Inspection on 17/12/07 for The Firs Nursing Home

This inspection was carried out on 17th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Firs Nursing Home 27/11/08

The Firs Nursing Home 24/01/07

The Firs Nursing Home 14/06/06

The Firs Nursing Home 04/10/05

The Firs Nursing Home 13/04/05

The Firs Nursing Home 15/10/04

The Firs Nursing Home 18/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Firs Nursing Home 251 Staplegrove Road Taunton Somerset TA2 6AQ Lead Inspector Gail Richardson Unannounced Inspection 09:30 17 December 2007 th X10015.doc Version 1.40 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 DS0000003297.V353291.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000003297.V353291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Nursing Home Address 251 Staplegrove Road Taunton Somerset TA2 6AQ 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) 01823 275927 01823 336463 Care West Country Limited Kathleen Anne Vound Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to six places for personal care. Date of last inspection 24th January 2007 Brief Description of the Service: The Firs Nursing Home is located in a residential area approximately one mile from Taunton town centre. The home fronts onto the busy Staplegrove Road and is close to a local pub and Staplegrove Village Hall. Access to the home is via the car park to the side of the property. 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 persons who need personal care only. The registered provider is carrying out major refurbishment work of the home. The refurbishment includes upgrading bedrooms in the present home along with communal areas. The final phase will include building ten new bedrooms that will overlook the garden area. Once completed all the bedroom accommodation will have an ensuite facility including shower. Accommodation is over two floors with communal rooms on each floor. Bedrooms on the first floor are accessed by a 4-person/300Kg lift. A registered nurse supervises the staff team on duty twenty four hours a day. The registered nurse’s are all experienced in nursing older persons. Care staff are experienced and receive appropriate training to deliver personal care to service users. The home also has catering, housekeeping and maintenance staff. A deputy and an administrator support the registered manager. The current fees charged are from £400.00 to £504.00 per week. The fees do not include hairdressing and chiropody. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 5 The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over 1 day (5.30 hours) on the 17th December 2007 by inspector Gail Richardson. A tour of the home took place and a selection of the bedrooms and both communal areas were seen. There were 20 people currently residing at the home. The inspector spoke to 5 people using the service, 1 visitor and 6 members of staff, the Registered Manager and the Deputy Manager were available throughout the inspection. The home also provided CSCI with a completed AQAA (Annual Quality Assurance Audit) which was completed by the Registered Manager and gives details of all aspects of the home. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and their representatives, GP’s, District Nurses and Care Workers. Surveys were sent to people using the service and good levels of responses were received. The inspector spent time talking to people within the home, a visitor and staff and observed that on the day of inspection, residents appeared comfortable in all areas of the home. It was evident from this observation that the people looked well cared for. All people using the service spoken to, and who were able, spoke of the staff members kindness and support. Surveys from staff stated they felt supported by the management of the home. Staff were happy to tell the inspector that they enjoyed working at the home and felt that the standard of care given was high. Records relating to care including three care plans, staff files, finances and health and safety records were examined The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Care plans are required to contain sufficient details of the plans of care for people using the service who have care, specific nursing and psychological interventions. This detail is required to ensure that staff have a clear plan of action for each person. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 8 The activity provision within the home is required to be developed to ensure that all people using the service have social and recreational activities which are person centred and reflect peoples choices and preferences. Some areas of medication procedure require review to meet the Royal Pharmaceutical Guidelines for the safe administration of medicines. The complaints policy used by the home is required to have the contact details of CSCI to ensure people using the service/relatives/staff are able to contact CSCI if required. The management of the home is required to ensure that all people using the service have the appropriate equipment required, this is with reference to the provision of Hi/Low beds for people using the service with identified nursing needs. The recruitment files examined did not contain a photograph of the staff member and are required to do so. It is further recommended that all gaps in employment histories of prospective staff are explored and documented to ensure that people using the service are not placed at risk. All substances, which are hazardous to health, must be stored in line with the COSHH regulations to ensure that people using the service are not placed at risk. The Statement of Purpose is recommended to be updated to include the correct contact details for the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be able to provide prospective residents and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective residents receive a pre admission assessment to ensure the home can meet the assessed needs identified. EVIDENCE: The home provides a Statement of Purpose and Service User Guide which is detailed and comprehensive and details the ongoing changes to the home. The Statement of Purpose is recommended to be updated to contain the correct contact details for the home as the current contact details are for another home. The inspector examined three care plans all of which included a pre admission The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 11 assessment and SAP assessment, there was evidence of family involvment in the admission process. Involvment of other health profesionals in the descision to admit was also evident to ensure that the home were confident they could meet all needs prior to admission. All 5 Residents surveys received and 7 relatives surveys stated that all had received a contract and all felt they had received enough information prior to admission, about the home to make an informed decision. Contacts were examined and contained the correct information including the terms and conditions of residency. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person using the service has a care plan, the assessed areas of need were not all reflected in this plan of care and the detail recorded did not ensure that staff would be advised of all the areas of need. The management of medications systems requires further attention to meet the required standard. Staff were observed to treat service users with dignity and respect at all times and residents confirmed that they felt well cared for. EVIDENCE: When asked do you receive the care and support you need, all 5 surveys said always, all 5 responded that staff listen and act on what the residents say and all 5 felt they received the medical support they needed. Comments received included ; ‘On the whole the home is very good.’ and ‘The staff have been most helpful and seem very caring’. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 13 Relatives commented; ‘They are always caring, sympathetic and understanding, The present staff and management are well in control Very satisfied with everything We have good communications with the care home They will always phone or write with any problems however small, we call in regularly. I think they cope very well, they try to integrate my relative with mixing with other residents. My mothers needs are met I am satisfied with my mothers care’ 3 Care plans were examined by the inspector. All 3 care plans contained risk assessments for nutrition, pressure risk, falls and dependency. There was evidence of relative and health professional input in the care plan process and regular reviews of care. Staff confirmed that considerable work has been undertaken to improve the standard of care planning. The inspector could see that work is ongoing but advised that all areas of identified and assessed need are required to be care planned to ensure that staff have the clear directions required to provide the care needed. This is currently not taking place and may place people using the service at risk if the directions for staff are not clearly available. These areas must include, for example, personal care, care during the night time period, mobility, wound care, nutrition and the specific care needs related to the diagnosis of each person using the service. One person had been admitted 5 days previously and risk assessments confirmed high risks in some areas but no care plans had been made to support staff to ensure that the staff were aware of the care needs. It was noted that there was no evidence of people using the service being involved in the their care planning process. It was discussed with the manager and deputy manager that development of care plans to support people to maintain and improve independence will develop a more person centred approach to care planning. The people using the service observed by the inspector appeared comfortable and settled. There was evidence of use of pressure relieving equipment and equipment was provided to support independence. The inspector observed staff interaction with people using the service during inspection and observed that people using the service were treated with dignity and respect at all times. Staff were observed to knock on doors before entering and to behave in a courteous manner. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 14 The medication systems were assessed to be mostly satisfactory with some areas requiring addressing. There were several gaps evident in the Medication Administration Records were no explanation was made for the omissions. There was no evidence of regular audit of medication records to ensure that any gaps were explained. There was evidence of variable doses being recorded. On 6 occasions hand transcribed entries had not been signed by 2 staff and it was noted that on 6 occasions these hand transcribed entries where not dated. This is required to enable a clear audit trail of the date of medication commencement. The registered manager has implemented a system to record the administration of all prescribed creams on a record maintained in each persons room and dietary supplements are recorded on the Medication Administration Records as given. People using the service have the option to self medicate should they want to but nobody is self medicating at the moment. Lockable storage is available as required. The home is recommended to reorganise the storage of prescribed dressings to ensure that dressings no longer required are disposed of and not at risk of being used on other people using the service. A homely remedy policy is in place with signed consent on agreed protocols by the relevant GP’s. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a range of opportunities for social stimulation which is recommended for further development, residents are supported to join in with some organised activities or pursue their own interests. The meals in the home are of a good quality and a wide range of choice is available. EVIDENCE: Resident’s surveys asked are there activities arranged by the home that you can take part in, 1-always, 4 -sometimes. One staff survey commented that ‘The home could improve by more interaction between care staff and residents’. One person using the service confirmed that ‘There are not too many activities’. The inspector spent time talking with people using the service and observed people reading, having manicures and chatting to staff and visitors. A local school visited to sing carols in the afternoon. One member of staff was employed to do hand massage and nail care. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 16 The planned activities are advertised on a board in the hallway and a news letter was observed. Currently the home has 2 activity co coordinators who, at this time, are not available at the home. Further development is recommended to develop social care histories for all people using the service to ensure that activity provision is developed to be person centred. It was also discussed that the record of activities undertaken should be accurately maintained as the records are not currently regularly maintained and do not reflect people using the service’s opinions and level of participation. It was noted during case tracking that some people using the service did not have these records complete or there were significant gaps of time with nothing recorded. It was discussed with the manager that one to one sessions of activity/discussion should also be planned and recorded for the people using the service who remain in their bedrooms. Quality Assurance undertaken by the home also noted comments about the need for more activities to be undertaken. One visitor to the home confirmed that they were always made welcome to the home and found staff to be helpful and they felt that there was ongoing communication regarding care needs. One person using the service commented that ‘Visitors can come and go and they are always made welcome’. People using the service’s rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen in some cases of people’s own furniture in their bedrooms. Those people who were able confirmed that they could get up and go to bed within a reasonable time of request. Lunch observed was appetising and plentiful and a choices related to personal preferences were provided. Kitchen staff spoken to had a good understanding of peoples dietary needs. The menu offers a choice and people using the service were satisfied with the meals provided. Special diets were available for diabetic diets and pureed diets were served separately. Meals were served both in the dining room and in peoples bedrooms if preferred. On the day of inspection lunch consisted of: Corned beef with onion mashed potato or cauliflower Cheese. Desert was either lemon mousse or jelly and ice cream. All people using the service spoke positively about the standard of the food and mealtimes appeared to be a pleasant dining experience. Resident’s surveys asked if residents like the meals at the home, 1-always, 2usually and 1-sometimes. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 17 The menu is available in the main foyer of the home, one person stated that ‘The menu on notice board always updated and various alternatives offered each day the staff ascertain the day before the choice of resident’. One person commented that ’The food is always very good.’ Staff were available to assist people using the service with eating and drinking, relatives comments confirmed this ‘-Food is cut up, apples cut up and sliced for them’ and’ They feed them well and are very kind’ One staff comment was ‘Our kitchen staff present very appetising food which service users really enjoy and there is always choice. We happily make extra cups of tea day and night’ The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and people using the service are confident that the homes management team would appropriately deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent service users from the risk of abuse. Further policies regarding wills and bequests are recommended. Recruitment procedures protect people using the service from the risk of abuse. EVIDENCE: People returning the service surveys and who spoke to the inspector, confirmed that they knew how to make a complaint and were confident that their complaint would be acted upon. No complaints have been made at the home since the last inspection and CSCI have not received any concerns about the home. 9 relatives surveys and 5 people using the service surveys, confirmed that they knew how to make a complaint and surveys confirmed that people knew who to speak to if they were unhappy. Residents surveys confirmed that if unhappy they would know who to talk too, 3-always, 2-usually. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 19 Comments received included ‘They will always phone or write with any problems however small, we call in regularly’ and’ On the few occasions I have been concerned they have responded as anticipated.’ All staff are trained through induction and on going training is provided, further training in abuse awareness is provided for staff. Policies are available to support staff with regard to complaints, abuse awareness and whistle blowing. The policies need to be updated to include the contact number for CSCI and also to include a policy to advise staff about any involvement in wills and bequests. All 5 staff surveys received confirmed that they had received a Criminal Record Bureau Check and examination of recruitment files confirms that these check were undertaken before staff commenced employment. It was discussed with the manager that during the recruitment process that all prospective staff are recommended to provide an employment history for the previous 10 years to ensure that people using the service are not at any risk of abuse. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is a large building with some parts of the building suffering from wear and tear that would be typical of a building of similar age and usage. An on going refurbishment program is in place and improvements to areas of the home are evident. EVIDENCE: The homes AQAA states that ‘New carpets have been fitted in refurbished areas and refurbishment continues.’ Comments include ‘I am very impressed flowers outside and in the foyer make it homely’ and ‘All staff always greet you and speak. I am always impressed by the look of entrance foyer and daily menu boards’ 2 residents surveys confirmed that the home is always clean and fresh and 1 said usually. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 21 One staff commented’ Could improve laundry service’. The home has an ongoing refurbishment programme, established rooms are being refurbished and this has been done whilst trying to keep disruption to people using the service to a minimum. Ongoing work was evident. All bathrooms and toilets were maintained to a good standard and suitable hand wash arrangements to reduce the risk of cross infection were in place. Evidence of pressure relieving equipment being available and other equipment such as pressure mats and wheelchairs were available and were routinely maintained. It was noted that some people using the service with nursing needs were being nursed on divan beds which do not have the hi/low facility. It was discussed with the manager that the people using the service must be risk assessed and prioritised to receive the new beds. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home appear adequate to meet the assessed needs of people using the service and staff training is promoted. The induction process for staff has been developed to meet the Skills for Care, Common Induction Standards. Staff training is comprehensive and well recorded. EVIDENCE: Resident’s surveys asked if staff were available when you need them said, 3always, 2-usually. One person stated’ Staff availability-Depends, I may have to wait for the toilet if others are before me, on the whole its very good, everything is clean, beds and everything’. On the day of inspection there was; 1 Deputy Manger- (the Manager arrived mid morning) 1 qualified nurse 4 care staff, (2 upstairs and 2 working downstairs) 1 Cook, 1 kitchen assistant 1 housekeeper, 2 cleaners 1 laundry assistant 1 handyman The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 23 Staff were complementary about working at the home and felt that morale was good, one comment received was ‘The home has a friendly and relaxed atmosphere. The staff although at different levels of experience, have all completed a broad based induction package of training and can deliver a high standard of care but also are friendly and welcoming to service users.’ Staff commented several times that they felt one of their strengths was a good level of communication between staff to support people using the service. 8 staff returned comment cards to CSCI, 5 staff confirmed that they felt they had received adequate induction and supervision when they commenced their job. A staff training matrix confirmed that all mandatory training is completed and further specific update training is provided which included Dementia Care and Venapuncture. One staff comment was ‘I have been sent on training courses which has improved our practice during this process and come to understand our service users needs better.’ The registered manager confirmed that in excess of 90 of staff have currently achieved an NVQ level 2 or above. 3 recruitment files of the most recently recruited staff were examined. The recruitment procedures were mostly complete and no staff commenced employment prior to 2 references, POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) check having been received. It was noted that there were no photographs on the 3 staff files, this is required to be addressed. The Commission recommends a 10-year employment history to be requested and any gaps explored and documented to ensure people using the service are not put at risk. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 24 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All staff, service users and visitors spoken to were positive about the management and felt able to raise concerns and felt that their ideas are listened to. Staff are adequately supervised. Further improvements are required to ensure the health and safety of people using the service, staff and visitors to the home. EVIDENCE: Staff, one visitor and people using the service spoken with at the inspection, were positive regarding the management style of the manager and most staff said they felt supported. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 25 Comments received included ’The manager visits and sits down for a chat’ and another commented that ‘ I call her the big white chief’. The registered manager currently works in a nursing capacity within the home 2 shifts per week. Minutes of regular staff meetings were viewed which confirmed that staff are able to discuss their concerns with the management of the home and review areas of practice causing concern. As required, the company in accordance with Regulation 26 of the Care Homes Regulations 2001, carries out monthly visits which are recorded and supplied to CSCI. Records seen at this inspection were appropriately and securely stored and staff have access as required. Quality assurance records were seen at inspection. Questionnaires were last audited in August 2007, the responses were discussed at residents and staff meetings. There are established systems in place for dealing with service users finances. The inspector evidenced that each service users personal monies were stored in individual envelopes with a running total of deposits and withdrawals. 3 random accounts were checked, 2 accounts required updating but were confirmed as correct at the time of inspection. Staff supervision was confirmed by staff and records available confirmed supervision to be ongoing and covers all areas identified in the Common Induction Standards. Accident records were viewed and accidents are audited monthly for trends and regular occurrences and action taken to reduce any risks of further accidents taking place. Maintenance records were well maintained and up to date, these included; * Fire Extinguishers were last serviced 30/07/12 and are checked monthly last date 03/12/07. Fire systems were last serviced 19/06/07 * Fire tests take place weekly last date 07/12/07 and the last fire drill was 03/10/07 * Hoist Servicing /LOLER took place in February and November 2007. * Emergency lighting is checked monthly by the maintenance staff and was last checked 03/12/07 * Boiler/gas servicing was recorded on 3 boilers 10/05/07 with one boiler due servicing on the day of inspection. Landlords Gas Safety Certificates are required to be forwarded to CSCI when completed. * Lift servicing last took place 05/11/07 The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 26 * Hard wiring certificate was 01/11/07 * Fire risk assessment was undertaken in 2007 * Nurse Call system was last checked on 19/10/07 * Hot water temperatures are checked monthly and all were recorded as below 43 degrees * COSHH records were seen To ensure the safety of service users, all upstairs windows have restricted openings and wardrobes are secured to the wall. The manager agreed to forward details of the PAT testing certificate to CSCI. Further Health and Safety Issues discussed at inspection : It was noted that dental tablets were accessible in several rooms and one bottle of surgical spirit was accessible to people using the service. Risk assessments are required and appropriate action taken. All substances which are hazardous to health must be stored in line with the COSHH regulations. The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 27 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. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 1 The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15(1)(a)( b) Timescale for action (1) Unless it is impracticable to 01/02/08 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met. (2) The registered person shall— (a) make the service user’s plan available to the service user; keep the service user’s plan under review; This refers to the need to ensure a detailed care plan that reflects the service users present care needs and evidences their involvement. The care plan must be reviewed monthly to record the care outcome. Previous timescale of 25/03/07 not met The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 29 Requirement 2. OP9 13(2) The registered manager must ensure that all medications are recorded as given on the Medication Administration Records or an appropriate code recorded to ensure that a record is maintained of all medications given as prescribed. 01/02/08 3. OP9 13(2) The registered manager must 01/02/08 ensure that all prescribed creams are dated when opened to ensure that the expiry date is evident. The registered manager must ensure that all hand transcribed medications are signed and dated when commenced to ensure a clear audit trail of commencement of medication. The registered person must ensure that suitable adjustable beds are provided for those service users with an assessed nursing need. The registered manager is required to ensure that a recent photograph is stored on each staff members recruitment file The Registered Manager is required to ensure that All substances which are hazardous to health must be risk assessed and stored in line with the COSHH regulations. 01/02/08 4. OP9 13(2) 5.. OP24 16(1) & 16(2)(c) 01/02/08 6. OP29 9(schedul e 2) 01/02/08 7. OP38 13(4)(a) 01/02/08 The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations The manger is recommended to ensure that the Statement of Purpose contains the correct contact details of the home. The registered manager is recommended to reorganise the storage of prescribed dressings to ensure that dressings no longer in use are not available for use on other people using the service. The registered manager should ensure that social care needs are included in the service users care plan. The manager is recommended to develop social care histories for all people using the service to develop person centred social/recreational care. The manager is recommended to develop the system for recording activities to include development of activities to be person centred. 4. OP16 The home is recommended to provide staff with a policy for direction regarding involvement in wills and bequests. The manager is further recommended to include the telephone number of CSCI within the complaints procedure 5.. OP29 The registered manager is recommended to request a 10 year employment history for each prospective employee and that any gaps are explored and documented. 2. OP9 3. OP12 The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Firs Nursing Home DS0000003297.V353291.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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