CARE HOME ADULTS 18-65
The Firs Nursing Home Kings Hill Great Cornard Sudbury Suffolk CO10 0EH Lead Inspector
Helen Fontaine Unannounced Inspection 15th February 2006 10:00 The Firs Nursing Home DS0000031547.V284033.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 The Firs Nursing Home DS0000031547.V284033.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. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Firs Nursing Home Address Kings Hill Great Cornard Sudbury Suffolk CO10 0EH 01787 371301 01787 880603 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Craegmoor Healthcare Judy Herring Care Home 23 Category(ies) of Learning disability (23) registration, with number of places The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th January 2005 Brief Description of the Service: The Firs is a nursing home for adults with a learning disability. Some of the service users are older adults who originally came from the closure of a long stay hospital. More recently the home has admitted a number of younger adults to the home. The Firs is a purpose built care home on two floors with a shaft lift connecting the two. The home has two interconnecting lounges and a separate dining room. The home has a number of single rooms and one shared room, which will eventually convert to a single. The premises are set on a compact site that allows for parking of several cars to the front and the garden that is used by the service users in the summer. Daytime activities tend to be provided by the home and are based at the home. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of The Firs Nursing Home took place over five hours and was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. Fifteen requirements and four recommendations were set at the previous inspection, one requirement has been partly met and revised requirement has been set to take account of this. A further two requirements have not yet been met and have been restated in this report with a new timescale for compliance. Two new requirements and one new recommendation were given at this inspection. The manager of the home was present during the inspection and her assistance was very much appreciated. A tour of the home was made with a visit to the kitchen and the cook. A member of staff was talked to, one resident was visited in their room and talked to individually. What the service does well: What has improved since the last inspection?
The home had a large number of requirements and recommendations from the last inspection. The home has done a lot of work and some seven requirements and four recommendations have been met. The residents care plans are now kept in a lockable cupboard in the deputy’s/staff room. Although the keys are kept in the cupboard, the door of the office is locked at 5 pm every evening and only the qualified nurse on duty holds a key. During the daytime especially in the morning, the staff and the deputy manager are in the office and the files are in constant use. The homes medication was looked at and all the medication prescribed is available. Any PRN medication is clearly documented on the Medicine administration records (MAR) sheets and all prescribed creams that had been opened were dated. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 6 A number of issues over the environment have been addressed, the garden fencing has now been mended. The badly marked carpets in the communal areas have been replaced and no bars of soap were found left in the communal bathrooms. All the communal bathrooms were found to have paper towels available for residents to use. At the last inspection it was noted that one residents bedroom had vinyl flooring rather than carpeting. The resident concerned has now moved to another room, more suitable to their needs and the empty room is awaiting the fitting of a new carpet before any other resident moves in. The home now has eighteen residents and on duty every shift is a qualified nurse and in the morning there are four staff and three in the afternoon. At night there is again a qualified nurse and two carers, this does give the home adequate staffing levels for the needs of the residents it currently has. What they could do better: 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 Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 7 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 The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 8 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): 1 and 2 Residents cannot be assured that they will receive information to make a judgement about moving into the home. However the resident’s needs are assessed before moving into the home. EVIDENCE: The homes statement of purpose was not available for inspection and it does need to be noted that this has been a requirement for the last five inspections. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. The homes initial assessment of a resident was looked at and these were on a number of different formats. The manager informed the inspector that the registered provider is developing a new person centred format, as well as a new format for the care plans. Documents looked at during the inspection, included the newest resident to move into the home. Included in the file was the Care Management assessment from a Social Worker and the homes own initial assessment. The manager indicated that either they or the deputy go and do the assessment and there was only one occasion when this was not possible and here the service user was in West Sussex. The home received extensive health and social care assessments before they moved into the home. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 9 The assessments looked at covered personal details, medication history, housing circumstances, and general and physical health. At the end of most of the sections there was space for comments by the carer and the assessor as well as the signature of the person concerned. The assessment also covered emotional needs, daily activities, personal care, eating and drinking and most domestic activities. The assessment had a summary of the needs and one documented that the person concerned said, “that staff look after me”. The assessment had quite an in-depth section on the health care needs and it was documented on one section that the service user said, “he feels alright.” At the end of the assessment was a summary of all the needs identified with a signature of the assessor and carer/family. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 10 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): 7 and 10 Residents do make decision about their lives and that information about them is handled appropriately. EVIDENCE: A resident spoken to during the inspection had been to watch a football match and showed the inspector photographs of the event. The residents can choose to either have their meals in the dining room or their own rooms and one resident was observed choosing to have their meal in their room. Care plans looked at during the inspection for two of the residents, had a section headed the things I like to do. The care plan documented that the resident liked to watch soaps on the television and chat to people. Another section of the care plan was headed the things that I don’t like to do and was documented that the resident did not like to be rushed or have seizures. The manager indicated that one of the residents is planning to go to Florida for their holiday. Another resident on the care plan had asked that they liked to listen to religious services. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 11 The issue over the residents care plans, which was a requirement at the last inspection, has been resolved. All the care plans are in cupboards in the deputy’s office, which is also used by the staff. The manager indicated that they had tried to keep each of the four cupboards locked, but the keys got lost and this resulted in the care plans not being used. The office is locked at 5 pm in the afternoon or if not being used and only the qualified member of staff holds the key. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 12 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): 12 and 13 Residents do take part in local community events and appropriate activities. EVIDENCE: The two standards for this section of the report are very much linked to the standards in the previous section. The staff are undertaking some activities with the residents, there was a display on the wall of the dining area of Valentine cards and pictures the staff had assisted the residents to make. The previous activities worker book was looked at during the inspection, it had no structure to activities and the manager said that it depended on how well the resident were on the day. Documented was music, colouring, and visit to the local shops or the park and now with the new homes bus the residents can access the main town of Ipswich. There is also a musician that comes to the home every five weeks and during special festivals local choirs come to the home. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 13 The manager said that the local parish church support the home and invite the residents to any events going on. The manager indicated that the home go to the local pub on occasions and have takeaway nights when the residents choose which takeaway they want. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 14 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): 19 and 20 Residents can expect to have their physical and emotional needs met and are protected by the homes medication policies and practices. EVIDENCE: During the inspection the resident’s physical and emotional needs were looked at. Most of the residents both during the morning and in the afternoon were in the lounge and dining room area. One resident was staying in bed as the manager indicated that they were unwell after having a seizure. Another resident was receiving personal care from the staff and another had chosen to stay in their room. As there are qualified nurses on duty every shift, the resident’s personal care and health care needs can be met. One of the residents spoken to said that staff help when they need it and care was given how they liked it. Another resident with mobility problems had been moved from an upstairs room, to a downstairs room. The home had three requirements around their policies and practice with medication. During the inspection the three areas of concern were looked at and were now found to meet the National Minimum Standards. The homes medicine room was looked at and so was the Medicine Administration Record (MAR) sheets. All medication prescribed to the residents were available and either in blister packs, boxes or bottles. All PRN medication was clearly marked as PRN on the medicine administration record (MAR) sheet. There was
The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 15 only one cream prescribed at the time of the inspection, the opened tube was dated. The manager of the home said that the home work very hard with the residents GP, to make sure that residents are only on medication that is absolutely necessary. As a result the medication needed is quite low for a nursing home with eighteen residents. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 16 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): 22 and 23 Residents can expect to be listened to but are not protected by the homes policies. EVIDENCE: The homes complaint book and comment book was looked at and there were no complaints or comments. One residents spoken to said that any concern they had would be listened to and that they felt safe living at the home. Other residents in the home did have communication difficulties and the inspector did not know them well enough to have an understanding of their views. A member of staff talked to said that any concern the residents had or themselves would be listened to. The member of staff felt that, as they knew the residents well, they would know if any of the residents were not happy. The home had a requirement from the last inspection around the whistle blowing policy and ensuring that staff are aware of their responsibility to report bad practice. The requirement also documents that the policy must also explain to staff their right to employment protection. This issue was explored with the manager during the inspection and the manager produced a framed document from the main hall. This documented that the staff could contact the director, the clinical governor or the Commission for Social Care Inspection with contact numbers if anyone had a concern. This document did not address the issues raised in the requirement. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 17 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): 24, 25 and 30 Residents can expect to live in a home that is clean and hygienic but not always homely. EVIDENCE: The home had a number of requirements from the previous inspection and these were looked at. During the tour of the home it was established that the marked carpet in the communal area had been replaced. The homes bathrooms were looked at and no bars of soap were found. However the bathrooms are in need of some refurbishment and one of the bathrooms the bath was unusable. The manager said that the bath hoist necessitate the staff kneeling on the flower, this puts them at risk. Another bathroom although functional, was not homely and felt very clinical. Another shower room looked at, the manager said that the water from the shower came under the door, the home have had to get an extra mat for outside the door. It was also noted during the tour of the home that the doors that were scuffed, still had not been repaired. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 18 The other requirement about the garden fencing the manager said that this has now been repaired. There is an ongoing problem that the driveway along this piece of fence is access for other properties and not the responsibility of the home. However none of the resident’s accessing this driveway will take responsibility for the fence up keep. The whole home is in need of some refurbishment and although the home is clean it lacks the homely feel. The kitchen of the home was visited during the inspection, it is small and the manager indicated that there has been an ongoing request with the registered provider to resolve this for sometime. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 19 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): 33, 35 and 36 Residents can expect to be support by adequate and trained staff, but not by staff that are supervised. EVIDENCE: The staff roster was looked at during the inspection and found to have adequate staffing levels for the needs of the residents. The home had eighteen residents at the time of the inspection, with a qualified nurse on duty every shift. In addition to the qualified nurse there were four carers on for the morning shift, three carers on during the afternoon shift and two at night. The staff training folders was looked at and five of the staff are signed up with West Suffolk College to do their National Vocational Qualification (NVQ) level two. The manager indicated that the others would sign up shortly afterwards and would result in all the staff gaining their National Vocational Qualification (NVQ) level two. The staff files looked at had certificates and dates for, induction training, foundation course, manual handling, health and safety, COSHH, basic food hygiene and first aid. At the last six inspections the home has received a requirement for staff supervision and at the last supervision this was an immediate requirement. Despite the manager being able to produce new documentation for staff supervision and the deputy manager having received training, the staff are still not receiving supervision.
The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 20 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): 37, 39, 42 and 43 Residents can expect to live in a home that is well run and their health and safety is protected. Resident’s views do not underpin the development of the home. EVIDENCE: The homes documents were looked at and the staff roster is now kept in a glass case that is locked. The manager said that the deputy came up with this idea to stop the staff roster being changed. The staff roster was seen and there were no alterations in typex, this resulted in the correct levels of staffing at all times. The homes quality assurance was looked at during the inspection, the manager was able to produce questionnaires sent to carers and family. These had been sent out by the registered provider and returned to them, the manager had received copies. The home has a number of residents without family or carers, resulting in these residents having no opportunity to express their views about the home. The questionnaires were not in a format that was suitable for the residents to use or understand.
The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 1 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 2 X X 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 X 1 X X 3 3 The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 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 YA1 Regulation 4&6 Timescale for action The registered person must 22/03/06 update the Statement of Purpose to include all up to date information. The statement of purpose must also reflect the unique and specific services on offer at The Firs. This requirement is repeated from the last five inspections. The registered person must 22/03/06 update the whistle blowing policy to ensure staff are aware of their responsibility to report bad practice or suspicions of abuse. The policy must also explain to staff their right to employment protection under the Public Interest Disclosure Act 1998 when highlighting these matters in good faith. This is a repeat requirement from the last two inspections. The registered person must 08/08/06 ensure that badly scuffed doors within the home are replaced. All areas of the home are refurbished and made homely. The registered person must 22/03/06 ensure that all staff receive appropriate supervision.
DS0000031547.V284033.R01.S.doc Version 5.1 Page 23 Requirement 2. YA23 12(5) 13(6) 21 3. YA24 16 4. YA36 18(2) The Firs Nursing Home 5. YA39 24 This requirement has been repeated at the last seven inspections. The registered person must 08/05/06 ensure that there is a sound quality assurance system in place including service users comments and wishes. 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 YA12 Good Practice Recommendations The home develops more activities and stimulation for the residents and recruits a new activities worker. The Firs Nursing Home DS0000031547.V284033.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000031547.V284033.R01.S.doc Version 5.1 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!
