logbook, assessments of the safety of the building and staff recruitment files. Since the last inspection three unannounced visits have been made to the home, two by an inspector and one by a Pharmacist inspector. These visits were made to follow up concerns, relating to issues of health and safety, hygiene and medication, raised at the previous inspection. The requirements made as a result of these visits have been met. What the service does well: What has improved since the last inspection? Some improvements have been made in the procedures to ensure that medication is handled safely at the home. Resident’s benefit from an improved procedure relating to fire safety at the home. Fire doors are no longer kept open at night and a door that did not close fully has been repaired. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 7 During the last inspection it was noted that items had been left on a corridor floor, increasing the risk of residents tripping. Attention has been paid to making sure the building is safe for residents to walk around by removing any hazards in corridors and by staff becoming more aware and alert to potential risks. 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 Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 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, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 3 & 6. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service Resident’s benefit from good admission and assessment practice, which ensures that the home is able to meet their individual needs. EVIDENCE: Residents said that they had been visited by a member of staff, prior to admission, when their care needs were assessed and they were given information about the home. Three residents plans of care were looked at; all included a comprehensive assessment of the health, welfare and social care needs carried out before they made a decision to live at the Firs. The assessment ensures that individual needs are known and that potential residents can be assured that they can be fully met at The Firs before deciding to live there. The manager and staff said that family members and potential residents were welcome to visit the home, ask any questions, meet the other residents, if they are agreeable, and have a meal if they wished. Copies of the home’s statement of purpose, service user guide and the most recent inspection report are kept in the reception and are available to all visitors on request. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 10 A questionnaire returned by a health care professional stated “I have made several successful placements within this home. On initial 6 week review the residents have been happy and settled in their environment. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 & 10. Quality in this outcome are poor. This judgement has been made using available evidence including a visit to this service Improvement is needed in the care planning process at the home. Medication is generally well managed but attention is needed in two areas. Residents’ privacy and dignity are met and promoted by the staff and management at the home. EVIDENCE: All residents have a plan of care but not all personal needs have been identified. Four residents care plans were looked at. There was no evidence of any achievable goals being set with the input of residents to maintain their independence. Nutritional assessments had not been undertaken putting vulnerable residents at risk, records of care given were inconsistent, care plans were not up to date, there was no evidence that care plans had been reviewed regularly or that residents were involved in the planning, or reviewing, of their care. The manager discussed plans to improve the format of care planning. and began to rewrite some of the care plans during this visit. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 12 Several residents when asked were unaware of care plans and said they had not been involved with them. Residents said they were happy with the care given at the home. One care plans included a life history of the resident that had been written by a relative. Residents have access to healthcare services that meet their needs including chiropody, opticians, dentists and district nurses Some improvement in the management of medication has taken place at The Firs since the last inspection. Generally only staff who have been appropriately trained administer medicines, however, some medication is being dispensed by members of staff and administered later by other members of staff who have not had appropriate training. This puts residents at risk of receiving the wrong medication. During this visit the administration of medication was seen to be thorough and safe. Unlabelled creams with no expiry or date of opening were seen in a resident’s room during this visit. Creams and ointments deteriorate once opened. Current practice puts residents at risk of infection and decreases the effectiveness of the cream. Not all medicines are checked when received at the home, not all medication is returned to a pharmacy when no longer needed and when a record of medication received at the home is hand written, a second person has not checked the accuracy of the recording to ensure that the information is correct. All residents confirmed that they are treated with dignity and that their privacy is respected by staff at all times. Staff were seen knocking on residents doors and waiting to be invited in before doing so. A telephone room is provided at the home to enable residents to make, or receive, calls in comfort and private. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14 & 15. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are well managed, creative and provide daily variation and interest for people living at the home. Residents are encouraged to maintain their independence, exercising choice and taking control of their lives. EVIDENCE: The daily routine, including getting up and going to bed and mealtimes, appeared to be flexible. Several residents had been served breakfast in their rooms and could choose when to call for further assistance Residents’ interests and preferences, in relation to social activities, had not been consistently recorded in their care plans. A member of staff who is responsible for activities is employed at the home for three afternoons a week. Activities and outings that have recently taken place include residents going to theatre matinees, trips to local nursery gardens, and a trip to Buckfast Abbey and shopping trips. Staff said that residents who do not wish to join in with group activities are encouraged to undertake individual activities in their rooms. Staff said that often there are not enough staff on duty during the afternoons to meet this need. Many of the residents’ choose to stay in their The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 14 rooms and were seen enjoying watching TV or listening to music. Residents are supported to maintain their religious beliefs by staff at the home. There is no restriction on visiting times although residents said they preferred not to receive visitors early in the morning, during meal times or late at night. Visitors to the home were greeted by staff in a kind, friendly manner and during this inspection visitors confirmed that this was always the case. Residents may choose where they want to spend time with their visitors, either in the privacy of their rooms, the dining room in either of two conservatories or in the lounge. During the visit good quality, fresh, fruit and vegetables were seen and the midday meal was balanced and nutritious. The home caters for all dietary needs including vegetarian and diabetics. The menus offer a variety of meals on a three weekly rotation, a choice of meal at both midday and evening and are displayed outside the dining room for all residents to see. However. It does not clearly show whether a good standard of nutrition is provided, as it does not list vegetables on offer. The manager amended the menus immediately adding that fresh seasonable vegetables are served with main meals. On the day of the visit meals were served to residents from a heated trolley, residents were able to choose the size of their meal and all said how enjoyable the meals at the home were. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16 & 18. Quality in this outcome are adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests carried out. Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: Records of incidents recorded indicate that all issues are taken seriously and dealt with promptly. Residents confirmed that they feel comfortable discussing any concerns with staff at the home although they were unable to confirm that they had seen the home’s written policy. There was nothing to suggest that residents are anything other than well cared for at The Firs. Residents said that staff were very helpful, respectful and that nothing was ever too much trouble for them. Staff have undertaken Adult Protection training since the last inspection and were able to discuss different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,23, 25 & 26. Quality in this outcome are poor. This judgement has been made using available evidence including a visit to this service Residents live in a home that is pleasant but some rooms do not meet the required environmental standards. EVIDENCE: The Firs is well maintained, with comfortable accommodation including two lounges, a conservatory and a dining room. Residents’ rooms were homely and many had been personalised with their own belongings and some small items of furniture. Decoration is ongoing at the home; the outside of the building was being painted at the time of this visit. The home was clean and generally free from offensive odours apart from two rooms. The situation was remedied in one room when the morning cleaning had been done but not in the other. Strategies for reducing the problem were discussed with the manager and a district nurse. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 17 The laundry room, which is outside of the main building, was generally untidy and not clean. The room is also used as a staff room where some staff smoke. At the time of this visit it was also being used for the storage of several tins of paint. Not only does this present a fire risk but as residents clean clothes are hung in the room they are at risk of smelling of cigarette smoke. Hand washing facilities are not easily accessible in the laundry or facilities for the disposal of gloves or aprons. A member of staff described the arrangements for disposing of protective clothing and hand washing which involved going back into the main building to the nearest bathroom. This arrangement increases the risk of infection. Call systems are fitted in all residents’ rooms. Whilst walking around home it was noted that several residents could not to call for assistance when they needed, as their call bells were not within easy reach. Not all residents who choose to sit in the lounges, dining room or conservatory have access to a call bell. The staff and manager said that usually a resident, who can reach the call bell, would do so for a resident who can’t. When residents are sitting in the lounges staff said that they frequently visit them to check that they were comfortable and safe. Some more able residents said that this did not cause a problem but those who were less able could not comment on the current arrangements. Residents who chose to live in two first floor rooms, in an extension completed during November 2005, have a restricted view from the rooms due to the height of the windowsills, and there is limited natural light because of the windows’ size. A condition was made that the home must apply to East Devon District Council for planning consent to have the sills lowered, to enable a resident, when either seated or in their bed, to have a reasonable view of the outside world. At the time of this visit one resident said that she chooses not spend any time in the room other than at night. The other resident stays in the room all the time and said that she didn’t mind not being able to see out, but after discussing the situation said that she would like to be able to see out. Both confirmed that they were told about the limited view before they decided to move in and that they had been offered an alternative room when available but did not choose to move. The manager was unable to confirm whether planning permission has been applied for. If a person registered in respect of an establishment or agency fails, without reasonable excuse, to comply with any condition he is guilty of an offence. The providers have been required to inform the Commission of how it plans to meet the Condition and enable residents to see out of the windows in the two rooms. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 27,28,29 & 30. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service. The number of staff on duty throughout the day and night meets residents’ personal and health needs. EVIDENCE: The number of staff on duty on the day of the inspection was sufficient to meet residents’ needs. The manager aims to have 5 carers on duty between 8am2pm, 3 carers between 2pm-8pm and 2 carer between 8pm-8am. The manager is also available at the home between 9am-5pm. The home employs a cook to work until 2pm daily therefore care staff are sometimes responsible for preparing residents’ evening meals. When feasible the evening meal is prepared by the cook during the morning so that care staff have to serve the meal. A questionnaire received from a health care professional stated that staff were “kind as far as it went but didn’t just sit down and chat.” Residents spoken with confirmed that their needs were met in a timely way. The inspector saw staff responding to residents’ bells swiftly throughout the day. Residents and relatives confirmed that staff were kind and helpful. Information received from the manager, prior to the inspection, indicates that 33 of the current staff have completed National Vocational Training at level 2 The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 19 or above. This will protect residents by ensuring that they are cared for by competent staff. The manager has experience of health and social care training and is committed to providing training. Since the last inspection training relating to the Protection of Vulnerable Adults has been undertaken. Future planned training includes dementia awareness, moving and handling and basic food hygiene. Individual records are kept of training undertaken by staff ensuring that updates or gaps in training can be easily identified. Staff at the home are eager to undertake training and were able to highlight their individual needs during this visit. Three staff recruitment files were looked at during this visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at the home. This protects residents, as only people who have undergone this robust procedure will be employed to work at their home. All newly employed staff undergo a period of training when they start working at the home which includes the role of the worker, maintaining safety at work, communication, recognising and responding to abuse and professional development. Two comprehensive records were looked at during this inspection. The time taken to complete this training will depend on past experience and individual abilities. One member of staff, who had experience of working in a hospital, described working with an experienced carer or three days and being introduced to all residents. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op 31, 33, 35 & 38. Quality in this outcome are good. This judgement has been made using available evidence including a visit to this service. There is clear leadership and guidance to staff to ensure residents receive consistent care in a reasonably safe environment EVIDENCE: The manager has worked at the home since February 2006 and is currently in the process of applying to the Commission to be registered. She gives clear direction and leadership to the staff at The Firs. Residents, staff and relatives all said how approachable she is if they have any problems. The home has a system to monitor the quality of care and enable residents and their families to contribute to the running of the home. This ensures that standards of health, social care and welfare needs will be maintained and a programme of continuing improvement developed at the home. Residents will benefit by being assured that the home is working towards delivering high The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 21 standards of care. The home’s system for assuring quality includes regular residents’ meetings, when residents are encouraged to feedback any suggestions to the manager, monthly unannounced visits to the home by the home’s general manager, a report of which is sent to the manager, owners and the Commission, and an audit of any accidents that happen at the home. Residents and relatives have recently been sent a questionnaire asking them to comment on various aspects in the home, for example, meals, staff, decoration and cleanliness. The manager said she plans to act on the information supplied in the questionnaires and publish the result in the home’s statement of purpose. This will further ensure that the information collected will be available to all current and potential residents. The manager said that residents are also consulted daily about the running of the home. A record is kept of any monies held by the home for some residents’ everyday outgoings such as hairdressing, newspapers and chiropody. The records looked at during this visit were correct and up to date. Residents’ records are securely stored and would be made available to them, or their representative with their consent. Records show that staff undertake training in the prevention of fire and fire alarms and emergency lighting tests have been carried out regularly. An assessment of identified hazards and associated risk relating to the environment, including fire hazards, has been undertaken which contribute towards ensuring that The Firs is a safe place to live. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 22 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 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 2 3 X 3 1 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15[1][2] Requirement Timescale for action 2 OP9 13[2] The registered person shall,make the written plan[ “care plan”] available to the service user, 24/07/06 keep the service user’s plan under review and, where appropriate and, unless impracticable to carry out such consultations, after consultation with the service user or a representative of his, revise the service users plan and notify the service user of any such revision. [This relates to: residents not being involved in planning or reviews of their individual care needs. Individual goals for residents not being recorded Care plans not being reviewed regularly. Nutritional assessments not being consistent. Care plans not reflecting individual residents’ current health care needs.] The registered person shall make arrangements for the recording, 24/06/06 handling, safekeeping, safe administration and disposal of medicines received into the care DS0000047358.V289742.R01.S.doc Version 5.1 Page 24 The Firs, Budleigh Salterton 3 OP25 24 Care standards Act 2000 home. [This relates to: -medicines being kept which should have been returned to pharmacy medicines not recorded on arrival at the home - the current procedure of medication being given by a member of staff who has not received training and did not witness the medicine being dispensed. If a person registered in respect of an establishment or agency fails, without reasonable excuse, to comply with any condition for the time being in force by virtue of this Part in respect of the establishment or agency, he shall be guilty of an offence and liable on summary conviction to a fine not exceeding level 5 on the standard scale. [The providers must inform the Commission of how they plan to meet this condition] 24/06/06 4 OP26 16[2][k] 5 OP26 13[3] The registered person shall keep 24/06/06 the home free from offensive odours. [this relates to two rooms which had an offensive odour at the time of the visit] The registered person shall make suitable arrangements to prevent the spread of infection at the 24/06/06 home. [This relates to hand washing facilities being unavailable in the laundry] The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4. 5 Refer to Standard OP7 OP8 OP9 OP22 OP26 Good Practice Recommendations The home’ 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. Two members of staff should sign to confirm hand written information on medication records are correct Call systems with an accessible alarm facility should be provided in every room. Arrangements should be made to ensure that residents’ freshly laundered clothes are stored in a way that keeps them fresh. The Firs, Budleigh Salterton DS0000047358.V289742.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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.V289742.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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