Inspection on 31/10/05 for The Firs, Budleigh Salterton

This inspection was carried out on 31st October 2005.

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 21/05/07

The Firs, Budleigh Salterton 30/05/06

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 Anita Sutcliffe Unannounced Inspection 31st October 2005 05:30 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.V262119.R01.S.doc Version 5.0 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.V262119.R01.S.doc Version 5.0 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 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th May 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. The home is currently without a registered manager. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a Monday between 5:30 am and 3 pm. Staff activities therefore included getting service users (residents) up, providing breakfast, care throughout the morning, providing lunch, and care during the afternoon. Most residents were met, but the care of 3 was examined in detail. Each was frail or had recently been unwell. Most of the home was visited, including the laundry, kitchen, and sitting rooms. The management of medicines and the duty rota was examined in detail; recruitment and fire safety records were checked. Seven staff were spoken with; the manager was there part of the time. The responsible individual for the company was present for the majority of the inspection. Information leaflets, including contact CSCI details, were left at the home. The family of a prospective resident was spoken with both during and after the inspection. What the service does well: What has improved since the last inspection? A new manager was employed in May, bringing consistency and leadership. Staff said how much more organised the home is now. Activities at the home have improved, and residents were pleased that an activities worker was now employed. One commented that she was glad noise and disruption from the building work had now stopped. Staff said that the training provided for them had improved, which added to their confidence and abilities. They also felt that home was more settled now that the building works were completed and there had been consistent management for several months. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 6 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.V262119.R01.S.doc Version 5.0 Page 7 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.V262119.R01.S.doc Version 5.0 Page 8 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): Both key Standards 3 and 6 were inspected and met at the previous inspection visit. EVIDENCE: The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 9 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): 7, 9 & 10 Individual health and care need is well planned, and based on residents’ wishes. The system used for the recording, administration and storage of medicines has the potential to place the residents at risk. Residents’ dignity and privacy are not always being respected. EVIDENCE: Care plans had been reviewed regularly and demonstrated a very good understanding of individual needs and how to meet them. The method used for recording information is currently under review. Medication practice was fully examined and in one case an inconsistency was found which indicated a mistake having been made. Unsafe handling included tablets out of their packaging; keeping tablets which should have been returned to pharmacy; out of date records; ointments and creams without recorded expiry date, and medicines (eye / ear drops) insecurely stored in the kitchen fridge. Not all medicines were recorded on arrival into the home, therefore reducing the safety measure provided through internal audit. Where The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 10 staff recorded new medication by hand, a second person has not checked accuracy to further ensure the safe transfer of information. The labelling of some medication was illegible. This was a fault from the supplying pharmacist, but had not been corrected. Some staff were observed being kind, helpful and respectful to residents. However, privacy and dignity was severely compromised whilst showing visitors around the home, as this included occupied bedrooms without permission having been sought and with little regard to the resident’s feelings. Night staff were also observed walking in and out of bedrooms to deliver personal care, having made no attempt at communication (including consent or permission) with the resident. Staff interviewed said that foreign staff sometimes communicate to each other in their own language, thus excluding residents from the conversation. Residents who were able to express their feeling felt that privacy and dignity were upheld. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 11 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): 12, 13, 14 & 15 Residents benefit from the improved organisation of activities. balanced and nutritious diet. They receive a Residents sometimes have daily routines imposed upon them without choice. EVIDENCE: Able residents are pleased with an increased number of organised outings and the home continues to provide in house activities. These are clearly listed in a brightly displayed manner. There has recently been a well-attended bowls competition. Able residents said they make daily choices and are quite happy with the home’s routines. However, a frail resident was observed being woken from sleep at 5:40 am. She was then dressed and seated in her chair where she stayed for the duration of the inspection. Her care plan stated she liked to get up between 8 to 8:30. This was not an isolated case. The staff member when questioned said it was “night staff work”. The manager and responsible individual for the home said this practice would be addressed immediately. The majority of residents said they were very happy with the meals provided. There is a choice of meal most days, fresh fruit and vegetables on a regular basis, and sufficient quantity. One resident was unhappy with the food. Able The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 12 residents use their meetings to express feelings about the menu, and several staff and residents shared the comment that “the chef is good and approachable”. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 13 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): 16 & 18 The home’s complaints policy is clear and accessible. Staff understand the need to protect the vulnerable adults in their care but need better training and support to do so consistently. EVIDENCE: The complaints policy is clear and concise; complaints are considered a way of improving the service provided. The Commission has not received any complaints against the home. Staff understood their responsibilities and spoke confidently of how they should respond if they saw abusive practice. However, there has been no training in the protection of vulnerable adults, and the whistle blowing policy is only found in a locked office with no casual access. Training, and an openly displayed whistle blowing policy, could further protect residents. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 14 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 & 26 Residents benefit from an attractive, clean and homely environment, but their health and safety is not being fully protected. EVIDENCE: With the new extension nearing completion, there will soon be increased sitting room space, and the number of steps within the home have been reduced, which will decrease the likelihood of falls. Hygiene and cleanliness are met through a good supply of equipment and a satisfactory laundry system. The home was odour free, and unclean areas were dealt with by the lunchtime. Once again health and safety were compromised. Fire doors, which should be shut at night, were open; the kitchen fire door did not fully shut. An electrical wall socket was broken and the lift machinery door was closed but unlocked. A resident was left in her room with a wet slippery floor. Staff confirmed that frail residents could not be weighed to monitor their weight, when there was an obvious need. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 15 The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 16 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): 27 & 29 Recruitment practice protects residents. Residents’ needs are not fully met through the numbers and skill mix of staff. EVIDENCE: At the previous inspection it was recommended that full employment histories be obtained to further ensure that staff are suitable to work with vulnerable adults. This has been achieved. The one (waking) member of care staff on night duty was unable to safely meet the needs of the 21 residents because the second (sleeping) member of night staff was not being asked to assist. Residents needing two staff to move them were moved by one, which was a danger to both resident and staff. At this same time the safety of a wandering resident was compromised, as they were completely unsupervised. The staffing rota showed that staff might work a ‘sleeping’ night duty preceded and then followed by a full days work. If woken to assist during the night their fitness to work the following day might be compromised. A large proportion of staff have been employed from outside the United Kingdom, some being medically trained in their country of origin. Of the three foreign staff the inspector met two were able to converse in English but the third appeared not to understand questions or information given. Residents’ The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 17 well- being might therefore be affected if misunderstandings occur, as when the staff member did not dry a wet floor in an occupied room. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 18 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): 31 & 38 The manager designate has provided consistency at a difficult time, and is working to address problems. The health and safety of residents is not fully protected. EVIDENCE: The manager designate started with the home in May of this year. The building works of the new extension immediately followed, involving much additional work. She has applied to the Commission to be approved as the registered manager. Residents and staff were complimentary of the work she has done. For the third consecutive visit the health and safety of residents were being compromised. Staff confirmed that they were receiving moving and handling training, but a staff member single-handedly lifted a resident without the required help or use of equipment. This posed a danger to both resident and The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 19 staff. Frail residents are not being weighed because the home’s scales are not suitable, (seated weighing scales have been recommended at previous inspections). The handling of medication was not fully safe (see Standard 9). Night staffing numbers do not protect residents (see Standard 27) and there were environmental hazards found (see Standard 19). Staff said they were pleased with increased training provided, and residents spoken with felt the home was safe. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 1 The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 05/11/05 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. [This refers to: - a medication error - tablets left out of their packaging - tablets kept which should have been returned to pharmacy - some out of date records - external medicines without expiry date - eye and ear drops insecurely kept in the kitchen fridge - medicines not recorded on arrival at the home - a single signature to confirm hand written information is correct - the illegible labelling of information which had not been corrected] Requirement The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 22 2 OP10 12(4)(a) 3 OP12 12(3) 4 OP19 23 (4) 5 OP27 18(10(a) The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. [This refers to entering residents’ rooms without seeking permission to do so and not conversing with a resident whilst providing personal care] The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their feelings and wishes. [This refers to not following the wishes of a resident, as described in their care plan, and working to the convenience of routine rather than residents’ wishes] The registered person shall after consultation with the fire authority take adequate precautions against the risk of fire [this relates to fire doors being kept open at night and the kitchen fire door not closing fully] (The timescale of 19/06/05 was not fully met) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers are as appropriate for the health and welfare of service users. [This refers to inadequate numbers of waking night staff]. DS0000047358.V262119.R01.S.doc 31/10/05 31/10/05 02/11/05 02/11/05 The Firs, Budleigh Salterton Version 5.0 Page 23 6 OP38 13 (4) (a) 7 OP38 13(5) The registered person shall 02/11/05 ensure that all parts of the home to which service users access are so far as reasonably practicable free from hazards to their safety [this relates to the trip and slip hazards of a wet floor and items left on the corridor floor; the unlocked lift machinery door, and a broken electrical socket] (Previous timescale of 21/10/04 not fully met) The registered person shall make 31/10/05 suitable arrangements to provide a safe system for moving and handling service users. [This relates to staff manually handling a non weight bearing service user without assistance or use of equipment]. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP18 OP22 Good Practice Recommendations Staff should receive training in the protection of vulnerable adults from abuse. It is recommended that seated weighing scales be provided to enable the monitoring of service users weight. The Firs, Budleigh Salterton DS0000047358.V262119.R01.S.doc Version 5.0 Page 24 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.V262119.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!