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Inspection on 18/10/05 for The Firs Nursing Home

Also see our care home review for The Firs Nursing Home for more information

This inspection was carried out on 18th October 2005.

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 22 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents` comments included "the food is alright", "the manager is nice and so are the staff" and "I can see my doctor every four weeks". The residents are able to meet as a group on a regular basis to discuss and raise their opinions about important decisions and issues in the home, such as reviewing menus and arranging leisure pursuits.

What has improved since the last inspection?

Residents commented about the new menus, they confirmed that two meals were available at lunch and dinnertime and that although they at times did not like both choices there were always other options. There has been considerable improvement in the assessment of residents needs resulting in more informative care plans. Policies to guide staff in the administration of medicines and to protect residents from abuse have been implemented. The owner and manager have developed and implemented a rigorous and extensive programme of decoration and refurbishment for communal areas and within residents` rooms.

What the care home could do better:

All residents must have a risk assessment in place that has been completed after consultation with residents in relation to mental health and relapse. The training of staff in all areas of health and safety practices must be undertaken and then kept up to date.The manager and owner must ensure that all nurses manage medication in a safe and effective manner. Some residents expressed concern that the hot tea making facilities are not always available during the day. Risk assessments pertaining to the building, fire and food must be appropriately reviewed.

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 18th October 2005 09:20 Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 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.V259842.R01.S.doc Version 5.0 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.V259842.R01.S.doc Version 5.0 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.V259842.R01.S.doc Version 5.0 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. 05/07/05 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.V259842.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was conducted on an unannounced basis. Regulation inspectors were able to meet many residents and some staff. Records pertaining to care, services and health and safety were seen. Residents’ rooms and communal areas were viewed on a sampling basis. Many of the requirements of previous inspections have been addressed. However it is clear that there is further improvement needed to safely and fully meet the individual needs of residents. What the service does well: What has improved since the last inspection? What they could do better: All residents must have a risk assessment in place that has been completed after consultation with residents in relation to mental health and relapse. The training of staff in all areas of health and safety practices must be undertaken and then kept up to date. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 6 The manager and owner must ensure that all nurses manage medication in a safe and effective manner. Some residents expressed concern that the hot tea making facilities are not always available during the day. Risk assessments pertaining to the building, fire and food must be appropriately reviewed. 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.V259842.R01.S.doc Version 5.0 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 Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 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): Standards 2, 3 and 4 Residents are involved and provided with information to help decide on whether they wish to live at the home. The skills and staff practices will support residents in meeting their goals and aspirations. EVIDENCE: Residents who have recently been admitted have a pre-admission assessment completed including an assessment of all activities of daily living, current mental and physical health and any historical or presenting risks. Social work reports and care plans are also completed and available to describe assessed needs. These residents were able to have a day’s visit and an overnight stay prior to being admitted, records regarding the visits have formed part of the assessment process. Staff were observed effectively communicating with residents, it was evident that some residents and staff had developed trusting professional relationships. Care assistants have attended in-house training sessions including the role of the care assistant, empowering residents, mental disorder, schizophrenia and what is mental health. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 9 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 and 9. The residents’ health, safety and welfare is compromised as they are not fully consulted about risk and in planning for their needs, this may lead to inappropriate care and risks escalating. EVIDENCE: Written care plans are available for residents and most following assessments detail the physical health, personal and social care provided by staff to support each resident. Some residents did not have a mental health care plan available. The sampled care plans did not always have care plans signed and dated by the resident and staff. It is not clear that residents are involved or are offered opportunity to be involved in the reviewing of their care plans. Monthly reviews of care plans are not routinely conducted and some have not been reviewed for three months. Risk assessments for residents are available they include self medication, fire safety and aggression, however the mental health relapse of residents is not always risk assessed to indicate triggers, signs and actions to be taken by staff and resident. Risk assessments were reviewed routinely and when needed. Residents appear not to have been involved in the development and review of these risk assessments. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 10 Some older residents do have risk assessments available to help manage concerns in respect of tissue viability, nutrition and mobility. The more detailed manual handling needs of these residents are not assessed and risk assessments are not always reviewed following concern, such as high risk on the Waterlow rating scale and then subsequent planning of pressure area care. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 11 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, 14, 15, 16 and 17. The lifestyle needs of residents are assessed but residents are not always supported to access well planned activities. Residents are not fully supported to develop their own routines and remain dependent on staff. Residents are provided with a varied yet healthy and nutritional diet, food safety practices are not always good and may put residents at risk. EVIDENCE: Residents have assessments completed to identify their educational and occupational needs and interests, where possible the staff have made plans to support the residents. However there appears to be an acceptance that some residents are not able to fully be involved, this is recorded but must be regularly reviewed and all possible opportunity for education and occupation within the home and externally considered. Assessments have been completed in respect of residents engaging in fulfilling and preferred activities. Residents were seen taking in part in board games, going for walks, watching television and residents were frequently seen going out to the local shops. One resident confirmed he was going to Kings Heath to buy a friend a present. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 12 Residents files include details of contact with important people in their lives, this information needs to be included within a care plan to inform staff what actions they need to take to support residents to maintain this relationship. Residents confirmed they have a keyworker, and records of meetings with the keyworker are available. Records suggest that some work is undertaken to help develop new routines and to break areas of institutionalisation, it would possible help that these meeting also include discussing and making plans for fulfilling activities as well discussing mental health issues. The hot water urn was found not to be on, which prevented residents making their own hot drinks, residents confirmed that they remain reliant frequently on staff to make hot drinks. New menus were complemented by some residents and some residents confirmed that two choices were available at lunch and dinner time. Some residents felt that they did not always enjoy the two choices and were normally offered something else. Some residents need to have their diet and fluid intake monitored, which is recorded and the cook advised how he prepares special diets such as for diabetics. It is not clear on the menus that there is a healthy option and that this is suitable for diabetics. Residents with diabetes must be provided with a dessert that is healthy for them and not always fruit such apples and oranges. A food safety risk assessment is available and this does include actions such as cleaning and hygiene in the kitchen, taking fridge and freezer temperatures and probing food for temperatures, however a regular review is needed. Attention must be taken to ensure all cupboards in the kitchen are kept clean. Certain food items in the fridge were not labelled with dates to use by and items belonging to staff were also mixed with residents’ food. There are more than adequate stocks of food, fresh and frozen and good stock rotation is practice. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 13 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): Standard 19 and 20. Residents are not altogether able access health services and this may put their safety at risk. Medication management is not safe and residents are at risk of possible harm. EVIDENCE: Records that reflect access to community healthcare services were found to vary. It was evident that some residents regularly access all services yet some residents appear not to see dentists or opticians. Residents confirmed that they do see their psychiatrist and GP, and it was clear that certain residents are supported to access hospital appointments including dieticians and psychologists. Certain areas of medication practice have improved, yet both inspectors were concerned that the practices are not fully safe. Areas for improvement include gaining agreement and guidance from the GP’s to administer any homely medicines, maintaining accurate stocks of medicines as some medicine could not be accounted and some was not recorded when received, dating creams when opened and disposing of them when expired and ensuring insulin is at all times appropriately stored, an opened insulin pen was stored in the fridge, it was evident that crystallisation had occurred. Residents who are prescribed as required medicines do have a written risk management plan, which guides staff to when it should be administered. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 14 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 Residents and their representatives are able to raise concerns and have them addressed in a positive manner. Residents are not fully protected, as some staff awareness in what to do should abuse be suspected is limited. EVIDENCE: Since the last inspection dated the 5th July 2005 the CSCI have investigated one complaint. The complaint raised concerns that residents were not provided with adequate quantity of food, that the menu was inadequate, that the kitchen was used to prepare food when unsafe, staffing levels were poor and that the manager and the owner had a challenging relationship. Some elements of the complaint were upheld, including inadequate menus, safety in the kitchen and the owner / manager relationship. Requirements to improve the service were made and these have been addressed. A log of complaints detailing concerns, actions and outcomes is available at the home. A policy to protect vulnerable adults has been developed, it meets with local multi-agency guidelines. Staff training in protecting vulnerable adults has commenced, this needs to be extended to all staff, prioritising immediate concerns and care staff. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 15 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): Standards 24, 27 and 30. Individual and communal facilities are maintained to a good standard, which enables residents to live in a degree of comfort. Some infection control measures are unsafe and put residents and other people at risk. EVIDENCE: Since the last inspection on the 5th July 2005 the owner and manager have developed and implemented a rigorous and extensive programme of decoration and refurbishment for communal areas and within residents rooms. The inspector was advised that this programme would be completed by the December 2005 ensuring that comfortable seating and adequate storage space is available for all residents. There are a variety of toilets, bathrooms and shower rooms to meet the needs of residents this includes assisted baths with hoist chairs and showers with grab rails. Toilets are close by all resident accommodation. One toilet door could not be locked as the latch had been removed. All high-risk areas such as toilets and the kitchen have appropriate hand washing facilities. The garden area must be maintained at all times to ensure the health and safety of residents and others, in respect of infection control Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 16 issues. As identified at the last inspection a risk assessment must be fully implemented to reduce public health risks. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 17 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 33, 35 and 36. Residents are receiving a service from staff who are knowledgeable of their needs and available in good numbers, risks remain for residents in that some staff are not adequately trained in areas of health and safety related practices. EVIDENCE: Staff rotas reflect there are adequate amounts of staff on duty, that nursing, care and ancillary staff are available in good numbers to provide effective support for residents. All staff were observed to be caring and skilled whilst providing support, they had a good understanding and knowledge of the residents care plans. New staff undertake a detailed induction programme. Staff training records evidence that many staff have completed mandatory training, however some staff have not received recent training in Fire Safety, Health and Safety and Infection Control. All staff are currently involved within an in-house programme of service specific training, which includes mental health awareness, empowerment and mental illnesses. Records of staff supervision were sampled. Supervision appears to be conducted frequently and includes such areas as roles and responsibilities, concerns, care planning and key working with residents. Training and development needs were not recorded in the sampled records and thus gaps in practice and mandatory training had not been identified. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 18 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 39 and 42. Residents are asked about their opinions of the services they receive, this information is not made available in the form of an annual report. The health and safety of residents and other persons is generally well maintained. Certain risks are not fully monitored which is needed to further promote safety. EVIDENCE: An annual review of the quality of care has not been completed. Residents are asked their views about the services in a questionnaire, which is completed on a frequent basis. It was recommended at the last inspection that the manager audit the accidents, this has not been completed. Accidents are immediately filed and no reference is available for them to be tracked. Risk assessments in respect of the premises are available, however they are not regularly reviewed, some risk assessments had not been reviewed in the past two years and do not reflect on the risk being well managed or otherwise. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 19 The fire risk assessment, which had been recently reviewed, did not detail findings of the recent fire officer’s visit. A fire door was found to be wedged open, an immediate requirement to ensure fire safety was issued at the inspection. Health and safety checks, service and maintenance for the building and equipment are conducted in line with legislation and good practice, including fire systems, electric, water and call systems. At the time of inspection a recent landlord certificate in respect of gas safety was not available, however since inspection the manager has forwarded a copy of the certificate to the CSCI. It was a concern that some kitchen cupboards particularly wall cupboards had been noted on records as recently cleaned, when these were checked they were not clean. It was also a concern that bottles of preserve such as sauces were sticky with spilt sauce. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 3 X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 2 X X 2 LIFESTYLES Standard No Score 11 X 12 2 13 X 14 3 15 2 16 2 17 Standard No 31 32 33 34 35 36 Score X X 3 X 2 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 1 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 21 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 YA6 Regulation 15(1) 14(4)(c) Requirement All care plans must clearly describe the needs of residents and be accurately completed including signatures and dates of staff and residents. Timescale for action 31/12/05 2 YA6 3 YA9 Previous timescale of 31/8/05 not met, this requirement is carried forward. 15(2)(b)(c) Written care plans must be 31/12/05 reviewed on a monthly basis and where possible involve residents. 13(4) Risk assessments and 31/12/05 15(1)(2) associated management plans in relation to the mental health of residents and the risks of relapse must be completed for all residents. Residents must be involved in the development and review of their risk assessments. 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 4 YA9 13(4)(5) 31/12/05 Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 22 need is identified pertaining to their manual handling needs. Previous timescale of 31/8/05 not met, these requirements are carried forward. Risk assessments must be reviewed when specific health needs change such as the increased risks of developing pressure sores. Residents who require support 31/01/06 to access in-house or external services to develop lifelong learning and fulfilling activities must be offered all relevant support and have assessments kept under frequent review. The home must assess who is 31/12/05 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. A protocol/procedure to inform all residents of when the hot drinks facilities are not available due to prevalent risk must be utilised. Previous timescale of 30/9/05 not met, this requirement is carried forward. The hot drinks facility must be available at all other times. A variety of healthy options for dessert must be included upon the menu. This must be suitable for diabetics. 5 YA12 14(1)(2) 6 YA15 16(2)(m) 15(1) 7 YA16 12(1) 13(4) 30/11/05 8 YA17 12(1) 16(2)(i) 30/11/05 Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 23 All food items in the fridge and freezers must be appropriately labelled. Items of food in the fridge belonging to staff must be stored separately to those of residents. A regular review of the food 31/12/05 safety risk assessments must be undertaken. All residents must be provided 31/01/06 with opportunity to be seen by a dentist and an optician, records of such healthcare services must be maintained for each resident. There must be agreement and 30/11/05 guidance from the GP in respect of the administration of homely medicines. The home must record quantities and carry over balances of medication on the MAR chart to enable audit to be completed, this must be completed accurately. Previous timescale of 31/5/05 not met, this requirement is carried forward. 12 YA20 13(2) The registered manager must 18/10/05 ensure that all staff are aware of the medication procedures and complete an audit of all “as required” medicines. The registered manager must ensure that the safe handling and storage of medicines is maintained at all times. The registered manager must provide training for staff in protecting vulnerable adults from abuse. Care staff must receive this training as a DS0000024840.V259842.R01.S.doc 9 10 YA17 YA19 13(4)(c) 12(1) 12(1) 13(1)(b) 11 YA20 13(2) 13 YA23 13(6) 31/12/05 Firs Nursing Home, The Version 5.0 Page 24 priority. Previous timescale of 31/5/05 not met, this requirement is carried forward. All toilets must have appropriate locks that can be locked from the inside but which enable staff to access in emergencies. The garden area must be maintained in a clean and hygienic condition at all times. The actions to reduce risk as detailed in the risk assessment to maintain hygiene in the garden must be fully implemented. Previous timescales of 5/7/05 and 7/7/05 respectively not met, these requirements are carried forward. All staff must be trained in first aid. All staff must receive receive regular training in fire safety. Previous timescale of 30/9/05 not met, these requirements are carried forward. All staff must receive training in infection control and health and safety. 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. 14 YA27 13(4)(a) 12(4)(a) 13(3) 31/12/05 15 YA30 30/11/05 16 YA35 18(1)(c)(i) 31/01/06 17 YA36 18(2) 31/12/05 Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 25 The training and development needs of staff must form part of the supervision process. 18 YA39 24 The introduction of a quality assurance system is required. Previous timescale of 31/8/05 not met, this requirement is carried forward. The manager must audit the accident and incidents in the home at least every 3 months and following any serious incident. Risk assessments pertaining to the premises must be regularly reviewed to indicate findings and compliance. 31/01/06 19 YA42 12(1)(a) 13(4)(c) 31/12/05 20 YA42 13(4) 23(4) 31/12/05 21 22 YA42 YA42 Fire risk assessments when reviewed must also include details of recent fire officer inspections. 23(4)(a)(c) Fire doors must not be wedged open. 13(3) Standards of hygiene in all 16(2)(j) areas of the kitchen, including kitchen cupboards and food containers must ensure the safety of residents. 18/10/05 30/11/05 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 YA16 Good Practice Recommendations It is recommended that the keyworker meetings also include discussing and making plans for fulfilling activities as well discussing mental health issues. Firs Nursing Home, The DS0000024840.V259842.R01.S.doc Version 5.0 Page 26 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.V259842.R01.S.doc Version 5.0 Page 27 - 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. 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