Inspection on 11/01/07 for The Firs Nursing Home

This inspection was carried out on 11th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 31 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs Nursing Home 04/12/08

The Firs Nursing Home 26/11/07

The Firs Nursing Home 19/04/07

The Firs Nursing Home 23/05/06

The Firs Nursing Home 15/02/06

The Firs Nursing Home 23/06/05

The Firs Nursing Home 27/01/05

The Firs Nursing Home 01/09/04

The Firs Nursing Home 22/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 The Firs Nursing Home Kings Hill Great Cornard Sudbury Suffolk CO10 0EH Lead Inspector Tina Burns Key Unannounced Inspection 11th January 2007 10:30 DS0000031547.V326155.R01.S.doc Version 5.2 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 DS0000031547.V326155.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 Adults 18-65. 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. DS0000031547.V326155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Nursing Home Address Kings Hill Great Cornard Sudbury Suffolk CO10 0EH 01787 371301 01787 880603 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) www.craegmoor.co.uk Craegmoor Healthcare Post Vacant Care Home 21 Category(ies) of Learning disability (21), Learning disability over registration, with number 65 years of age (6) of places DS0000031547.V326155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may care for 21 adults, under the age of 65, of either sex, who require care by reasons of learning disability. The home may care for 6 named service users over the age of 65 years, under the category of Learning Disability as named in the letter to the Commission dated 10th November 2006. 23rd May 2006 Date of last inspection Brief Description of the Service: The Firs is a care home with nursing for adults with a learning disability run by the large organisation Craegmoor Healthcare. It is located in Gt Cornard close to the town centre of Sudbury. The home is on two floors with a shaft lift connecting the two. It has two interconnecting lounges and a separate dining room and a mixture of single and double bedrooms. The premises are set on a compact site that allows for parking of several cars to the front. There is a small garden area to the entrance of the home and an enclosed garden at the rear. Daytime activities tend to be provided by and based at the home. The current base line accommodation fees are £802 per week but are variable according to service users needs. DS0000031547.V326155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to care homes for young adults. The inspection was undertaken by two inspectors and took place over approximately eight hours. The report has been written using accumulated evidence gathered prior to and during the inspection including evidence from four random inspections undertaken since the last key inspection in May 2006. During this inspection one inspector focused on the examination of a range of documents including three staff files, five service user files, and a range of policies, procedures and health and safety records. The other inspector toured the premises and grounds, met and spoke with several service users and staff, and observed staff and service user interaction and activities undertaken at the time of inspection. The acting manager, recently appointed by the home, but not registered with the commission, was present throughout the inspection and fully contributed to the process. What the service does well: What has improved since the last inspection? Since the last key inspection there is evidence that the home has improved its pre admission assessments and procedures, a number of risk assessments have been developed and agreed with service users representatives and appropriate complaints and adult protection procedures were in place. Some areas of the home have been redecorated and a number of doors, that were previously badly scuffed, have been replaced. Further more, at the time of inspection the home had improved in some health and safety areas, most DS0000031547.V326155.R01.S.doc Version 5.2 Page 6 specifically regarding the control of hot water temperatures that were found maintained at reasonable temperatures. Overall staff morale and motivation seemed to be more positive at this visit. Staff spoken with were complimentary about the homes new manager and commented that they found them helpful and approachable. What they could do better: Following the last key inspection twenty-one requirements and four recommendations were made. Additional requirements were made at four further visits to the home in August, September and October 2006. Overall the home has been slow to respond to requirements and often failed to meet timescales given. Following this visit twenty-three requirements and three recommendations have been made. Six are repeat requirements, four of these being repeated for a second time. The home needs to develop its Statement of Purpose and Service User Guide so that they include all information required by legislation. Furthermore the home should develop the Service User Guide so that it is user friendly and in a format that meets the needs of the people that it is intended for. Individual care plans are in place but they need to be developed and reviewed with the involvement of the service users and/or their representatives. The home also needs to ensure that service users are appropriately represented by liaising with independent advocacy services. The risk assessment in place for one service user restrained by a lap belt needs to be developed and signed and agreed by appropriate professionals and the service users family or representative. Risk assessments also need to be in place for the use of hoists in individual bedrooms. The home needs to ensure that appropriate social and leisure activities are offered to all service users regularly and the nature of the homes shift patterns promotes, and does not restrict, service users choice, dignity and independence. Meal times need to be more relaxed and unhurried. Service users requiring 1-1 assistance with their food should be assisted in a style and at a speed that respects their dignity. Ongoing issues relating to the management of residents financial accounts need to be resolved, including matters of procedure, interest and reimbursements. The home should be more proactive about the maintenance of the building and grounds so that areas do not become unsightly, ‘shabby’ or hazardous. DS0000031547.V326155.R01.S.doc Version 5.2 Page 7 The home must also ensure that it has an appropriate fire risk assessment in place and escape routes remain clear at all times. The kitchen area must have a Hazard Analysis of Critical Control Points in place and equipment used for testing hot water temperatures must be checked for accuracy periodically. Written references unavailable for one care worker must be obtained and available for inspection. All staff must undertake mandatory training and receive appropriate supervision and appraisals. The homes quality assurance procedures must include consultation with service users and finally, the homes policies and procedures must be reviewed regularly and updated appropriately. 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. DS0000031547.V326155.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000031547.V326155.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective service users can expect the home to undertake an assessment of their needs, however the home does not ensure that service users or their representatives receive full and clear information about the home. EVIDENCE: At the previous key inspection a repeat requirement regarding the detail of the homes Statement of Purpose was made as the document did not adequately reflect the nature of the services provided by the home. Further requirements regarding the Statement of Purpose were made following additional visits on 3rd August 2006 and 25th September 2006. At the random inspection on 25th September 2006 the previous acting manager agreed to submit an amended version to the Commission by 29th September 2006. Consequently a repeat requirement was made with a deadline of 1st October 2006. However, although the homes subsequent improvement plan indicated that the Statement of Purpose had been revised a copy was not submitted to the Commission, further more it was not submitted following correspondence from the commission giving them a deadline of 15th December 2006. At this key inspection the Statement of Purpose was examined once more and although some amendments had been made, including room sizes of bedrooms, it did not reflect age ranges of the service users accommodated or include all DS0000031547.V326155.R01.S.doc Version 5.2 Page 10 information required in Regulation 4, Schedule 1 of the Care Homes Regulations 2001. A copy of the homes Service User Guide was also examined and included information about the organisation, the homes Statement of Purpose and terms and conditions of residency. However, the acting manager confirmed that the base line fee stated in the document was incorrect and should have been £802 not £900 per week. Furthermore, it did not make clear what is and is not included within the fees. Additionally the Service User Guide was not user friendly and was not available in a style appropriate to the service user group, for example using pictures or symbols. Three service users records were examined including the records of one person admitted to the home since the previous key inspection. Records evidenced that a pre admission assessment had been undertaken by the home in addition to an assessment by the funding local authority. The homes pre assessment included the service users perspective, relationships/social contacts, clinical background, health, senses, safety, finances, personal care and physical well being, pain management, sleep/rest, breathing and body temperature, mental health, behavioural difficulties, routines/resistance to change, language and communication. In addition further assessments had taken place on the day of admission and included an assessment based on the activity of living, a nutritional assessment, a moving and handling assessment and a waterlow pressure sore assessment. DS0000031547.V326155.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect to have a care plan in place but they cannot be sure that they will be appropriately represented or supported to make decisions about their daily lives. EVIDENCE: Five service users records were examined and included individual care plans and a range of risk assessments including manual handling assessments, waterlow assessments and nutrition assessments. Some information held about service users likes/dislikes and circumstances was out of date and although overall care plans and risk assessments had been reviewed regularly there was little evidence that service users or their representatives were involved in the development and review of individual care plans. Since the last key inspection risk assessments in place for the use of ‘bedsides’ had been signed by service user’s representatives and appropriate professionals, however there was not a suitable risk assessment, signed and DS0000031547.V326155.R01.S.doc Version 5.2 Page 12 agreed by appropriate professionals, in place for one service user confined to a specialist chair and strapped in by a lap belt. Due to the complexity of needs most of the service users resident at the home require assistance to make decisions about their every day lives. At the last key inspection evidence indicated that many service users did not have personal representatives or access to independent advocacy services. Furthermore records did not consistently detail how individual choices were made. On this occasion there was no significant evidence that advocacy services had been approached to support those residents requiring assistance and although the previous manager had advised the inspector of their plans to begin a ‘residents/relatives group’ there had been no progress in this area. On this occasion the acting manager advised that in fact many service users had close relationships with family members who tended to represent them but there remained few opportunities for service users to access independent advocacy services. The home has an appropriate confidentiality policy in place. Records seen indicated that staff employed had received an employee handbook that included their terms and conditions of service and the organisations code of conduct. The handbook examined included details of the expectations of staff in relation to confidentiality. Confidential information held on the premises was appropriately stored. DS0000031547.V326155.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot be certain that they will experience enjoyable mealtimes, further more appropriate opportunities for personal development and social and leisure opportunities may be limited. However, they can be confident that they will be supported to maintain relationships with friends and family. EVIDENCE: Discussion with the staff and acting manager and records seen confirmed that since the previous key inspection the home has employed two part-time activity workers, one works on a Monday to Friday basis between the hours of 9.30am and 3.30pm and the other works two mornings a week. Observations during the inspection, discussion with staff and service users and records examined indicated that this has improved opportunities for many of the service users to enjoy group and 1-1 activities within and outside of the home. However, records examined for a period of one month evidenced that there were several service users for whom opportunities for activities remained very DS0000031547.V326155.R01.S.doc Version 5.2 Page 14 limited and although care plans did include some details of individual’s likes, dislikes and interests there was an absence of planned activity or personal development programmes. Resources within the home included equipment such as televisions and stereos and one of the lounge areas also included a large fish tank. The home also had an enclosed communal garden area at the rear of the building and a minibus to enable service users to ‘get out and about’. During the inspection most of the service users were seen and spoken with in one of the communal lounges or the adjoining dining room. However, some bedrooms were visited during this and other visits since the previous key inspection. On these occasions the inspectors found that service users rooms were very individualised and appeared to reflect the service users interests. Records seen and staff and service users spoken with indicated that relatives and visitors were welcome at the home, there was also evidence that the home supports service users to maintain relationships and friendships outside of the home. Observations made during this visit and discussion with the staff and acting manager indicated that overall service users required assistance with most of their daily activities and routines and were supported appropriately by staff. However, the staff rota and discussion with the acting manager confirmed that the staffing levels at the home in the evening do not promote individual choice regarding bedtimes or social/leisure activities. Shifts changed at 8.30pm when the night staff start their duties and staffing levels are reduced from five to three. During the inspection one inspector observed activity during the midday meal and found that overall the quality of the food was good but the mealtime itself felt hurried and unrelaxed. On this occasion there was seventeen residents in the dining room as three were served in their own rooms. Some service users required assistance with feeding; others were able to manage without support. During the meal the dining area felt generally ‘cramped’ and lack of space led to two staff standing up to feed service users. Staff supporting service users were busy and interaction with service users, particularly those being fed was poor. Service users spoken with said that they liked the food. Examination of the homes menu and discussion with the chef, service users and staff on duty indicated that the home offered a choice of suitable meals that reflected service users likes and special needs. However, the menu was not produced in a user-friendly format, for example with pictures or photographs, and there was no record of choices that service users had made. DS0000031547.V326155.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall service users can expect to receive appropriate personal support. Furthermore they can expect the home to meet their health needs and be protected by the homes medication procedures. EVIDENCE: Service users records examined included details about individual’s personal support and health care needs. Appropriate information and guidelines were in place in relation to areas such as peg feeds and epilepsy. Records also evidenced that the home was appropriately monitoring service users weight and recording GP and hospital visits. Requirements made following the last key inspection regarding the monitoring of one service users skin condition and another’s pressure care was found to be met at a random inspection on 15th August 2006. Records seen and staff and service users spoken with confirmed that service users continued to receive consistent support from designated ‘key workers’. Service users spoken with indicated that they were happy with the support they received. Observations were that service users seemed physically well DS0000031547.V326155.R01.S.doc Version 5.2 Page 16 cared for and their personal tastes and personalities were reflected in their dress and hairstyles. Policies and procedures examined, records seen and observations made during a medication round indicated that the home had appropriate policies and procedures in place for the administration of medicines. Systems in place for the ordering and storage of medication will be examined more fully at a future inspection. DS0000031547.V326155.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Overall service users can expect the home to respond appropriately to complaints and concerns but they cannot be certain that their finances are handled appropriately. EVIDENCE: At the previous key inspection the home had an appropriate complaints procedure in place but the copy on display in the foyer had not been amended to include updated information about the organisations contact details. Further more it did not reflect the fact that the National Care Standards Commission had been replaced by the Commission for Social Care Inspection. At a further visit to the home on 3rd August 2006 the inspectors found that the homes complaints procedure displayed in the entrance to the home had been updated to include correct contact details for the both the organisation and the Commission of Social Care Inspection. During this visit the complaints records examined indicated that the home had received two complaints since May 2006. The first complaint had been responded to appropriately and did not require investigation, the second was referred by the home to the local authority adult protection team and an investigation remains ongoing. Requirements previously made concerning the absence of adult protection procedures were also reviewed during the visit to the home on 3rd August 2006. During that inspection the previous acting manager advised that the organisation did not currently have an abuse policy but details of the local authority guidelines and procedures were in place. However, examination of DS0000031547.V326155.R01.S.doc Version 5.2 Page 18 the documents evidenced that they were not local authority procedures and did not include reporting procedures or contact details. Further more, leaflets available in the entrance of the home were regarding Essex authority procedures, not Suffolk procedures. Following advice from the inspector the manager accessed the appropriate local authority procedure from their web site and printed it for immediate reference. The leaflets from the entrance hall were also removed. A further visit on 15th August 2006 confirmed that staff had signed that they had read and familiarised themselves with the procedures. Since that time the home has made two referrals to the Suffolk local authority adult protection team. Both investigations are ongoing. At the previous key inspection the acting manager advised that a number of financial concerns had been identified regarding inappropriate expenditure of residents monies. After consultation with the local authority a further visit was undertaken on the 3rd August 2006 and one inspector examined procedures in place for handling residents monies, documentation available regarding a number of residents accounts and the action taken by the home following an internal audit of residents accounts. Findings included: • • Resident’s contracts/agreements did not clearly specify additional expenses that would be charged to residents, for example holiday costs. One resident was charged for a shower chair. The resident had since left but the shower chair remained at the home. There was no evidence that the resident had been appropriately reimbursed or offered reimbursement. A resident’s building society book being held for safekeeping by the home had gone missing. There was no evidence that the home has taken appropriate action to remedy this. Records of clients accounts held at the home did not include any details after February 2006. Consequently the inspectors were able to assess whether or not residents had been appropriately reimbursed. Records up until March 2006 did not include specific details of reimbursements to residents who were inappropriately charged for items such as refrigerators. There was no evidence to confirm whether or not two residents had received appropriate reimbursement for meals not taken at the home whilst they were on holiday in Florida. Records showed that interest payable on client’s accounts did not reflect comparable savings accounts. Furthermore there was no evidence to confirm whether or not interest had been paid on resident’s accounts, whether or not interest owed is applied to the savings of residents that have • • • • • DS0000031547.V326155.R01.S.doc Version 5.2 Page 19 died and whether or not interest owed has been paid to residents that have left the home. Following the visit on 3rd August 2006 four requirements concerning resident’s finances was made. Three of these were reviewed having passed their timescale for action at a further visit on 25th September 2006. Documentation examined at that visit did not evidence that all matters had been dealt with satisfactorily consequently five further requirements were made. In December 2006 the Commission wrote to the divisional managing director concerning the homes improvement plan received on 27th November and outstanding matters regarding six requirements. Five of the requirements concerned were related to financial procedures and residents finances. The letter required further information to be sent to the Commission by 15th December 2006. Following discussion with the area manager the timescale was increased to 22nd December 2006. However, at the time of this key inspection a response had still not been received. At this visit the acting manager confirmed that a draft response had been forwarded to the divisional managing director for their approval. A copy of this letter was seen and dated 18th December 2006. During this inspection all outstanding requirements concerning financial procedures and residents monies were reviewed: A copy of the homes policy for the administration of resident’s money was available and examined. Overall the procedures detailed were appropriate and included the matters of interest and how and when it should be applied to client’s accounts. However, the acting manager confirmed that the policy is out of date and does not accurately reflect current procedures. Improvement plans completed by the home and received by the commission indicated that the revised policy would be completed by initially 30/11/06 and then 10/12/06 but at the time of inspection this remained outstanding. Records/receipts were submitted to the Commission to evidence that an ex resident had been reimbursed appropriately for a bath chair purchased by the home. The acting manager advised the inspector that five service users resident at the home had died in the last two years, three in 2004, one in 2005 and one in 2006. Copies of their financial statements ending 20th November 2006 were given to the inspector and confirmed that their estates had not been fully reimbursed. The acting manager advised that they had recently been instructed to forward details of the deceased residents next of kin for payment. Up to date records of resident’s accounts were not held at the home. The acting manager agreed to forward appropriate documentation to the DS0000031547.V326155.R01.S.doc Version 5.2 Page 20 commission to evidence that all outstanding interest owed to residents accounts has been paid. Documentary evidence was submitted to the Commission to confirm that appropriate action had been taken regarding a residents missing building society book. DS0000031547.V326155.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect their bedrooms to be personalised and well equipped and the home to be clean and hygienic. However, they cannot be certain that it will be appropriately maintained. EVIDENCE: The Firs is a large property situated on a main road in the village of Great Cornard. It has parking to the front of the building with paved and bedding areas to the entrance of the home and a small but enclosed rear garden. At this visit the grounds were found to be tidy and free of hazards with the exception of an unravelled hosepipe that was found discarded outside a fire exit in the back garden. The hosepipe was potentially a tripping hazard and additionally a potential hazard in the event of a fire evacuation. The hazard was brought to the homes attention during the visit but no action was taken to remove it and it remained in place at the end of the inspection. On the day of inspection a tour of the premises was undertaken and the home was found to be warm, safe, clean and free of offensive odours. Staff had DS0000031547.V326155.R01.S.doc Version 5.2 Page 22 made a good effort to make the environment cheerful, homely and comfortable for service users. The majority of service users were seen using the communal areas that consisted of two adjoining lounge areas and an adjacent dining room. Areas seen were accessible to all service users including wheelchair users. Some redecoration had occurred since the last key inspection and several doors had been replaced, however some areas still seemed a little ‘shabby’, for example the stair carpet was stained and a number of walls and doors remained scuffed. The acting manager advised that the home’s part-time gardener/handyman did most of the maintenance in the home and grounds but there was not a maintenance/renewal programme in place. Observations made and staff and service users spoken with indicated that service users are encouraged and assisted to personalise their bedrooms. Bedrooms were appropriately equipped and seemed to reflect individual’s interests and personalities. The homes laundry room was clean, tidy and appropriately equipped. General observations were that staff were aware of and observed infection control procedures. DS0000031547.V326155.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that they will be supported by competent and qualified staff that are appropriately trained and supervised. Further more, they are not entirely protected by the homes recruitment procedures. EVIDENCE: At the time of inspection records seen and discussion with the acting manager confirmed that the home employs nine registered nurses and twelve care workers. The rota seen on the day of inspection indicated that there was a minimum of one qualified nurse on duty every shift in addition to four to five care workers during day time hours and two between the hours of 8.30pm and 7.30am. Out of the twelve care workers employed one had achieved a level two National Vocational Qualification in care. A new acting manager commenced employment at the home at the end of October 2006. In addition the inspectors were advised that since the last key inspection a number of care workers have left resulting in a considerable change to the staff team during recent months. However, staff spoken with during the inspection and observations made over the course of the day DS0000031547.V326155.R01.S.doc Version 5.2 Page 24 indicated that staff morale had improved and the team was more positive and cohesive. Staff records examined, conversations with staff on duty and discussion with the acting manager evidenced that regular planned 1-1 staff supervision had not taken place. Further more there was an absence of staff training. Records examined evidenced that only one out of the three staff who’s files were examined had training in relation to manual handling, fire safety, health and safety, food hygiene and first Aid. There was also no evidence to confirm that a care worker that had commenced employment in June 2006 had received appropriate induction training. Further more there was no evidence of appraisals and individual training plans. The recruitment records of three staff were examined. All three records included copies of each individual’s application forms, declarations of health, individual’s photographs, evidence of personal identification and Criminal Record Bureau disclosure checks. Two included copies of references that had been undertaken but one did not include any evidence of references. DS0000031547.V326155.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that they will receive a well-managed service. Furthermore, they cannot be certain that their health, safety and welfare will be promoted and protected. EVIDENCE: The home has had three different managers, one of whom was registered, in the past year. The first was registered with the commission but left in early in 2006. The second was at the home from March 2006 but left in October 2006 before submitting a registered managers application to the commission. The current acting manager transferred to the Firs from another Craegmoor home on 30th October 2006. To date the commission has not received an application for registration by the manager or undertaken a ‘fit person’ assessment. However the current acting manager confirmed that they were a registered nurse and had completed the NVQ level 4 in management and Registered Managers Award. At the time of inspection the acting manager was supported DS0000031547.V326155.R01.S.doc Version 5.2 Page 26 and line managed by the organisations area manager but had no administrative or management support at the home. Lack of compliance regarding care standards and regulations since the last key inspection and failure to respond to requirements and correspondence from the commission within given timescales evidence that the home has not been well run. At this visit there was evidence that the home had undertaken a number of internal audits including a quality assurance audit, a medication audit, a health and safety audit, a food safety audit and an infection control audit. However, there was no evidence that a requirement made in February and repeated in August 2006, to ensure that the homes quality assurance systems included service users comments and wishes had been met. Further more the home did not have an annual development plan in place. The staff handbook included summaries of many of the organisations policies and procedures for staff reference, however the policies and procedures manual given to the inspector for examination did not evidence that they had been reviewed and updated appropriately, all policies were dated June 2002. Discussion with the acting manager and training records examined evidenced that not all staff had been trained appropriately in areas such as manual handling, food hygiene, fire safety, first aid and infection control. Furthermore, a previous requirement for the home to ensure that suitable risk assessments are in place for the use of hoists in individual bedrooms had not been met. Following a visit to the home by a fire officer in August 2006 a number of issues were identified that the home needed to address to comply with fire regulations. However the acting manager was not clear about the issues raised and could not confirm whether or not they had been addressed. In addition the homes fire risk assessment was incomplete and did not fully safeguard service users and staff. Overall observations during the inspection, records seen and discussion with the cook on duty evidenced that food hygiene procedures were good. However, there was not a Hazard Analysis of Critical Control Points in place regarding the production of food. A requirement regarding hot water temperatures was made following the previous inspection and repeated again at the random inspections undertaken on 3rd August 2006 and 15th August 2006. Five further requirements were made regarding hot water temperatures and safeguarding service users following another visit on 25th September 2006 and four following a visit on 5th October. At this inspection hot water temperatures tested were close to 43°C and records seen confirmed that temperatures were being monitored appropriately. However, there was a slight discrepancy in the readings of the thermometers used on the day and this highlighted that the home did not carry out checks to ensure that the digital thermometer used was accurate. DS0000031547.V326155.R01.S.doc Version 5.2 Page 27 DS0000031547.V326155.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 3 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 3 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 1 2 X 1 X DS0000031547.V326155.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes. See requirements 1, 4, 15, 18, 20 & 21. 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 YA1 Regulation 4 Requirement The registered person must update the Statement of Purpose to include all information required in Regulation 4, Schedule 1 and forward a copy to the commission. This is a repeat requirement from 3rd August 2006 and 25th September 2006. The registered person must update the Service User Guide to give accurate information about the homes fees and any additional costs and forward a copy to the commission. The registered person must ensure that service users or their representatives are fully involved in the development and review of individual care plans. The registered person must ensure that residents have access to independent advocacy services. This is a repeat requirement from 3rd August 2006. The registered person must ensure that there is an DS0000031547.V326155.R01.S.doc Timescale for action 01/03/07 2 YA1 5 01/03/07 3 YA6 12 & 15 31/03/07 4 YA6 YA7 12(2)(3) 31/03/07 5 YA7 YA9 12 & 13 01/03/07 Version 5.2 Page 30 6 YA11 YA12 YA13 YA14 YA16 7 8 YA17 9 YA17 10 YA23 11 YA23 12 YA23 13 YA24 appropriate risk assessment in place for the service user restrained by a lap belt and that the service user’s representative and an appropriate professional sign it. 12 The registered person must 16(2)(m)(n) ensure that all service users have access to appropriate activities for recreation, socialisation and training. 12, The home must undertake a 16(m)(n) review of staffing levels/shift 18(1)(a) times to ensure that daily routines promote service users choice, dignity and independence. 12(1)(a) The registered person must 12(4)(a) ensure that resident’s choices of meals are recorded. 12(1)(a) The registered person must 12(4)(a) ensure that service users that need help to eat are assisted in a manner that respects their dignity. 13(6), 20 The registered person must ensure that all monies owed to resident’s estates are paid without further delay and notify the Commission that this has taken place. 13(6), 20 The registered person must ensure that the homes policy for the administration of service users accounts is current and up to date and forward a copy to the Commission. 13(6), 20 The registered person must ensure that evidence is forwarded to the commission to confirm that all outstanding interest owed to service users has been paid into their accounts. 23 The registered person must ensure that the home has a planned maintenance and renewal schedule and it is DS0000031547.V326155.R01.S.doc 28/02/07 31/03/07 07/02/07 07/02/07 31/03/07 31/03/07 31/03/07 31/03/07 Version 5.2 Page 31 14 YA24 YA42 13(4) 23(4) 15 YA34 19 Sch 2 16 YA35 YA32 12(1)(a) 13, 18 17 YA36 12,13, 18 18 YA37 8, 9, 12, 18 19 YA39 24 20 YA40 12, 13 21 YA42 12(1)(a) 13(5) maintained in a good state of repair and is reasonably decorated throughout. The registered person must provide adequate means of escape from fire and ensure that service users are as far as reasonably practicable free from hazards to their safety. (Regulations 13(4), 23(4)) The registered person must ensure that the employee named during the inspection has full and satisfactory information in place. The registered person must ensure that care workers are suitably trained and qualified. This is a repeat requirement from 3rd August 2006. The registered person must ensure that staff receive appropriate supervision and appraisals. The acting manager must submit an application to register as manager with The Commission for Social Care Inspection. The registered person must ensure that there is a sound quality assurance system in place including service users comments and wishes. This is a repeat requirement from February 2006 & 3rd August 2006. The registered person must ensure that the homes policies and procedures are reviewed and updated appropriately. The registered person must ensure that suitable risk assessments are in place for the use of hoists in individual bedrooms. This is a repeat requirement from 3rd August 2006 and 25th September DS0000031547.V326155.R01.S.doc 11/01/07 28/02/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 28/02/07 Version 5.2 Page 32 2006. 22 YA42 12(1) 13(4) 23(4) 07/02/07 The registered person must take adequate precautions against the risk of fire. This is a repeat requirement from 23rd May 2006 and 5th October 2006. The registered person must 28/02/07 ensure that a Hazard Analysis of Critical Control Points is in place regarding the production of food. The registered person must 14/02/07 ensure that there are systems in place to ensure that the equipment used to test hot water temperatures is accurate. 23 YA42 12(1) 13(4) 24 YA42 12(1) 13(4) 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 Refer to Standard YA1 YA17 YA17 Good Practice Recommendations The Service User Guide should be developed in line with national minimum standards. The home should develop the menu so that it is in a format appropriate to the service users. The home should explore ways to improve the experience of meal times for service users. DS0000031547.V326155.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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