CARE HOMES FOR OLDER PEOPLE
The Firs Nursing Home 251 Staplegrove Road Taunton Somerset TA2 6AQ Lead Inspector
Judith Roper Barbara Ludlow Unannounced 13th April 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Firs Nursing Home Address 251 Staplegrove Road Taunton Somerset TA2 6AQ 01823 275927 01823 336463 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care West Country Limited Care Home 37 Category(ies) of Care Home with Nursing (37) registration, with number of places The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Elderly persons of either sex, not less than 60 years, who require general nursing care. 2. Up to six places for personal care. Date of last inspection 11/10/04 Brief Description of the Service: The Firs Nursing Home is located in a residential area on the outskirts of Taunton, close to a local pub and Staplegrove Village Hall. In front of the home, next to the car park, is a lawned area with seating. The home is registered to take up to a maximum of 37 elderly persons (aged over 60years) who require general nursing care; six places are registered for personal care only. Over the years there have been alterations to the premises and eight bedrooms have en suite facilities of WC and wash hand basin. There at least two bedrooms that have a toilet partitioned with a curtain only. Not all of the single bedrooms measure 10 square metres or the double bedrooms 16 square metres. Bedrooms on the first floor are accessed by a 4-person/300Kg lift. Part of the first floor area, known as the flat is accessed via a ramp. The communal toilets are all small and not large enough to allow a person in a wheelchair to access the toilet with one or two helpers and a hoist. In view of this the bathroom toilets are used for disabled access. One first floor bathroom has been converted to create a spacious shower facility. There are two assisted bathrooms, one on the first floor has been out of order for some time.There is planning permission to extend the home and improve facilities and individual accommodation to meet the National Minimum Standards. This work is due to commence this year. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out by two inspectors for CSCI and was unannounced. The inspection started at 10am on 13.04.05 and concluded at 1745. There was a Registered General Nurse on duty and the Responsible Individual Mrs B Norville, for the care home who was on a late shift, came in earlier to assist with the inspection process. Mrs B Norville is an experienced nurse and a Registered Care Home Manager in Wales for the company, was providing holiday cover for the homes deputy matron / acting manager. The home was warm, very clean and there was a good atmosphere. Service users were spoken with and offered positive feedback about care at the home. A tour of the premises was made. The administrator, cook, housekeeper, handyman, nursing and care staff were seen, all were helpful and spoke freely and positively about the home. Care records, financial records, maintenance files and recruitment files were all seen. What the service does well:
The Firs Nursing Home has been running at far less than capacity occupancy for some time and will continue to do so until the extension is built. Good staffing levels have been maintained with the addition to the nursing and care staff group of a number of overseas staff. Qualified overseas nurses and one doctor are working as care assistants at The Firs. The home has a core ancillary and nursing staff group that have been with the home for a number of years. Service users commented on the kindness of all the staff at the home. Staff at the home generally manage medications and health care of the service users well. The food at the home was reported to be good and the kitchen is well managed. The home is in need of updating but is kept very clean and well maintained. The garden is attractive and well kept, this is accessible from the conservatory. Service users expressed their enjoyment of the view onto the garden. The Proprietor and the homes management have worked closely and openly with CSCI during recent months. In particular with the management and building development proposals for extending and improving the premises. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
The home requires the appointment of a Registered Manager to lead the development of the home. The appointment of a manager is now a condition of their Registration and is must be met within 6 months. The home needs to be updated to meet the environmental National Minimum Standards. This is planned alongside the addition of a new wing which will be undertaken first, this will then be used enabling access for the older part of the building to be altered. In the care plans that were sampled the findings included that some aspects of care were not recorded, such as rest and sleep management. Risk assessment for bed rails was missing in one care plan. Social care needs and service user input to their care planning was not recorded. An annual review of diabetes was not evident for one diabetic service user for 2004. The management of diabetes was not clear either, there was no clear plan for the interval of blood sugar monitoring nor the action to be taken where blood sugar levels were outside of the normal range. A good level of professional input was recorded in two care plans. Eye tests and chiropody visits were recorded. Pressure relieving equipment was seen in use. One service user was reported to have a pressure sore, appropriate pressure relieving equipment was in use. Body maps are used to record any sore areas, wounds or bruising . Care plans required some careful updating. The current care planning style is task orientated for staff, the inspectors felt that a more person centred approach would be beneficial in the approach to care at the home as well as the care record keeping. Medications management was examined and there were a small number of recording deficits namely where medications had been hand transcribed and where alterations had been made. Other recording was satisfactory.
The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4, Prospective service users have access to clear service use information. Visits to the home to look around, are welcomed. Pre admission assessments are made by the homes senior nurse either to the persons home or to the hospital. Service user assessment and the decision to admit someone to the home would only be made if the homes senior nursing staff felt that the individuals care needs could be met at The Firs. The assessed standards were met. . EVIDENCE: The home has a Statement of Purpose and a Service User Guide. Copies are available in the foyer and the Service User Guide is provided to individual service users. Prospective service users and or their representatives are welcome to visit to home. Pre admission assessments are made to ensure that the individual service users assessed needs can be met at the home and that admissions are appropriately made. Trial periods are offered. Input from community professionals such as the District Nurse and Social Worker, is accessed for the individual requiring placement. The paperwork to support pre admission assessment has been recently updated and a new assessment was seen.
The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 10 Contact with CSCI has been made by the homes management on the occasion where admission has been declined for being out outside the homes registration category of general nursing care. Contracts are provided for service users and examples were seen. There has been some improvement in the systems since the last inspection. It was evident from the files seen that contracts are now issued more promptly. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10, Care plans required some careful updating. The inspectors felt that a more person centred approach would be beneficial in the approach to care at the home and to care record keeping. Diabetes management could be improved, attention to rationales and strategies for management would improve current practice. Annual diabetes health checks should be made and recorded. A small percentage of entries on the MAR charts that required two signatures had only one. Otherwise medications management was competent. All service users were seen to be treated with care and dignity. Service users confirmed that they are treated kindly and their privacy is respected. EVIDENCE: In the care plans that were sampled the findings included that some aspects of care were not recorded, such as rest and sleep management. Risk assessment for bed rails was missing in one care plan. Social care needs and service user input to their care planning was not recorded.
The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 12 An annual review of diabetes was not evident for one diabetic service user for 2004. The management of diabetes was not clear either, there was no clear plan for the interval of blood sugar monitoring nor the action to be taken where blood sugar levels were outside of the normal range. Medications management was examined and there were recording deficits where medications had been hand transcribed and where alterations that had been made. Other recording was satisfactory. Storage was satisfactory. A new thermometer had been ordered and the fridge storage was within normal range. The BNF ( medications formulary) in use were dated 1997 and 2001, an up to date copy is recommended. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14,15 The service users at The Firs were satisfied with the care and life at the home. Visitors are welcomed and service users were observed to be treated with respect and dignity. Lunch was nicely served, unhurried and assistance was given as needed on a one to one basis. Drinks are accessible at all times. These standards were met. EVIDENCE: Service users were seen and spoken with throughout the inspection day. Some service users explained that they choose to spend time in their rooms and are enabled to do so. Others were seen in the communal areas. Service users confirmed that they have activities that include craft sessions. Visitors are welcomed and contact with families is supported. Some relatives visit regularly, service users asked confirmed that their visitors are made welcome. One service user commented on much pleasure there was from being able to see out onto the well kept garden from the conservatory. Praise was heard for the quality of the catering, lunch was seen served and looked appetising. Staffing in the kitchen has been addressed and the cook confirmed that there were no concerns in her department. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 14 Cold drinks are available in the communal rooms at all times and hot drinks are offered during the day. Persons requiring assistance with food and drink were helped and encouraged sensitively and appropriately The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has not received any complaints since the last inspection. These standards are met. EVIDENCE: The home has a complaints policy and procedure for hearing them. Evidence at previous inspections where prompt action has been taken with complaints supports good practice and appropriate responses made by the home. The home has policies and procedures for protecting service users from abuse. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The physical environmental standards are not met. The home was registered prior to April 2002, therefore the NMS environmental standards do not apply. However the Proprietor wants the home to succeed and major investment is planned for the redevelopment of the home, this is due to commence later this year. This is a very positive step for the home. The home is kept very clean and is well maintained. Individual service user accommodation can be personalised and is respected as the service users private space. EVIDENCE: The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 17 The environment is somewhat dated but is well maintained and is kept very clean. The home had been adapted as a nursing home. To address some of The Firs environmental limitations, a bathroom was altered to provide an assisted shower facility. One assisted bath was seen to be still ’out of order’ and is now due to be replaced within the renovation programme. The inspectors have been informed that this does not restrict service user choice of a bath or shower. There are a number of bedrooms in the home that are not suitable to accommodate service users who require assistance with manual handling. These rooms are currently not in use and will be kept empty until they have altered to meet the NMS. The government has reviewed some of the requirements for existing homes and they do not now have to meet all of the environmental standards previously required by 2007. However the Proprietor of The Firs plans to make considerable investment to upgrade The Firs to meet the National Minimum Standards environmental standards. This work is due to commence this year. CSCI have received copies of the building plans. The building currently is reported to be compliant with the fire officer’s requirements. The home has one bedroom in use that has a curtain only to screen the toilet facility. The communal toilets are small and the toilet in the downstairs bathroom is used, as this is more spacious. There is no separate disabled toilet facility. Bedrooms are personalised and service users are free to make their bedrooms their own. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29. Staffing levels are adequate, skill mix was good. Standard 27 is met. Due to the skill level of care staff recruited at the home, Standard 28 is met. Recruitment practice was generally good and recommendations are made. One requirement is made where a misunderstanding had occurred with regard to CRB and POVA First. Therefore standard 29 is not met. EVIDENCE: The home does not have a Registered manager but has an experienced deputy and the input of the company senior management to provide assistance as required. Mrs Norville (RI) was providing ‘hands on’ management cover at the time of this inspection. The home has retained a core team of loyal staff for many years, all of whom are committed to supporting the home. There is a registered nurse on duty at all times and the care staffing levels at the home are good. They have been met and are maintained with the recruitment of overseas staff. These staff are Registered nurses and care staff. Many of the care staff are overseas nurse trained and two were doctors. Staff recruitment files were examined and recruitment practice was generally satisfactory. Photographic ID held on file and the addition of a date section added to the reference request form are recommended. A misunderstanding has been made with regard to the employment of an under 18year old and a CRB and POVA First had not been requested, this was due to be dealt with by the RI immediately after the inspection. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34,35,36,37,38 Standards 31 and 32 cannot be assessed as the home does not currently have a Registered Manager. Standard 34, this standard has been supported by meetings and written evidence from the homes Proprietor and is met. Service users monies and accounts were seen to be well managed. Staff supervision should be formally recorded in line with NMS36.2 and NMS 36.3, this standard was not met. Record keeping was satisfactory in the offices and storage was safe. Records held in the lounge were The storage of identified confidential information and accident records requires to be changed. Data must be stored in line with the Data protection guidance. Fire safety is well managed. A requirement is made for the safe management of bed rails. EVIDENCE: The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 20 The home does not have a Registered manager but has an experienced deputy and the input of the company senior management to provide assistance as required. Mrs Norville (RI) was providing ‘hands on’ management cover at the time of this inspection. The proprietor has met with the inspectors to discuss the home and the financial input by the company group. At the time of writing this report a comprehensive business plan had been submitted by the Proprietor. This plan detailed the business planning in line with the redevelopment of the home. Service users accounts, contracts and financial records were available for inspection. These records demonstrated good practice and record keeping was satisfactory. All transactions were clearly recorded. No evidence of staff supervision was seen recorded on file for one member of staff. Staff are supervised as part of the normal management process on a day to day basis and formal staff supervision was recorded for two staff but not all on the sample files seen. Supervision for care staff should be recorded in line with NMS 36.2 and 36.3. Record keeping was satisfactory in the offices and storage was safe. Records held in the lounge on top of the bureau and behind bedroom doors were thought to be indiscreet and safer more confidential storage was recommended at the time of the inspection. Accident records are not held in line with data protection recommendations. This was discussed at the time of the inspection. Maintenance records were seen, fire alarm tests had been made each week and zones are alternated. There is good safety checking of hot water delivery at bath and basin outlets. Emergency lights are tested and repairs were noted for attention. Fire extinguishers were maintained annually and checked monthly. The administrator is currently redoing the homes Fire Risk Assessment. No COSHH issues were raised and chemicals were appropriately stored. The bed rails are not numbered and no regular fitment checks were recorded. One bed rail was identified as entrapment hazard, where the side required tightening up. This was identified at the inspection. Monitoring is required of bed rails in use and of bed rail safety checks. Accidents are checked by the deputy manager and audit, this is good practice. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 2 2 2 2 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 N/A N/A x 3 3 x 1 1 The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 22 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 7 Regulation 15(2)(b) (c) 13.2 19(1)(b) (i) Schedule 2 18(2) 17(1)(a) (b) 23(2)(c) Requirement Timescale for action 11/07/05 2. 3. 9 29 Care plans must be dated and reviwed to reflect current care needs and have a person centred approach Handtranscribed medications 11/06/05 entries must be countersigned. Pova First and CRB must be 11/06/05 taken for all new staff at the home. Formal Supervision for all care staff must be introduced. Confidential information and accident records must be appropriately stored. Bed rails must be numbered and those in use must be safety checked at least monthly and a record kept. 11/07/05 11/06/05 11/06/05 4. 5. 6. 36 37 38 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. Refer to Standard 29 Good Practice Recommendations Photograhic ID should be held on staff personnel files. A date section should be added to the recruitment reference
D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 23 The Firs Nursing Home request letter.. The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Firs Nursing Home D53 - D02 S3297 The Firs V221690 130405 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
