Inspection on 04/08/08 for The Firs, Budleigh Salterton

This inspection was carried out on 4th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

The Firs, Budleigh Salterton 21/05/07

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 09/11/2008.

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 4th August 2008 09:15 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.V366710.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.V366710.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 Ltd Manager 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.V366710.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 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.V366710.R01.S.doc Version 5.2 Page 5 Date of last inspection 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. Electronically operated gates have recently been fitted and people need to speak to a member of staff via a speaker to gain access. 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. 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 29 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£600 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.V366710.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This inspection was undertaken over 2 days by one inspector. We spent 6 hours at the home on the first day and 2 hours on the second. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 10 people living at the home, 10 staff and 10 health care professionals. All questionnaires were completed and returned to us from people expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 10 staff, including the manager, deputy and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Currently the fees of between £294 & £600are charged. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Copies of the inspection report are available from the office. What the service does well: People living at this home were generally very happy with life at the home; one person told us, “ couldn’t be in a better place” and “ we are all very fortunate to live in a place where we are so well cared for”. Staff are recruited robustly to ensure that people are protected. Many people praised the staff team for their caring approach and attitude. People spoke highly of the staff; and told us “All staff are wonderfully kind and patient” and “Staff are very nice”. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 7 During our visit staff were attentive and friendly in their approach to people living at the home. We saw staff skilfully meet the needs of individuals and ensure that individuals were offered choices. Some good information is available to people to help make a decision about whether this home would suite their needs. A good admissions process ensures that the home can meet people’s needs. People’s health care needs are well met and the home works with other professionals, such as GPs and nurses to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were generally happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. Several people described the atmosphere at the home as warm, friendly and welcoming. People feel confident that their complaints or concerns will be addressed. The environment is clean, comfortable and safe. People were very happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Overall, health and safety is well managed and people are safeguarded from harm. What has improved since the last inspection? An assessment of health, social and welfare needs is undertaken for all people considering making the Firs their home. All staff at the home including the General Manager and the deputy have worked hard to improve the care planning procedure since the last inspection. Care plans now include more detail to inform staff how to meet the needs of the individual. This is to ensure that people receive the care they need in the manner [This improvement needs to continue. Please see what they could do better] Medication is well managed at the home. An accurate staff rota is now displayed, so that the number of hours worked by staff can be seen. This is so that staff do not work excessive hours. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 8 All newly employed staff receive structured induction training. This is to ensure that competent, well trained staff cares for people living at the home at all times. A requirement was made at the last inspection that all staff receive training in first aid. This has been complied with as all staff but one was trained and this person has since resigned. What they could do better: The Registered Person must provide evidence to the Commission that the security arrangements for external fences and doors do not unduly restrict the liberty of people using the service and comply with current legislation, good practice and guidance including the Mental Capacity Act and Deprivation of Liberty Safeguards. The views of people living at the home are not included in the home’s statement of purpose for any interested parties to refer to, or to the Commission. Assessments of peoples’ health, welfare and social care do not contain sufficient detail or information on which a comprehensive plan of care may be based. Information included in care plans, although improved, is not sufficiently detailed. They do not include enough detail to inform staff how to meet the needs of the individual. The involvement of people in the reviewing of their care plans is inconsistent. Records are not always kept when they, or their representatives, have been involved or consulted. Although the quality of information in daily reports has improved they are not consistently being written in sufficient detail to ensure that aims of goals highlighted in individuals’ plans of care have been met. Not all people living at the home are provided with information about the meals being served to enable them to make a choice about the food they receive. Information provided is not in a format that all can clearly see and understand. Copies of outcomes of quality assurance surveys are not being sent to the Commission. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 9 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.V366710.R01.S.doc Version 5.2 Page 10 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.V366710.R01.S.doc Version 5.2 Page 11 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): 1, 3, 5 & 6. Quality in this outcome area is adequate. Systems are in place to ensure peoples’ needs are assessed before they move into the home. Prospective residents would benefit from the assessments being more personalised with consideration being given to their individual needs, concerns and anxieties. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All six of the people living at the home who returned questionnaires to us before this inspection confirmed that they had been given enough information about the home before they made a decision to live there. We were told that people are invited and encouraged to visit the home, have a meal, talk to others living there and staff to help them make a decision about whether The The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 12 Firs is where they would like to live. Everyone we spoke to told us that they had made “the right choice” and that the home met their needs. Information about the home is included in the home’s Statement of Purpose and Service User Guide, both of which are available in the reception area for people to read and are given to all who make enquiries about moving to the home. A copy of the most recent inspection report is also available, for all who wish to read it. However we did note that some information had been included in the file that did not relate to the Firs and could be misleading. [Refer to standard 33] The assessment included basic care needs including details of whether they needed chiropody, information about diet, nutrition, hearing and the number of staff needed to assist when transferring them. However, there was little information relating to the person’s abilities, what they hope for and want to achieve and the support they need or the person’s choice of how they wished their care to be provided. Prior to admission the home promotes peoples’ rights by confirming details such as fees; admission date and whether or not people’s identified health and social care needs can be met at the home. Most of the people we spoke to during this inspection were happy with the amount of information that had been provided before they chose to make the Firs their home. One person who responded to a survey commented, “ not only did we visit the home but we were visited at home. All easy, professional and reassuring”. The home does not admit people for intermediate care. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 13 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. Systems in place generally inform staff about peoples’ care needs, although lack of adequate detail in some care plans may prevent truly individualised care for everyone. Improvement in keeping records of when individuals are encouraged to be involved in the planning, reviewing or development of their care plans will promote person centred care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a system in place to ensure that all people have individual plans of care, which are kept securely in the reception area and are readily accessible for all staff to refer to. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 14 During this inspection we looked closely at the care plans for 5 people currently living at the home, including those for a person who had recently moved into The Firs. Risk assessments were in place and generally reflected behaviour or situations which may cause harm to people, for example poor mobility, falls and the use of equipment such as bed rails. Moving and handling assessments and plans, skin care and tissue viability and continence assessments were in place and generally provided staff with the instructions needed to deliver care. Care files showed that people have access to outside professionals such as G.P, community nursing service, specialist consultants, palliative care team; chiropodist and optician in order to ensure their health care needs are met. Some care plans have already been updated since the last inspection, using the revised method and the manager and deputy manager are currently working towards ensuring that all care plans would be the revised within the next 3 months. The quality of information included in the plans varied. We looked at the new format care plan for one person living at the home. The plans of needs to be met by staff were clear, concise and well written. The plans highlighted what staff needed to do to meet the assessed needs of this person. The care plans were dated and signed by a relative when they had been involved in the initial drawing up of the plans. The plans included some good personalised details of how the person chose to have their needs met, including eating and drinking, mobility, sleeping and communication. Plans for one person included “carers to be aware of [this persons] mobility and to offer help but in a way that respects [their] dignity in this area”. However, it was not clear that care was being carried out as stated in care plans. We spoke to staff, asking them how useful they find the care plans, what input they have in care planning and how care plans are kept up to date on a daily basis. Staff said they thought care plans included some good information and told us how they care for individuals but not all the care plans reflected this. Not all information included in the care plans we looked at was up to date. One person’s spouse had recently died at the home but this information had not been recorded. Staff were well aware of the fact and were able to discuss with us how they dealt with the situation and some good records of discussions with relatives about how the bereavement was managed had been recorded. However, the person moved from the room they shared with their spouse to another room and there was no evidence to suggest that they had been given a choice or how this had been managed. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 15 Daily reports for people living at the home did not always include sufficient information to confirm that their care needs were being met in a timely way. For example, staff had noted that a person had lost weight and sought advise from a dietician. However, we noted that a month previous to the referral staff had recorded in the person’s daily record that the person had been “acting strangely” and had “difficulty in swallowing” and that this had been reported to a senior member of staff. However there was no further reference to this issue at all until a referral was made to a dietician. The outcome of this referral resulted in an increase in weight, increased independence when eating and an improvement in mobility. The person was not able to communicate well with us but seemed happy and comfortable when we spoke to them. The manager recently reported an incident to the Commission when a person living at the home was reported missing after unlocking an outside door. We looked at then persons care plans and noted that this had happened on several occasions. The plan of care stated that the person was to be monitored but no details as to how this was to be carried out. The manager had consulted with a Relevant health care professional and a detailed plan of how the situation would be managed had been drawn up and were being promoted during this inspection. The lack of continuity of observation, monitoring and recording potentially puts people at risk of their health care needs not being met. Other information in care plans included that a person did not join in activities provided at the home and that staff were “ to prompt” them “ with reminiscing by using photo album or speaking to them. Daily records did not refer to whether this had been carried out or not. This makes it unclear as to whether this person’s assessed needs are being met. Observations of the persons emotional/psychological needs were judgemental; plans for meeting these needs had not been established and the plan had had not been updated. This puts the person at risk of not having their needs identified or met. We spoke to several people living at the home. Not all were able to fully communicate but those who did said how much they enjoyed living at the home and how well they are looked after. None of them was aware that they had a “care plan” and could not recall being told of any changes. A record of care plan reviews is kept and the deputy manager told us that she does discuss any changes will the person concerned at the time or their relatives. Staff told us that they ensure that people are treated with dignity and that their privacy is protected. We saw several examples of this being carried out throughout this inspection. For example staff were observed being discreet in offering to provide personal care or assistance, all personal care was carried The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 16 out in private and people confirmed that they wear their own clothes which are very well cared for. Staff demonstrated a good knowledge and understanding of the importance of the safe handling, storage and recording of medications and carries this out to a good standard. Medicine Administration Records (MAR) were looked at; where hand written entries had been made two signatures had been obtained to ensure accuracy, this is good practice. Where variable doses of medication are needed, accurate records were available with the actual dose given. Prior to this inspection we sent questionnaires to people living at the home and staff to help gather information about the home. We received responses from 5 people currently living at the home. Three people confirmed that they always or usually receive the care and support they need. Six members of staff returned questionnaires. Five agreed that they are sometimes given up to date information about those living at the home but one person stated that they are “never” given this. We discussed this with staff and the manager. We saw a record of details discussed at staff handovers. All staff that we spoke to confirmed that they are given up to date information about people living at the home. One member of staff in response to a questionnaire commented “ Information given at handover meetings at 8am, 2pm and 8pm, verbally”. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 17 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 good Routines are flexible and people are supported to exercise control over their daily lives. Social activities generally meet peoples’ expectations and preferences and people enjoy a balanced diet. Improvement in recording individuals likes and dislikes and ensuring that all people are given choices would further promote person centred care. People benefit from contact with their family and friends, which is encouraged and supported by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During both of our visits to the home we saw people walking around freely. We were told that there are no hard and fast routines at the home about times people get up or go to bed. Some people living at the home told us they can do “what we like”. We saw people going outside to sit with staff, chat and enjoy the weather. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 18 The home employs a person who serves breakfasts to people living at the home and several prefer this to be served in their rooms. We also saw people having breakfast in the comfortable dining room. An activities organiser works at the home 3 times a week. During their visits they encourage people to take part in a number of activities that include games, crafts and exercising. Outings are also arranged and people told us how much they enjoy these. One person said that they would like more imaginative trips and not “just going out for a cornet”. Many people choose to spend the majority of their time in their rooms. We asked staff what they do to ensure that these people do not become socially isolated. We were told that staff visit them frequently, chat with them give them manicures if they wish and tell them about what is going on in the home so they may take part if the chose. However, several people told us they do not see staff very often only when meals are being served or they are being assisted with personal care. A record is kept of visits to peoples’ rooms and mostly it is for a chat. All people we spoke to told us how much they enjoy the meals served at the home. The home has a comfortable, homely dining room, tables are well laid with tablecloths, and napkins and all had a small vase of flowers making it an attractive place to eat. A notice board outside the dining room clearly shows the meal that is being served for lunch and a menu showing evening meals. A large board in the dining room also clearly shows what the lunch dish will be. We asked several people in the dining room whether they knew what they were having for lunch. Three people said they did not know, one could not read the board in the dining room. People who choose to have their meals in their rooms did not know what they were going to be served for lunch. They told us that they do not see a menu and are not told. This means that not only do some people do not know what meals they will be having, therefore being given the opportunity to ask for an alternative, but not all people living at the home are being given the same information. The meal we saw being served on the day of our visit was well presented, hot and everyone said they had enjoyed it. The meal was served at a leisurely pace and staff assisted those who needed help discreetly. We spoke to a person who had recently moved into the home and during the conversation they told us they were “ a fussy eater”. We visited the kitchen and spoke to the person cooking on that day, but this was not the usual chef. We asked to see a record of individuals likes and dislikes and were told that people doing the cooking remember these details. This relies a lot on memory and potentially pits people at risk of being provided with food they may not like, especially those who are not consulted before meals are served. We saw visitors coming and going throughout the day and the visitors’ book confirmed this always to be the case. Visitors told us that they are always welcomed at the home; staff are always friendly and helpful. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 19 The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 20 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 good. There is a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A serious complaint was received by the Commission during February 2008 in relation to the quality of care being provided at the home. This complaint was referred to Devon Adult services Safeguarding Adults team. A number of Vulnerable Adult meetings were held, attended by professionals from the Police, Devon Adult Services and the Commission. The Commission carried out inspection at the home on 19/02/08, 28/04/08 & 08/05/08 to look into the issues and to ensure that all those living at the home were safe and well cared for. As a result of the findings of the inspection carried out in February the Commission issued three “Statutory Notices” to the home. These were in relation to the lack of pre admission assessments, health care needs not being fully met and medication issues. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 21 A “ Default Notice” was issued by Devon Adult Services restricting the admission clients, funded by them, to the home, has been lifted following a recent meeting when outcomes of this inspection and those of a Social Worker who carried out reviews of people living at the home recently, demonstrated some improvements and the fact that a manager has been recruited. The home has a clear complaints procedure that is displayed in the reception area. Although people were not able to recall being given a copy of the actual procedure all confirmed that if they were unhappy about anything at the home they would feel comfortable telling a member of staff or the manager about their concern. A member of staff commented in response to a questionnaire “Complaints book available and can speak to seniors/manager” Information received from the home prior to the inspection confirmed that two complaints had been made directly to the home and one has been made to the Commission [as above]. We have been told by Devon Adult Services that one complaint had been made to them. All staff have attended training relating to safeguarding vulnerable people and discussed what they had learned as a result of the training. All said they would not hesitate to report any suspicions of poor practice to the appropriate people/authorities. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 22 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, 20, 21, 24 & 26. Quality in this outcome area is good. The standard of the environment within the home is good providing residents with a safe, attractive, clean and homely place to live. Attention to reviewing environmental risk assessments in relation to potential restriction of liberty would ensure that people are able to live their lives as they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Firs is a 28 bedded home and all the rooms all have ensuite facilities. The home is accessible for disabled people and large vehicles with a slope to the front door and a lift to the first floor. There are disabled bathrooms with hoists The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 23 and equipment for special needs. The house is set in a large gardened area and a full time maintenance person is employed. During the 3 times we visited The Firs during this inspection the home was clean and well maintained both inside and outside the building. One person living at the home commented, “The home is very well looked after”. In response to questionnaires, people living at the home confirmed that the home was always or usually clean and fresh. 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 people living at the home with a conservatory leading off. All bedrooms visited had been personalised with items such as pictures, photographs and various pieces of furniture. Environmental risk is being well managed and decoration, fitting and fixtures such as furniture, curtains, carpets, pictures, lamps throughout the home are of a good quality. The laundry is well equipped and appeared to be well organised. There is a good supply of protective clothing and hand-washing facilities at the home and the laundry has equipment, which should effectively reduce the risk of cross infection. Everybody was well dressed at the time of this visit and several said that their clothes are well looked after. The communal bathrooms have been updated within the last 12 months with a therapy bath in the ground floor bathroom and a new hoist and bathroom suite in the first floor bathroom. Electric gates and a fence around the lawn have been erected to help provide a safe environment for people living at the home. [Please refer to standard 38] The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 24 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 good. People benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running of the home. People living at the home would further benefit if staff are provided with training that enables them to recognise and deal with some behaviours that may challenge them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection a cook, kitchen assistant, domestic, senior carer, five care staff and the manager were on duty throughout the morning as well as a gardener. In the afternoon, this changed to a senior carer three care staff, and the manager being on duty and a supper assistant during the teatime meal period. The home also employs a person who is dedicated to undertaking activities, outings and providing entertainment at the home 3 times a week. The rota shows that there are two waking staff on duty throughout the night. People living at the home who returned questionnaires felt there are always or usually enough staff on duty to care for them. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 25 The manager has promoted the role of key workers for each individuals with the aim that they know they get to know the resident well and support them with personal tasks. This works towards meeting the homes’ ethos of maintaining person centred care for all residents living at The Firs. People who responded to questionnaires and those spoken to during this inspection said that staff responded to their needs promptly. This was confirmed during this visit when staff responded promptly to peoples needs in a kindly manner. Throughout the day we saw staff asking people if they wanted a drink, were comfortable, reassuring people, visiting those who wished to stay in their rooms and engaging people in conversation. The manager discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. They stressed the importance of making sure that only good quality carers are recruited so that a high standard of service can be offered at the home. We looked at two recently employed staff files. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, training, evidence of identity, police checks and references. This procedure means that people living at the home are protected by the home’s recruitment procedure. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know those living there, 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. The manager and deputy are very aware that to ensure that people are well cared for staff need to be provided with up to date training and are committed to provide this. We were told that the home has recently become affiliated to Devon Care Training and staff will be attending relevant training. Staff told us that although they have had training in dementia this really only covered the subject on a broad scale and did not give them specific information to enable them to manage people’s behaviour that may challenge staff or others. One member of staff in response to a questionnaire commented “ I find it difficult to deal with aggressive residents, especially when they are physically violent”. The manager and deputy are aware of this and have plans for health care professionals to provide this. Information received prior to this inspection indicated that approximately 60 of the care staff have or are undergoing training for a nationally recognised qualification [N.V.Q.] this means that people living at the home can be confidant that they are being cared for by well-trained staff. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 26 Four of 6 staff who responded to questionnaires confirmed that their induction training covered everything they needed to know “very well” or “mostly” when they were first employed at the home. Two staff thought the training “partly” covered what they needed to know. One person commented, “ Induction could have been more thorough. I learned everything while doing the job, with guidance from my colleagues”. All confirmed that they are given training that is relevant to their role. Six staff felt there was “usually” or “always” enough staff on duty to meet individuals’ needs. One commented “Can be short staffed, often when staff off sick/holiday. Not enough time to spend with residents on these occasions”. Information received before this inspection from the home indicated there are plans to “concentrate on time management with the care staff to ensure that they have enough time to spend quality time with the clients”. Management ensures that all staff are kept up to date about people living at the home by having a handover meeting at the beginning of each shift when information is shared about individuals and any issues or problems that occur. Five staff that responded to questionnaires confirmed that the ways information is passed between staff “always” or “usually” works well. One person commented “ communication between certain members of staff can be lacking.e.g staff who come in once or twice a week may not be told everything as staff who are here full time may forget to tell them”. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 27 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): 31,32,33,35, 36 & 38. Quality in this outcome area is adequate. The home has recently gone through a number of changes, which people living there and staff have dealt with well. The home has a management structure in place that together is working hard towards trying to make sure the home is run in peoples’ best interests. Health and safety is managed well. Attention to ensuring that security arrangements at the home do not unduly restrict the liberty of people living at the home and comply with current legislation, good practice and guidance including the Mental Capacity Act and Deprivation of Liberty Safeguards would further ensure that care at the home is planned in a person centred way. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 28 This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although people living at The Firs and staff have recently experienced some inconsistency in management of the home the support of the General Manager of the Company and the deputy manager has remained stable. The home has recently successfully recruited a person to manage the home and an application has been made to the Commission to register them as manager. They have experience of working with younger people who have a learning disability and have also worked with older people. They have been involved in management of services for 4 years. They discussed their new role with us during the inspection and were helpful and well organised throughout. They told us that they found their new role an interesting and exciting area and felt well supported by staff, the general manager and the deputy manager. Prior to this inspection the General Manager sent us information about the management of the home and how the home has carried out improvements based on the feedback from the last inspection. They and staff have worked hard to meet the requirements made at the last inspection. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Records are kept in lockable filing cabinets, and those seen were up to date. Peoples’ feedback about such things as the quality of their life at the home, staffing, meals, cleanliness and activities is sought on a daily basis. Information provided prior to this inspection included “We liaise closely with relatives and clients and have completed quality audits”. When we looked at a file that included information available to prospective users of the service we saw the results of a “Satisfactory survey results for staff” which, on reading, did not relate to the Firs. We discussed this with the manager who thought that it may have been put there as an example of an audit. We told the manager that this could be misleading and should be removed, which it was, immediately. We were contacted by the general manager and were sent the results of a quality assurance but this had been undertaken in July and October 2007. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 29 None has been carried out since. The manager told us that they plan to undertake this as a priority as the results will be used as part of the homes annual development plan. The manager has consulted with people living at the home and it has been decided to hold “residents meetings” where people can discuss any issues, suggestions and relatives could be invited if requested and agreed by all. Information received prior to this inspection confirmed “the monies of all the clients are properly audited and can be accounted for. Their valuables are logged and kept securely in a safe behind a locked door”. This was not looked at during this inspection. Information received before this inspection indicated that all equipment is well maintained regularly all of which contributes towards ensuring that The Firs is a safe place for people to live. All staff that responded to questionnaires and those spoken to during the inspection confirmed that the manager or deputy met with them regularly to give support and discuss how you they were working. Comments included “the new manager is very approachable and meets with staff regularly” and “The manager has an open door policy and is very supportive of staff” Health and safety at the home is generally well managed. During our tour of the building no immediate hazards were identified. A requirement was made at the last inspection that all staff received up to date training in first aid. This has been complied with as the only person who had not received this training has since left the home. Electric gates and a fence around the lawn have been erected to help provide a safe environment for people living at the home. The manager recently reported an incident to the Commission when a person living at the home was reported missing after unlocking an outside door. Actions have been taken since this event to fit outside doors with alarms. We discussed how this could affect people who are able to go outside unattended. The manager said that risk assessments and discussion would take place with people and their families to ensure that people’s liberty is not at risk of being restricted by systems at the home. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 3 X X 3 X 3 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 3 2 X 3 3 X 3 The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 23[2][a] Requirement The Registered Person must provide evidence to the Commission that the security arrangements for external fences and doors do not unduly restrict the liberty of people using the service and comply with current legislation, good practice and guidance including the Mental Capacity Act and Deprivation of Liberty Safeguards. Timescale for action 30/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The views of people living at the home should be included in the home’s statement of purpose for any interested parties to refer to. Assessments of peoples’ health, welfare and social care needs should be undertaken in such detail that a DS0000047358.V366710.R01.S.doc Version 5.2 Page 32 The Firs, Budleigh Salterton 3. OP7 comprehensive plan of care may be based on the information. Improvement to information included in care plans should continue to be undertaken. Care plans must include enough detail to inform staff how to meet the needs of the individual. This is to ensure that people receive the care they need in the manner they choose. Individuals should be involved when their care plans are reviewed or kept informed of any changes. Daily reports should be written in sufficient detail to ensure that aims of goals highlighted in individuals’ plans of care have been met. Arrangements should be made to promote and make proper arrangements to meet peoples’ health and welfare needs at the home. This relates to scant information recorded about psychological health monitoring and any preventative restorative or care provided. All people living at the home should be provided with information about what meals are being served to enable them to make a choice about the food they receive. This relates to people who choose to have meals in their rooms not being given a menu or being told what is on the menu. Information provided to people should be in a format that they can clearly see and understand. This relates to the information that is displayed can not be seen or understood by all people. There should always be enough staff on duty to meet peoples’ individual health, welfare and social care needs. This relates to periods of sickness or at weekends when staffing may be below the intended numbers. The home should maintain a system for reviewing and improving services at the home involving people living at the home and/or their representatives. A report of any review undertaken by the provider must be to sent to the Commission. 4. OP8 5. OP15 6. OP27 7. OP33 The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 33 A copy of the report must also be made available to everyone. This is to ensure that people have a say in the running of their home. The Firs, Budleigh Salterton DS0000047358.V366710.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V366710.R01.S.doc Version 5.2 Page 35 - 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!