Inspection on 13/07/06 for The Firs Nursing Home

This inspection was carried out on 13th July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 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 11/10/07

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 Sean Devine Unannounced Inspection 13th & 14th July 2006 14:00 Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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.V293285.R01.S.doc Version 5.1 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.V293285.R01.S.doc Version 5.1 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.V293285.R01.S.doc Version 5.1 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. 18th October 2005 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 home consists of the original house, and a newer extension. The home offers accommodation over three floors. The home 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. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector undertook the key inspection visit over a period of two days. During the visit the inspector was able to meet many of the residents, staff and the owner. Records pertaining to the health and social care of the residents were seen and a tour of the premises, including residents’ accommodation and communal areas was completed. Some staff were informally interviewed and others were observed supporting residents. The registered manager was on annual leave, however a pre inspection questionnaire had been completed and returned to the commission by the owner. What the service does well: Many residents are happy at the home, they are pleased with their accommodation and were complimentary of many staff that help and support them. One resident commented, “my room is nice”, another said, “The staff are good” also indicating they have no concerns with the staff. Other residents commented that the food was really nice and that they go on trips out of the home to places like the Botanical Gardens and Weston Super Mare. The staff always fully assess new residents and invite them to visit prior to making a decision on whether to move into the home. All residents are provided with a copy of the homes statement of purpose. Some residents commented, “It was good to move out of hospital and into the home”. Residents are aware of their care plans and are invited to help develop them, many do decline to take part, one resident said, “I don’t get involved with it”; to help support these residents the key worker now meets with some of the residents on a monthly basis and care plans are often discussed. Residents are encouraged to continue with work and purposeful activity, however some residents do decline, however one resident said, “ I like to work, because I get paid and I’ve got some friends there “. A recent environmental health visit reported that the standards of food safety were very good. The premises are well maintained, it is evident that improvements are needed on a daily basis and these are quickly addressed. A more structured refurbishment and redecoration plan has commenced and is ongoing. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 6 The home is well staffed, good numbers of nurses and care staff are available at all times, residents are further supported by domestics and a cook. Staff were seen to mostly support residents in a respectful manner, some residents comments include, “they are very good” “there terrific” and “they all seem very nice”. Residents raised no concerns about health and safety in the home, this was further supported by the homes attention to ensuring all services, tests and maintenance of equipment and utilities are maintained. What has improved since the last inspection? What they could do better: Following on from the assessment of residents needs care plans are required where a need is identified including social activity, family and relationships; this is particularly needed for residents who do not have families and friends. All residents who are now over 65 years of age must have risk assessments in place that inform staff of the residents moving and handling needs, nutritional needs and of any risk of falls. It is important that the complaints policy and the homes practice in managing complaints include providing a written response to the complainant. The management of residents’ money must be improved, including reviewing the policy and practices to include how it is audited and how residents access their money. Residents appear to have set times to be given their money; as Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 7 many were seen and informed the inspector that they had come to the office for their money. The registered manager and the owner need to ensure that all staff have attended training in safe working practices and also ensure that training and development forms part of regular supervision. Recruitment practices need to always include an assessment of the employee’s health, which will ensure they are fit to do the job. One resident expressed his concern that a member of staff recently retired due to ill health. Although many residents commented they were happy with their rooms it was a concern that some room risk assessments had not been reviewed for some time. 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. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1, 2 and 5. The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. The home does demonstrate its ability to provide and gather information to enable prospective residents to make an informed choice on whether they would like to live at the home and also gathers information to determine whether they can meet the needs of prospective residents. EVIDENCE: Two residents were case tracked, this included viewing all records related to their care and informal interviews. There have been no recent admissions to the home; at present there are two vacancies. Whilst viewing the premises it was evident that all residents have been provided with a copy of the homes’ statement of purpose, this document was available in their rooms. Both residents’ files included documents relating to information supplied and gathered prior to their admission to the home. These included social work reports and other health reports e.g. psychology. Both residents were unable to remember how the admission was managed and if they had opportunity to visit the home as it was such a long time ago. They both said it was pleasing to move out of hospitals and have their own rooms. During the inspection a Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 10 nurse visited a prospective resident in hospital to conduct an assessment of need and to inform the prospective resident of what the home has to offer. Residents’ files did have a contract regarding terms and conditions of residency, however it was evident that essential information including room to be occupied and fees to be charged were missing. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The home does not demonstrate its full ability to assess and plan the needs of residents; omissions may cause residents to be at risk of inadequate and or inappropriate care. EVIDENCE: The residents’ files did include written care plans developed following an updated assessment of need. These care plans were informative, clear and concise, they identified what the objective of the care plan was. However after reading the assessments of need it was evident that residents did not always have care plans to support all their needs, e.g. for some residents social isolation and having no families and friends were clearly a concern. Both residents indicated they were aware of their care plans and had discussed them with their key worker, one resident said “ I don’t get involved with it “, this had been recorded as declined by staff on the evaluation of care plan form. The monthly key worker meeting minutes indicate that residents are asked how they feel about the care provided and their views and opinions are Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 12 sought. Residents meetings take place regularly and it was evident that residents are asked to make choices such as events at the home, day trips and holidays and also what they do and do not like on the current menu. The age range of residents at the home does vary greatly. Some residents over sixty-five years of age do have risk assessments in place regarding their mobility and tissue viability. The inspector did not see a nutritional screening assessment or a moving and handling assessment, it was also evident that residents over sixty-five did not have a falls risk assessment. Residents do have mental health relapse risk assessments in place, the management plans of these assessments provided staff with information to recognise when a residents is not mentally well and they directed staff in what they must do, e.g. refer immediately to the local mental health team. Additional risk assessments had also been completed to maintain the well being of residents including those who may be vulnerable or who may go missing from the home. There was documented evidence that the home had attempted to involve residents within the risk assessment management plans, however many had declined to be involved. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 ,15, 16 and 17. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The home does have the capacity to ensure that residents lead an individual and stimulating lifestyle, yet how this is assessed and implemented is not always clear and therefore the individual choices of residents must be considered to ensure appropriate care and support given. EVIDENCE: The educational and occupational needs of residents are assessed by the home. These assessments are revised regularly to consider the changing needs of residents. There was no evidence that the residents who were case tracked actively take part in lifelong learning and occupation, however it was evident from talking to other residents that they do have opportunity, some do attend the BITA and other attend day centres, one resident explained that he is paid for the work he does at the BITA and that he has been going their for many years, he stated “ I like to work, because I get paid and I’ve got some friends there “. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 14 The residents files included care plans and risk assessments regarding maintaining safety whilst out of the home, for one of the resident this meant that all visits out of the home were at present escorted (with a member of staff). This resident did not seem concerned about staff escorts. There was evidence that this is regularly reviewed. Other residents confirmed that they go to local shops and also into the city centre, others described that as a group they go on day trips to places of interest such as The Botanical Gardens, Lickey Hills and local parks. For some residents it was evident as described in standard 6 that they are at risk of social isolation as they have no recorded family or friends and they also have limited interest in social activities and their own pastimes. This resident did not wish to talk to the inspector. Regular residents’ meetings have records available; these records indicate that residents are asked about hobbies, interests and food, often where possible suggestions are acted upon including where to go on day trips and reviewing food menus. Some residents recalled the occasion when a visiting entertainer visited the home, the last occasion was approximately a month ago and the karaoke was really good fun. Another resident said that he enjoyed the visit by a man who helped them to relax, he said he would like this man to come again, however he could not afford the charge and that the initial visit was free of charge. On further discussing this with the resident and the owner plans are in process to have relaxation sessions managed by the nursing staff at the home, the residents was pleased to here this. Many residents have a developed need to have support from staff at specific times of the day; it is evident that they are reluctant for any change. This has been positively challenged to some extent by the staff at the home and individual times for residents to have their daily money allowance, cigarettes and medicines have been implemented. Some residents are happy with this and others are not and prefer to have their money, cigarettes and medicine upon request. This needs to be fully addressed through the care planning process. The menu is often discussed with residents, either at key worker or residents’ meetings or annually as part of a quality assurance review. The home was recently subject to an Environmental Health inspection with the findings being very positive. Some residents informed the inspector that they really do enjoy the meals; some said the foods “alright”, whilst others did not wish to comment. The home returned sample menus with the pre inspection questionnaire, the menus provide lots of choice and it appears well balanced and nutritional. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. The home demonstrates its ability to meet the personal and healthcare needs of residents in safe and effective manner this ensures residents receive timely and appropriate care. EVIDENCE: Many of the residents do require some support regarding personal care, this was evident in their care plans; these care plans mainly reflected monitoring and prompting residents to attend to their personal care when needed. One resident with a large beard and long hair stated he wished to grow it and it was his choice. Several residents commented that staff would help them with personal care if they need some help. Residents informed the inspector that they see their GP whenever needed; some residents also said that they see their psychiatrist and community psychiatric nurse on a frequent basis, usually every three months. Records on residents’ files support this and also indicate that residents as needed and some routinely see the dentist, optician and chiropodist. Other records indicate that support for residents where needed with arranging and attending hospital appointments is provided by the home. The nurses at the home Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 16 ensure that the ongoing healthcare needs of residents are assessed and where needed care plans are written. It was evident that the weights of residents are taken monthly to ensure early identification of any concerns. The management of medicine for the two residents being case tracked were inspected. It was evident that an assessment of the residents ability to selfadminister medicines is undertaken. Medicines are prescribed by GP’s and dispensed by a local chemist using a monitored dosage system. The nursing staff explained the system to the inspector and they were found to be knowledgeable of how to maintain the safe handling medicines. 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. As described in standard 16 many residents have an individual specific time for their medication, which enables the nurses to give out medication safely and have discussions with residents. The home has a contract for the disposal of medicines, evidence of safe disposal is available. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The home does not fully demonstrate its ability to ensure that complaints and the protection of residents is effectively managed, this may lead to residents not raising their concerns or complaints and services not improving and the risks of abuse not being addressed and made safe. EVIDENCE: The home has a complaints policy, this was seen to need revision to include other agencies that can be involved in the process, such as the local ombudsman, advocacy groups, social care and health and the CSCI. The commission has not received any complaints about the home in the past twelve months. The home does have a log of complaints, during 2006 two complaints have been made, both by a resident. Details of the complaint and a subsequent investigation had been recorded, however it was not evident that the home had made a response in writing to the complainant. No residents during inspection had any complaints or serious concerns to raise. The home has a policy for protecting vulnerable adults from abuse; the policy guides staff and confirms the homes intent to train staff and to take incidents of abuse very seriously. The inspector discussed the policy with nurses, it was evident that some nurses fully understand what they must do and others were not so sure, but would take direction from the manager. Training records indicate that not all staff have as yet received relevant training in protecting residents from abuse, however the owner confirmed that a programme to train all staff was in place. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 18 The home does manage some money on behalf of residents and provides a safe keeping service. The records of money in and out of the individual residents accounts are recorded, however some transactions had not been signed for and others as indicated in the policy had not been witnessed. Two records indicated a balance, which did not reflect money available, in both cases residents, had too much money in their plastic wallets. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All Standards. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The home is generally well maintained, clean and pleasant to live in, however the capacity to maintain a safe environment is a concern and some improvements are required to ensure the health, safety and welfare of residents, visitors and staff EVIDENCE: A full tour of the premises was undertaken sampling some of the residents’ rooms. All areas were found to be safe and well maintained; it was evident that a programme of refurbishment and redecoration were in place. Many residents commented, indicating it was a nice home, that they liked their rooms and that they have all they need in their rooms. The pre inspection questionnaire identified the areas that had been refurbished and redecorated, whilst touring the home this was seen to have been completed to a good standard including for example, all bedrooms refurbished and the lounge and dining room redecorated. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 20 The sizes of residents’ rooms vary as some are single rooms and eight are shared rooms. Although rooms have not been measured they appear to meet minimum standards and residents are happy with their rooms. There are a good range of storage areas in single and shared rooms, all residents have their own wardrobes, chests of drawers and cabinets. These rooms were very clean and tidy, bedding and curtains were pleasant, many matching and of good quality. Some residents commented that they have helped furnish their rooms and have bought their own stereo systems; televisions and some have brought in small items of furniture. Residents accommodation is 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. The flow of water from hot water outlets on the second floor in some residents’ rooms, toilets and bathrooms was poor, often not available. The downstairs bathroom has an assisted bath, the inspector was concerned that the lighting in the bathroom was not adequate to ensure safety and may limit the capacity of some residents to meet their own needs. The wall cabinet in this bathroom had many nail varnishes, which need to be stored in a more secure area. There is large amount of shared space in the home including, two lounges, a large dining area, residents’ smoking room and a well-used rear garden with patios and a lawn. The larger lounge has a television, stereo and many books and also has a snooker table. The smaller lounge has a television and is used by many residents, some who have mobility needs. It was a concern that the small lounge had a strong odour that was not being adequately managed. Many residents were observed having drinks in the garden, reading books and a game of “hoopla” with staff was convened. Several residents stated that they enjoyed spending tome in the garden, especially when the weather is nice. A passenger lift provides access to all floors in the home and there are wellsited handrails in the corridors, many toilets and bathrooms have grab bars to assist residents with their mobility and moving needs. The laundry area is small yet is adequate to provide a safe system of laundry to residents. The tiled floor has some tiles that have become loose, which could become a tripping hazard. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35 and 36. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The home does not fully show its ability to develop, support and recruit staff and to ensure they have the skills, knowledge, background to effectively and safely meet the needs of residents. EVIDENCE: The pre inspection questionnaire indicated that there are eleven care assistants of whom six have competed the NVQ level 2 in Care or above. The most recently recruited member of staff is a domestic and the file contained reference to an induction to the home. Many staff were observed talking with residents, some were seen to be supportive whilst others were not fully sympathetic to the feelings behind some residents conversations and were often to quick to go and do other work. Some residents were complimentary of staff stating; “they are very good” “they’re terrific” and “they all seem very nice”. The staffing support for residents 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. At night there is a minimum of one trained nurse and two care assistants. The registered manager is often Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 22 included in staffing levels and further support is available from part time domestic staff, normally fours a day and a full time cook. At present there is a vacancy for a part time cook. Several residents commented that there are always staff available to support residents, this was further reinforced when the call system was tested by a nurse and four staff attended without delay. Two staff files were sampled including details of how recruitment was conducted by the registered manager; both files had a completed application form and two written references. A criminal records bureau disclosure (CRB) check was not available on both files yet both had evidence of a POVA check with no matches found, it was a concern that no CRB was available for the nurse who had been employed for five months and who frequently takes charge of the home. This was discussed at some length with the owner who during the inspection made contact with the counter signatory to establish why a CRB had not been received. One of the staff files included a health screening form, this had not been completed for the nurse. A matrix of training was included with the pre inspection questionnaire, it was evident that some improvements had been made with training staff in safe working practices, this was discussed with the owner who confirmed her commitment to seeing through the training programme. The training programme included evidence of first aid, moving and handling, fire safety, adult protection, health and safety, violence and aggression and food hygiene. This programme needs to include training staff in good practices in respect of infection control. The training matrix raised concern that many of the night staff have not been trained in some of these safe working practices, the owner advised that she had written to all the staff who had not attended training following a consultation with ACAS. Residents’ commented that the staff were good at their jobs and one resident praised a nurse for her ability to help him relax when he was anxious. The sampled staff files for one staff member indicated that supervision would be a tool to monitor performance and conduct, however only one supervision had been conducted in five months. It is not evident that staff do receive supervision regularly to provide them with adequate support. One member of staff indicated supervision had not been conducted regularly since employment started. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 40 and 42. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. It is not fully evident that the home has the ability to ensure that the conduct and management of the home is effective in supporting residents and staff to receive and provide respectively a well-run quality service. EVIDENCE: Improvements are needed in certain areas of the home to maintain safety, where these are related to the environment the findings have been recorded under the environment outcome area of this report. At the time of the visit the registered manager was on annual leave. The owner informed the inspector that the manager had been on training events during the last twelve months including medication and employment law, however evidence of this was not available at the home; the owner advised she would forward this evidence in the post; this has not been received. There was no evidence that the registered manager is receiving supervision. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 24 The owner advised that she visits regularly and the manager provides her with a weekly report. The owner also provided evidence that she visits and writes a report on her findings as required under regulation 26 of the Care Home Regulations 2001, however it was not evident these visits are unannounced, comprehensive and that outcomes are recorded with an action plan for improvement. It was also apparent that the visit did not detail interviews with residents and staff and include inspecting the premises. Evidence is available that indicates that residents, staff and visiting health professionals have been asked their views and opinions about the standards at the home. This information has been shared with all interested parties in the form of an annual statement. The statement recorded how information had been gathered, improvements that had been made in the last year and also further improvements needed for 2006. Policies and procedures were sampled including those for accidents, adult protection, financial affairs of residents and complaints. Improvements needed regarding complaints have been identified in standard 22. The accident policy indicates it is for staff and not residents and does not inform staff what to do for injuries to head and neck, it also indicates that a first aider will always be on duty and how this is managed is unclear. The policy for the management of residents’ financial affairs also requires improvement, including how the accounts of residents’ money are audited, access and restrictions on their money and it does not give guidelines of good practices when staff purchase items on behalf of residents. The home has systems and procedures in place to effectively manage health and safety; this includes extensive risk assessments for the premises, fire and residents rooms. It was evident that some of the assessments for residents’ rooms were in need of a review, however many of the measures to promote safety remain in place. The fire risk assessment is soon due for review and as good practice the latest fire officers’ report should form part of the review. Servicing, tests and maintenance of equipment and utilities including hoists, passenger lift, fire equipment, gas, water, electric and the nurse call system are well maintained. Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 2 X 2 X Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5(1)(b)(c) Requirement The residents’ contracts regarding terms and conditions of residency must declare the fees to be paid and also the room to be occupied. All residents must have written care plans in place where a need is identified following the assessment. Timescale for action 30/09/06 2 YA6 15(1) 31/08/06 Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 27 3 YA9 13(4)(5) All residents’ risk assessments must be evaluated each month. Risk assessments must be developed for all residents over 65 years of age and where a need is identified pertaining to their manual handling needs. Previous timescale of 31/8/05 not met, these requirements are carried forward. Risk assessments to include; a nutritional screening and falls must be completed for each resident at risk or over 65 years of age. The home must assess who is important in the lives of residents and develop care plans to encourage and maintain the relationship. Previous timescale of 30/6/05 not met, this requirement is carried forward. The registered manager must ensure that the routines of residents of which they have become dependent have care plans and that the choices of residents are considered when these care plans are written, if a risk is identified then a risk assessment and management plan must be fully implemented. 31/08/06 4 YA15 16(2)(m) 15(1) 31/08/06 5 YA16 15(1)(2) 12(1) 13(4) 31/08/06 Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 28 6 YA22 22 The registered manager must ensure that the complaints policy is comprehensive and gives advice about support such as advocacy services, local ombudsman and social care and health. 31/08/06 7 YA23 13(6) Complaints received must have a written response to the complainant following the subsequent investigation. The registered manager 31/10/06 must provide training for staff in protecting vulnerable adults from abuse. Care staff must receive this training as a priority. Previous timescale of 31/5/05 not met, this requirement is carried forward. The registered manager must ensure that residents’ money is managed as indicated in the policy, including signing and witnessing all money transactions and also ensuring that the residents’ money in the plastic wallets corresponds with the current balance. The registered manager must ensure that the lighting in the ground floor assisted bathroom is improved. The registered manager must ensure that all hot water outlets have a supply of hot water at all times. 8 YA23 16(2)(i) 13(6) 31/07/06 9 YA27 23(2)(p) 31/08/06 10 YA27 23(2)(j) 31/07/06 Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 29 11 YA30 16(2)(k) 12 YA32 18(1)(a) 13 YA34 19(1)(b)(i) schedule 2 19(1)(b)(i) schedule 2 14 YA34 15 YA35 18(1)(c)(i) The odour in the small lounge must be effectively managed, if the odour is permeating from furniture this must be thoroughly cleaned or replaced ensuring the odour is removed. The registered manager must ensure that all staff are able to effectively communicate with residents. All staff must have a criminal records bureau disclosure completed as part of the recruitment process. All staff must have a health screening assessment completed as part of the recruitment process to determine the fitness of the prospective employee. All staff must receive training in infection control. Previous timescale of 31/01/06 not met this requirement is carried forward. 31/08/06 31/07/06 31/07/06 31/07/06 31/10/06 Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 30 16 YA36 18(2) Nursing staff must receive adequate support to maintain and develop their clinical practice. Previous timescale of 30/9/05 not met, this requirement is carried forward. The training and development needs of staff must form part of the supervision process. Previous timescale of 31/12/05 not met, this requirement is carried forward. Evidence that the registered manager is adequately supervised and does maintain and develop competencies; skills and qualifications must be available at the home. Policies and procedures must be reviewed to ensure legislation and good practices are maintained at all times, this must include review and further development of the following policies: 1. Accident policy. 2. Residents’ financial affairs. All policies and procedures must be subject to regular review. The nail varnishes in the wall cupboard of the ground floor assisted bathroom need to be moved to a safer area or a lock put on the cupboard. DS0000024840.V293285.R01.S.doc 31/10/06 17 YA37 17(2) Sch 4 (6)(f) 18(1)(c)(i) 18(2) 31/08/06 18 YA40 17(2) Sch 4 13(6) 31/08/06 19 YA42 13(4) 31/07/06 Firs Nursing Home, The Version 5.1 Page 31 20 YA42 23(2)(b) 21 YA42 13(4) The registered manager must ensure that the floor tiles that have become loose in the laundry are made safe. The residents’ room risk assessments must be subject to regular ongoing review. 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Firs Nursing Home, The DS0000024840.V293285.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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