Inspection on 11/10/07 for The Firs Nursing Home

This inspection was carried out on 11th October 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs Nursing Home 07/06/10

The Firs Nursing Home 01/04/10

The Firs Nursing Home 09/02/10

The Firs Nursing Home 21/09/09

The Firs Nursing Home 02/09/08

The Firs Nursing Home 13/07/06

The Firs Nursing Home 18/10/05

The Firs Nursing Home 05/07/05

The Firs Nursing Home 25/01/05

The Firs Nursing Home 07/06/04

The Firs Nursing Home 09/12/03

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Firs Nursing Home, The 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY Lead Inspector Kerry Coulter Key Unannounced Inspection 11th October 2007 09:45 Firs Nursing Home, The DS0000024840.V338855.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 Firs Nursing Home, The DS0000024840.V338855.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. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs Nursing Home, The Address 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY 0121 430 3990 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) Ms Janet Alice Murrell Mrs Rosemary Claye Care Home 25 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (25) of places Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home can care for 13 (thirteen) named service users over 65 years of age which is outside the category of registration. The home must ensure that the changing needs of the older service users can be met and that these care needs remain under regular review. The home must only provide a service to other service users aged 40 years of age or over. 13th July 2006 Date of last inspection Brief Description of the Service: The Firs is a care home, which provides nursing care and support to 25 adults with enduring mental ill health. The home is located close to the Maypole area of Kings Heath. It is close to local shops, post office, banks, and leisure facilities. It is located on a major trunk road into Birmingham, which also has good motorway connections. A regular bus service passes the home enabling easy access to Kings Heath and the city centre. The home was first registered in 1987. The Firs consists of the original house, and a newer extension. The home offers accommodation over three floors and has both single and shared bedrooms. No rooms have en-suite facilities. The home has a passenger lift enabling access to all floors. The home has an attractive rear garden. The CSCI inspection report is available in the home for visitors to read if they wish to. The Manager stated the fees vary from £421 to £630, but that toiletries, transport, holidays, hairdressing and chiropodist are extra. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over one day; the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. People who live at the home were spoken with during the visit. Surveys were received from one health professional, eight staff and two people who live at the home. Their views of the home are included in this report. What the service does well: The people living there are offered a healthy diet. The people living there have regular health checks and health professionals are involved in their care to help make sure that their health needs are met. Medication records showed that the right medication was given to people at the right time to make sure their health needs are met. The home is clean and well decorated making it a nice, comfortable place to live. There are enough staff employed to work at the home so there are always staff on duty that know the people living there well. Staff often ask the people living there what they think of the home and how it could be better. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Review the procedure for emergency admissions to the home to ensure individuals are assessed to determine if the home can meet their needs. Ensure that each person living at the home has a plan of care so that staff have the information they need to meet the individuals needs. All risks to individuals should be assessed to ensure that staff know how to minimise these ensuring the safety and well being of the person. People would benefit from the range of activities available being developed so that they take part in activities at times similar to others of the same age, gender and culture. People who share a bedroom should have made a choice to do so, this should be recorded in their care plan to show they have been fully consulted. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 7 Ensure that all nursing and care staff have received training in managing violence and aggression so that such incidents are managed safely. Staff meetings should take place at least six times a year to ensure all staff know about the needs of the people living there. The Owner must ensure the home is visited monthly and write a report of the visit that includes the views of people living and working at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Firs Nursing Home, The DS0000024840.V338855.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 Firs Nursing Home, The DS0000024840.V338855.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, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents have most of the information they need to make an informed choice about whether or not they want to live at the home. Planned admission practices determine whether the home can meet the needs of prospective residents, however emergency admission procedures are not robust enough to ensure that residents needs can be met. EVIDENCE: Whilst viewing the premises it was evident that all people who live at the home have been provided with a copy of the homes’ statement of purpose, this document was available in their rooms. The Manager said all new people admitted to the home are given a copy of the service user guide and information about the complaints procedure. At the last inspection visit it was identified that although people had a contract regarding terms and conditions of residency, essential information including room to be occupied and fees to be charged were missing. New contracts with this information have now been issued although not all of these have been signed. Previous inspections have found that planned admissions to the home are well managed, and this continues to be the case. One person who had a planned Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 10 move to the home was case tracked. Information had been gathered from other professionals prior to the move and staff from the home had completed an assessment to make sure the person’s needs could be met. Records showed that the person also had the opportunity to visit the home before moving in. One person had moved into the home a couple of weeks before the inspection visit but this was not planned, they had been admitted to the home as an emergency admission. Since admission the home has not completed an assessment of this persons needs and so there is no care plan or risk assessments in place. The Manager was able to evidence that information has been requested from the person’s social worker but has not yet been received. It is therefore unclear how the home know they can meet this persons needs. Firs Nursing Home, The DS0000024840.V338855.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not demonstrate its full ability to assess and plan to meet the needs of people at the home; omissions may cause people to be at risk of inadequate and or inappropriate care. EVIDENCE: Three people who live at the home were case tracked. For two people there was an assessment of need in place, although one of these documents needed review as it was dated January 2006. One person did not have an assessment of their needs as already stated earlier in this report, and so there were no care plans in place guiding staff as to how to meet their needs. The care plans for the other two people had been regularly reviewed and were generally informative, clear, concise and identified what the objective of the care plan was. People have mental health relapse risk assessments in place, the management plans of these assessments provided staff with information to recognise when an individual is not mentally well and they directed staff in what they must do. Records showed that the individuals had been regularly Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 12 consulted about their care, it was good that one person had the opportunity to record some of their own comments on their care plan. Residents meetings take place where topics discussed include activities and the menu. Records showed that there was no set frequency to the meetings, it would be a good idea if people were asked how frequently they would like the meetings to be held and minutes recorded when the next planned meeting is. The last meeting was held a week and a half before the inspection visit but the minutes of the meeting were in the office and not on display in the home. It is recommended that the minutes are put on display in the home so that people have easy access to them. The Commission had sent a newsletter to people who live in the home, this was also in the office but would be more accessible to people if it was on the main notice board in the home. Some people who live at the home share a bedroom, discussion with the Manager indicates that records do not show that people have been consulted about this and made an active choice to share a room. This is detailed further in the environment section of this report. Risk assessments had generally been completed to maintain the well being of people at the home, these included reducing the risks in the event of a fire, from smoking, from not taking prescribed medication and the risk of suicide. There were no risk assessments available for the person who had been admitted in an emergency. These will need to be completed to ensure their safety. Firs Nursing Home, The DS0000024840.V338855.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): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People would benefit from the range of activities available being developed so that they take part in activities at times similar to others of the same age, gender and culture. People are offered a healthy diet that meets their special dietary needs. EVIDENCE: The educational and occupational needs of people are assessed by the home. One person’s plan recorded they would like to do an Open University course. The Manager said this individual has now decided they do not want to do this course due to the cost. Staff therefore need to update the plan and consider finding cheaper alternatives for this person. Some people choose to take part in activities whilst others have chosen not to. One person had signed their plan to say that they did not want to take part in any in-house activities or go on any trips. It is acknowledged that some people at the home are difficult to engage in activities and so staff need to be more Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 14 creative about what is on offer to people. One persons records showed they took part in lots of activities to include going to church, shopping, a social club and making scones. Some staff said that more activities were needed and discussion with the Manager and sampling of records does show that more activities could be offered to people. The AQAA completed by the Manager recorded that more external activities needed to be provided. In February people said they would like to go to the Botanical Gardens, a trip was not arranged to take place until August but was then cancelled due to heavy rain on the planned day of the trip. The Manager said they were now hoping to arrange a trip to see the Illuminations instead. It is not clear why the cancelled trip to the Gardens could not have been rescheduled to take place shortly after the cancelled date to avoid people being disappointed. Each person has a care plan detailing the arrangements for contact with significant people in their lives such as family. Visiting times to the home are flexible. One person spoken with confirmed that they had their own key to their bedroom and had access to CSCI reports about the home if they wanted to read them. The menu is often discussed with people, either at key worker or residents’ meetings or annually as part of a quality assurance review. The menus provide lots of choice and it appears well balanced and nutritional. Tea time practice was observed, two options were available a meat or vegetarian option. People were offered a choice of what they wanted and also second helpings if they wanted. Fruit was observed to be available to people in the dining room so that they could just help themselves. Generally people spoken with were complimentary about the food and said it was ‘good’, ‘nice’ and ‘good, especially on a Sunday’. One person did comment that the ‘food used to be disgusting but it is much better now’. People do not have free access to the kitchen for drink making as it is a large commercial style kitchen. Usually there is a hot urn in the dining room so that people can make their own drinks. This was not on at the time of the visit as it needed to be re-secured to the wall so that it was safe to use. Firs Nursing Home, The DS0000024840.V338855.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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are sufficient to ensure that people receive support with their personal care and to meet their health needs so ensuring their well-being. The medication management systems generally ensure that the people living there have the right medication at the right time. EVIDENCE: Many of the people at the home do require some support regarding personal care, this was evident in their care plans; these care plans mainly reflected monitoring and prompting individuals to attend to their personal care when needed. The AQAA completed by the Manager says that the home has improved by detailing in care plans the days people prefer to have a bath or shower. One persons clothing was observed to be soiled with food after the evening meal, staff encouraged them to go and change their clothing. One survey was received by a health professional and this recorded that they thought the health care needs of people were met by the home. The healthcare provided to two people was case tracked. The nurses at the home ensure that the ongoing healthcare needs of people are assessed and Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 16 where needed care plans are written. Nutritional screening had been completed for both individuals as required from the last inspection but for one person the document needed to be dated to show that the information was current. It was evident that the weights of people are monitored monthly to ensure early identification of any concerns. Records sampled of the people who live in the home showed that people are registered with a local GP. Contact with other professionals such as the chiropodist, dentist and optician were documented to assist in meeting individual’s health needs. One person has recently refused to take one of their prescribed medications and their psychiatrist has been contacted to come and visit them regarding this in line with the guidance on their care plan. Medicines are prescribed by GP’s and dispensed by a local chemist using a monitored dosage system. The Manager said that a medication audit had been done the day before by the Pharmacist from the Primary Care Trust. The report has yet to be received but the Manager said there were no requirements resulting from the visit. Medication is administered by the nurses. It was evident that an assessment of the peoples ability to self-administer medicines is undertaken. A daily audit of boxed medicines is maintained and there have been no recent concerns. Stocks of medicines were found to be accurate; medication administration records were well maintained. Staff had signed the Medication Administration Records (MARS) appropriately. Copies of prescriptions are retained by the home so that staff can check that the right medication is received and administered. Some people have homely remedies, consent for their use has been obtained from the GP. Some people have medication that is given on an ‘as required’ basis. Written protocols were observed to be available guiding staff as to when this medication should be given. These were generally satisfactory although one could be further improved by clarifying the dose to be administered. Firs Nursing Home, The DS0000024840.V338855.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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the views of the people living there are listened to and acted on so as to improve the service. The home does not fully demonstrate its ability to ensure that the protection of people is effectively managed, this may lead to the risks of abuse not being addressed and made safe. EVIDENCE: The home has a complaints policy, as required from the last inspection this has been revised to include details of the local ombudsman and the CSCI. As suggested previously it would also be better if the procedure contained some information on local advocacy groups. The home does have a log of complaints, since the last inspection the home has received four complaints from the same person. The log includes the homes response to the complaints and the fact the individual declined a written response. Surveys received from people at the home indicate they are aware of the complaints procedure and know who to speak to if they are unhappy. The survey received from a health professional records that the home responds appropriately to concerns. The Commission has not received any complaints about the home in the past twelve months. One person who lives at the home made an allegation about a member of staff, this was investigated by a social worker and was not upheld. The home acted responsibly during this time by suspending the member of staff until the outcome of the investigation was known. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 18 At the last inspection it was identified that not all staff had received relevant training in protecting people who live at the home from abuse. Training records show that all but one member of staff have now received this training. The Manager said that she also intended to do training with staff about the Mental Capacity Act. This came into force this April and is about assessing each person’s capacity to make decisions so it is important that staff know about this. The home does manage some money on behalf of people. At the last inspection it was identified that some transactions had not been signed for and others as indicated in the policy had not been witnessed. Records sampled at this visit had the signature of two members of staff and some from the person who lived at the home. Discussion with the Manager indicates that staff do not do a daily check of peoples money as most people access their monies daily and it is checked then. It is recommended that a daily check is introduced for the money of people who do not access their monies daily to improve the safeguards of looking after people’s money. The incident log for the home was sampled. This recorded that one person had been asked to leave the dining room as they were taking other people’s sandwiches. They resisted and the record said that ‘breakaway techniques’ were used to remove them from the room. It did not record which techniques were used and the duration. Breakaway techniques are considered to be a form of physical intervention for which special training is needed. Staff training records do not show that staff have had breakaway training. This was queried with the Manager who was not aware of the record and confirmed that staff had not had this training as physical intervention was not used in the home. The Manager said she thought staff may have not been clear in their recording and will follow this up. It would be of benefit if all entries in the incident log were read and signed by the Manger with a record of any action taken as a result of the incident. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made and are continuing so that people live in a homely and comfortable environment. EVIDENCE: A full tour of the premises was undertaken that included sampling some people’s bedrooms. All areas were found to be safe and generally well maintained; it was evident that a programme of refurbishment and redecoration was in place. The AQAA recorded and observation of the premises confirmed that since the last inspection there had been new flooring to corridoors, new blinds in bedrooms, new flooring in the laundry room and top lounge and new chairs and sofas for one ground-floor lounge. The AQAA also recorded that it was intended to purchase more new chairs for the main lounge. A new boiler has also been installed and this has improved the water flow to bedrooms and bathrooms which the previous report identified as needing to improve. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 20 The sizes of bedrooms vary as some are single rooms and eight are shared rooms. Shared rooms were observed to have screening for privacy. One person said they liked sharing a bedroom. Another said they ‘sometimes’ got on with the person they shared with. The Manager said that people had been asked about sharing rooms but the care plans did not evidence that people had been consulted and had actively chosen to share a bedroom. Bedrooms sampled were generally personalised and in good decorative order. One bedroom was observed to have ‘tired’ looking décor and furnishings but an environmental audit recorded they did not want their room redecorating. This person was spoken with during the visit and they confirmed they did not want their room redecorating. Peoples bedrooms are located on all three floors of the home, they are not ensuite however all rooms are close to toilets, bathrooms and shower rooms, which are available on all floors. All toilets and bathrooms have good hand washing facilities and are hygienically maintained. There is large amount of shared space in the home including, two lounges, a large dining area, smoking room and a well-used rear garden with patios and a lawn. At the last inspection one lounge had a strong odour that was not being adequately managed, this has now been addressed. One person who lives at the home said they were concerned that one ground floor window was sometimes left open at night. It was observed that the window catches were very high up and difficult to reach. The Manager said that the window was always shut at night but that staff have to close it from the outside. Consideration should be given to altering the design of the window or the catches so that it can be shut by staff or people who live at the home from the inside. This may then reduce the anxiety of the person who raised the concern. The laundry area is small yet is adequate to provide a safe system of laundry. People have their own colour coded baskets to reduce the risk of clothes getting mixed up. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 21 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements need minor improvements to ensure that people are supported by well trained and supported staff that know the people living there so their needs can be met. People are protected by the home’s recruitment practices. EVIDENCE: The AQAA questionnaire indicated that there are ten care assistants of whom five have competed the NVQ level 2 in Care or above. This meets the standard that at least 50 of staff have this qualification so ensuring that they have the skills and knowledge to meet the needs of the people living there. Many staff were observed talking with people at the home, they were seen to be supportive. Some people were complimentary of staff stating; ‘staff are alright’ and ‘staff are very good...it’s a good home’. The staffing support includes trained nurses who are registered mental nurses; during the day there are a minimum of four staff on duty, often there are five, with a minimum of one trained nurse and four care assistants or two trained nurses and three care assistants. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 22 At night there is a minimum of one trained nurse and two care assistants. Further support is available from part time domestic staff and a full time cook. Staff surveys received indicated that staff feel there are usually enough staff on duty to meet peoples needs. Three staff records were sampled. These included the required recruitment records including evidence that a Criminal Record Bureau (CRB) check had been completed and a health screening questionnaire. Records showed that new staff had received an induction to the home. The Manager said that an additional nurse had recently been recruited and would commence work when their CRB check had been received. A matrix of training for the staff team was available, this showed that the training programme includes first aid, moving and handling, fire safety, adult protection, health and safety, infection control, violence and aggression and food hygiene. Some staff had not done training in first aid and moving and handling and the Manager had made arrangements for this to be done in October. Unfortunately the trainer had to cancel this due to a personal emergency. The Manager said this would be rescheduled. Some staff needed training in handling violence and aggression and others needed refresher training on fire safety. The Manager said these were being arranged. Discussion with the Manager and staff training records show that nursing staff have attended courses to update their practice, this has recently included infection control, medication update and verification of death. At the last inspection it was identified that staff did not receive supervision regularly to provide them with adequate support. Staff surveys and the supervision matrix show that staff now receive supervision regularly. Staff meetings do take place but these are more regular for the nursing staff rather than the staff team as a whole. Meetings should be held regularly so that staff know about the changing needs of the people who live there and are kept upto-date with best practice. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 23 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements generally ensure that the people living there benefit from a well run home. Arrangements are generally sufficient to ensure that the health, safety and welfare of the people living there is promoted and protected. EVIDENCE: The home has a registered manager who is a qualified nurse. The Manager was on duty at the time of the inspection visit. One staff spoken with said that the Manager was very approachable, listens and responds to any concerns. Staff surveys included comments such as ‘is a great manager’ and ‘manager gives support on a daily basis’. At the last inspection it was identified that the Manager was not receiving supervision. The AQAA questionnaire recorded that supervision for the Manager now takes place. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 24 Evidence is available that indicates that people who live at the home and visiting health professionals have been asked their views and opinions about the standards at the home via satisfaction surveys. A quality statement had been produced recording the improvements the home had made in the last twelve months and planned improvements for 2007. Evidence was seen that the Manager was also working on a new quality assurance policy for the home. The Owner visits the home and writes a report on her findings, however it was not evident these visits are monthly, comprehensive and that outcomes are recorded with an action plan for improvement. It was also apparent that the visit did not detail the outcome of interviews with people who live at the home and staff. The home has systems and procedures in place that generally manage health and safety for people at the home. Fire records showed that staff test the fire equipment regularly to make sure it is working. The West Midlands Fire Service reported in August 2007 that the fire precautions in the home were satisfactory. Staff test the water temperatures regularly to make sure they are not too hot or cold. Servicing, tests and maintenance of equipment and utilities including hoists, passenger lift, fire equipment, electric and the nurse call system are well maintained. However it was observed that the gas safety certificate for the home was due to expire the day after the inspection visit. It was good that when this was brought to the attention of the Owner and the Manager the Owner immediately made a telephone call to arrange for a gas engineer to visit. However, a system needs to be introduced that identifies when safety checks are due so that the Manager can arrange these in good time. As required from the last inspection people’s bedroom risk assessments had been reviewed. However there were some staffing risk assessments that had been completed that were not dated. It was therefore unclear how current the information within the assessment was. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 25 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 3 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(1) Requirement Timescale for action 30/11/07 2 YA6 15(1)(2) 3 YA9 13(4) 4 YA23 13(6) Review the procedure for emergency admissions to the home to ensure individuals are assessed to determine if the home can meet their needs. Ensure that each person 30/11/07 living at the home has a plan of care so that staff have the information they need to meet the individuals needs. Ensure that an 30/11/07 assessment of risk is available for each person living at the home detailing how any identified risk will be managed to ensure the persons health and safety is promoted. Clarify the type of 17/11/07 ‘breakaway’ technique that was used by staff, as recorded in the homes incident log and notify the CSCI of the outcome. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 27 YA35 5 18(1) 6 YA39 26 Ensure that all nursing 30/01/08 and care staff have received training in managing violence and aggression so that such incidents are managed safely. The Owner or their 30/12/07 representative must visit the home monthly and write a report of their visit that includes the views of people living and working at the home. 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 YA2 YA7 Good Practice Recommendations The new contracts should be signed by people living at the home to ensure they are fully aware of the terms and conditions of their stay at the home. Discuss with people who live at the home how often they would like ‘residents meetings’ to take place to ensure and make available minutes of meetings on the homes notice board. People would benefit from the range of activities available being developed so that they take part in activities at times similar to others of the same age, gender and culture. Increase the opportunities for people to participate in activities outside of the home to improve people’s links with the local community. Extend the information within one person’s protocol for ‘as prescribed’ medication so it is clearer what dose in required to make sure they get the medication they need. Make available within the complaints procedure or main notice board information on how to contact local advocacy groups to ensure people have the information they need to contact advocacy services if they wish to. DS0000024840.V338855.R01.S.doc Version 5.2 Page 28 3 YA12 4 5 6 YA13 YA20 YA22 Firs Nursing Home, The 7 8 YA23 YA23 9 10 YA25 YA24 11 YA35 12 13 14 15 YA35 YA36 YA42 YA42 Introduce a daily check for the money of people who do not access their monies daily to improve the safeguards for looking after people’s money. It would be of benefit if all entries in the incident log were read and signed by the Manger with a record of any action taken as a result of the incident to increase the safeguards in place for people living at the home. People who share a bedroom should have made a choice to do so, this should be recorded in their care plan to show they have been fully consulted. Consideration should be given to altering the design of the ground floor hallway window or the catches so that it can be shut by staff or people who live at the home from the inside. Re-arrange the cancelled training in first aid and manual handling as soon as possible to ensure staff receive the training they need to do their jobs safely and meet the needs of people at the home. Staff should have fire training every six months to ensure they know what to do to keep people safe in the event of a fire occurring in the home. Staff meetings should take place at least six times a year to ensure all staff have an opportunity to be updated about the needs of the people living there and best practice. Risk assessments should be dated on production to enable the reader to be sure the information within the assessment is up to date. A system needs to be introduced that identifies when safety checks are due so that the Manager can arrange these in good time. Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Firs Nursing Home, The DS0000024840.V338855.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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