Inspection on 02/09/08 for The Firs Nursing Home

This inspection was carried out on 2nd September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs Nursing Home 07/06/10

The Firs Nursing Home 01/04/10

The Firs Nursing Home 09/02/10

The Firs Nursing Home 21/09/09

The Firs Nursing Home 11/10/07

The Firs Nursing Home 13/07/06

The Firs Nursing Home 18/10/05

The Firs Nursing Home 05/07/05

The Firs Nursing Home 25/01/05

The Firs Nursing Home 07/06/04

The Firs Nursing Home 09/12/03

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOME ADULTS 18-65 The Firs Nursing Home 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY Lead Inspector Kerry Coulter Unannounced Inspection 2nd September 2008 09:10 The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 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 DS0000024840.V371291.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 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 DS0000024840.V371291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Nursing Home 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 The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. 3. Mental disorder, excluding learning disability or dementia (MD) 25 The maximum number of service users who can be accommodated is: 25 Age: Mental disorder, excluding learning disability or dementia (MD) age 40 and above. 11th October 2007 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 Firs consists of the original house, and a newer extension. The home offers accommodation over three floors and 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. The CSCI inspection report is available in the home for visitors to read if they wish to. The service user guide did not record the range of fees to live at the home, it said ‘fees are per individual contract’. The range of fees should be included in the guide. Additional charges are made for chiropody and hairdressing. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. An ‘expert by experience’ took part in part of the visit. An ‘expert by experience’ is a person who, because of their shared experience of using services and / or ways of communicating, visits a service with an inspector to help them get a picture of what is like to live there. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. People who live at the home were spoken with during the visit. Surveys were sent to ten staff and four were returned to us. We sent surveys to three people who live at the home and all of them were returned to us. Their views of the home are included in this report. Six surveys were sent to health care professionals and two were returned. What the service does well: People are consulted about their care plans so that they are supported in the way they prefer. The people living there are offered a healthy diet that they enjoy. When abuse is suspected or alleged the home takes action to make sure that people are protected. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 6 The home is clean and well decorated making it a nice, comfortable place to live. There are enough staff employed to work at the home so there are always staff on duty that know the people living there well. Staff often ask the people living there what they think of the home and how it could be better. Staff make sure they often do the fire and health and safety checks to make sure that the people who live there, staff and visitors are safe. What has improved since the last inspection? What they could do better: The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 7 The service user guide should be updated so that people have more information about the home, to include how much it costs to live there. This will help people decide if they would like to live at the home. Where people have an assessed need, there must be a plan of care in place so that staff have information on how to meet the persons needs. Systems for assessing risk to people need to improve so that staff know about any risks to people and can take action to keep them safe. Review the use of security cameras in the home so that they do not invade people’s privacy. The system of checking medication into the home needs to improve to ensure any errors are spotted by staff so that people get the medication they are prescribed. Staff records need to show that the right checks had been done before staff started working there to make sure that ‘suitable’ people are employed to work with the people living there. Additional training for care staff should be arranged about health conditions such as epilepsy and diabetes so that staff have more knowledge to meet peoples needs. Consider, with consultation of people who live at the home, how people’s bedrooms can be improved so that they are more homely in style. 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 DS0000024840.V371291.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have most of the information they need to make an informed choice about whether or not they want to live at the home. Admission practices generally determine whether the home can meet the needs of prospective residents. EVIDENCE: Whilst viewing the premises it was evident that all people who live at the home have been provided with a copy of the homes’ service user guide, this document was available in their rooms. The manager said all new people admitted to the home are given a copy of the guide. The guide was observed to be quite basic in content and would benefit from more information to include house rules about smoking, range of fees and photographs of the home. This would give people more information and assist them in making a decision to live at the home. The annual quality assurance assessment completed by the manager states it is intended to update the guide within the next twelve months. The records of three people who had moved into the home since the last inspection were looked at. Some people had moved into the home at short notice and so did not have the opportunity to visit beforehand, but where The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 10 possible the home does offer people the opportunity to visit the home before deciding to move in. One person told the expert by experience that they had visited the home before moving in and felt happy to come to the home. Records show that assessment of peoples needs had been completed prior to them moving in, this involved obtaining care plans from the social worker and information about the person from their previous homes. For one person the Firs assessment document had only been part completed and some sections had been left blank. The manager said this was because the information was not available when the assessment was completed. The manager was advised to record this rather than just leaving the sections blank to show that the home has tried to get as much information about the person as possible. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems for care planning and managing risk need some improvement to ensure staff have all the information they require to meet people’s needs. People are given choices in their day-to day lives and are supported to make decisions. EVIDENCE: We looked at three files of people living in the home. Each person had a care plan that had been regularly reviewed. Plans covered areas such as personal care, health care and mental health needs. Plans were generally informative but some needed further detail adding. For example where ‘needs assistance’ was recorded the plan needed to state what the type of assistance was. Some people’s plan referred to the fact that they were sometimes incontinent, care plans were needed on how to support the person with continence care. One person’s assessment recorded that they had a stammer but there was no care plan in place on how to support the person with communication. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 12 Records showed that people have the opportunity to meet with their keyworker regularly and contribute towards their care plan. Where able, people are given the opportunity to sign their plan to say they agree to it. Assessment had been completed of people’s mobility needs, however the format of the assessment is quite limited. It is recommended that the assessment is extended to include more areas, for example people’s ability to access the home’s bathing facilities. Since the last inspection the home has introduced a re-assessment process of people’s needs to be completed on an annual basis. This will determine any changes to the individuals’ needs. The annual quality assurance assessment completed by the manager indicates the home is intending to make some improvements to the care planning systems. This includes introducing a life history for people to look at their needs holistically and their individual life experiences and choices of future needs. Records and discussions with staff show that people are encouraged to make choices and decisions about their lives. We observed people being given choices about what to eat, what to drink and how much money they wanted for a trip to the shops. Meetings take place with people where topics discussed include activities and the menu. The agenda for the next meeting was on display so that people who live at the home could contribute towards it if they wanted to. Assessments had generally been completed for identified risks to people, however some needed further detail to include all the control measures in place. Assessments covered areas such as smoking, adult protection, aggression, self –medication and falling. Discussion with staff indicates that staff may need further information about people’s needs. One person had a risk assessment for falls but a member of staff spoken with was unaware that anyone at the home was assessed as being at risk. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are generally supported to exercise choice so that they are able to do things they enjoy. People have good quality food that they enjoy. EVIDENCE: Discussion with the manager, staff and outcomes from the home’s resident satisfaction survey indicates that some people who live at the home are difficult to engage in activities. The expert by experience spoke with several people who commented that they preferred not to get involved in activities. One said he liked being able to stay in his room watching TV, he gets on with other residents, but prefers to be on his own in his room. Another said they were not really interested in activities but would like to go on holiday. 60 of people who live at the home completed the survey, only 40 of people said they wanted to be involved in activities. Some people prefer to just read, watch the television or spend time in their rooms. As a result of the survey the The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 14 home has made some changes, this includes introducing a weekly social evening and twice a month fish and chip supper. One person spoken with said ‘everyone is happy here’. Some people attend activities away from the home, for example BITA, (Birmingham Industrial Therapy Association). An internal activity programme is in place, however this is not individualised and is based around group activities. It includes music, relaxation, quiz’s, café visits, board games, shopping, quoits and skittles. Records show that one person often goes to church. Since the last inspection the home has purchased a bingo machine and people were playing bingo on the afternoon of our visit. One person spoken with was very pleased as he had won a prize of a box of chocolates. Staff said that they often take people out to the pub or shopping and that during the summer a trip to Weston had been arranged. However one staff commented on our survey form that they thought more entertainment was needed for people. The manager recognises that people’s engagement in activities could be improved. The annual quality assurance assessment indicates that the home is hoping to improve people’s lifestyles by introducing elements of the ‘Eden Way’. This is an American concept looking at de-institutionalising culture and environment by the introduction of people giving care to other living things, this can be plants, animals or people. People have information in their care plan detailing the arrangements for contact with significant people in their lives such as family or friends. Visiting times to the home are flexible. We saw that the home has some internal security cameras, pictures from these are relayed to a television in the office. One of the cameras is in the main lounge and so staff or visitors in the office could see people in the lounge. This is an invasion of privacy. The manager said the camera was for security for the rear door and agreed to look at changing the camera angle to show the door only and not people in the lounge. People’s cigarettes and lighters are looked after by staff and handed out every hour. The manager said this helped keep people safe as the home has had two recent small fires. The expert by experience said ‘although this seems restrictive it is probably appropriate to the client group, as otherwise they might smoke all their cigarettes too quickly or disputes could arise’. The menu is often discussed with people, either at residents’ meetings or annually as part of a quality assurance review. A specific satisfaction survey has also recently been introduced for people to comment about the food. This was completed in July and indicates that people are generally happy with the food on offer. The menus provide lots of choice and it appears well balanced The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 15 and nutritional. Lunch time practice was observed, two options were available a meat or vegetarian option. People were offered a choice of what they wanted and also second helpings if they wanted. Fruit was observed to be available to people in the dining room so that they could just help themselves. Food is served from a trolley in the dining room. Several people arrived late for lunch and so it would be beneficial if the home had the facilities of a ‘hostess’ type trolley so that food could be kept warm for people who arrive late. A hot urn is available in the dining room, chained to the wall to make sure it is safe. This enables people to make themselves a hot drink during the day should they wish to. Staff spoken with said: ‘food is good quality, home has a new cook whose cooking is fantastic, residents like it’. ‘food is good, residents are always thanking the cook’. People who live at the home told us: ‘food is good, cannot fault it’. ‘lunch was nice’. ‘we get a choice’. One person told the expert by experience that the food in the home was improving. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems in place need to be developed to ensure that people’s health needs are met consistently. EVIDENCE: Many of the people at the home do require some support regarding personal care, this was evident in their care plans. One staff spoken with showed good knowledge in regards to meeting one person’s hair and skin care with regards to their cultural needs. Since the last key inspection a hairdresser now visits monthly as a result of the home listening to the residents satisfaction survey. The healthcare provided to three people was case tracked. Some people had some good information in their care plans, for example about their health needs regarding diabetes or epilepsy. Another person’s assessment recorded that they had epilepsy but there was no care plan in place so that staff would know what support they needed to manage this. Discussion with one staff indicated they were unaware the person had epilepsy, this shows that a care plan needed to be in place. Discussion with the manager and staff indicates that training in diabetes and epilepsy has The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 17 not been undertaken by support workers in the home, this should be added to the homes training plan to ensure all staff know how to keep people healthy. Records sampled of the people who live in the home showed that people are registered with a local GP. Contact with other professionals such as the chiropodist, dentist and optician were usually documented to assist in meeting individual’s health needs. However, for one person there was no record of them going to the dentist in the last twelve months. The manager said they had not been due to their current mental health and the distress this may cause them. This needs to be recorded in their care plan. Records are kept to show that people’s blood pressure and weight is regularly monitored. For one person their weight record had fluctuated in the last four months, they had a nutritional screening tool in their file but it had not been completed. The manager said it was felt that the fluctuating weight may be due to inaccurate weighing scales and that arrangements were being made to get new ones. Comments from health professionals included ‘act appropriately as per GP recommendations’, and ‘always appear respectful and considerate with the way they discuss individual patients’. Medication is stored securely in the home and administered by qualified nurses. A monitored dosage system is used that is stored in individual blister packs for the day and time the medication is to be given so reducing the risk of errors being made. Medication Administration Records (MAR) sampled included a photograph of the person at the front so if unfamiliar staff were giving medication they would know who to give it to. Where handwritten amendments had been made to the MAR it was good that these had been checked by two staff to make sure they were accurate. An audit of the homes medication system had been undertaken by the exmanager of the home, it generally found that medication systems were satisfactory. Where recommendations had been made for improvements these were found to have been acted on. Some people at the home are prescribed medication to be taken ‘as required’. One person was prescribed three types of ‘as required’ medication but there was no guidance in their care plan about this. Guidance needs to be available so that staff know when the medication should be given to ensure that people get the medication they need. We noticed that for one person staff had not signed the medication record to confirm that they had one of their morning medications. It was initially unclear why they had not had this medication as staff had signed to say new stock of the medication had been received. However, checking of the home’s medication supplies showed that there was none of the medication in stock. On The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 18 investigation the manager found that the GP had not issued a prescription and therefore the chemist had not supplied the medication. When checking in the medication staff had not noticed there was none of this medication but had signed the record to say it had been supplied. The staff who had administered the morning medication had not taken any action to find out why this medication was not available. The homes systems for checking in medication needs to improve to ensure that any errors are resolved so that people get the medication they need to stay healthy. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for people to comment on the service are satisfactory and ensure they feel confident that their views are listened to and acted upon. Systems in place ensure staff have the knowledge and skills they need to protect people from harm. EVIDENCE: The home has a written complaints procedure that is available in the home. We have not received any complaints about the home since the last inspection. The annual quality assurance assessment (AQAA) completed by the manager records that the home has not received any complaints in the last twelve months. Surveys we received from people who live at the home indicate they know who to speak to if they are unhappy. One person told the expert by experience that he knew how to make a complaint and felt that any comments he makes about the service, e.g. regarding the menu, are listened to. The AQAA records that the home intends to develop a comment file for people who live at the home, this will be a useful tool for people to raise any ‘grumbles’ they may have about the home. Since our last inspection of the home an allegation had been made concerning the conduct of a member of staff. This was reported to us and to the duty social worker, as is appropriate to ensure that the people living there are safeguarded. As a precaution the staff was suspended whilst the allegation was investigated. The manager said that the social worker had completed the investigation and found no substance to the allegation. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 20 Records and discussion with staff show that the majority of staff had received training in adult protection and the prevention of abuse so they know how to keep the people living there safe from harm. Refresher training was arranged for all staff for the week following our inspection visit. Staff records show that staff have received information on the home’s whistle blowing policy. The home does manage some money on behalf of people. The finance records of two of the people living there were looked at. Receipts were kept of purchases and where money had been handed to people they had signed their record to show it had been received. It is good that the home has acted on the recommendation from the last inspection to introduce daily checks of people’s money. This improves the safeguards in place to make sure peoples money is looked after. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was comfortable, clean and well maintained and generally meets the needs of the people living in the home. EVIDENCE: A tour of the premises was undertaken that included sampling some people’s bedrooms. All areas were found to be safe and generally well maintained; it was evident that a programme of refurbishment and redecoration was in place as some areas had been redecorated and new furniture purchased. Some furniture and floor coverings in the home whilst well maintained and in good condition do not always give a ‘homely feel’. One health professional commented that there was ‘room for improvement to make it more homely’. The expert by experience said ‘There is very much a hospital feel to the physical environment, including furniture and décor, and this extends to the bedrooms. The corridor area around the front door, office and smoking room is rather cramped and very busy, particularly as residents are in and out of the smoking room. During my visit there were several ‘traffic jams’ in this area. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 22 Despite the physical environment, service users told me that they feel at home’. The sizes of bedrooms vary as some are single rooms and eight are shared rooms. This limits the options for the home to be able to offer people a single room. Shared rooms were observed to have screening for privacy. Ideally people should be offered single bedrooms. However it is recognised that people who completed the home’s resident’s satisfaction survey said they were happy to share a room. Bedrooms sampled were generally personalised and in good decorative order. Some bedrooms would benefit from being made more ‘homely’ in style as the style of floor covering and design of bed detracted from a homely style. One bedroom had a stained carpet but the manager said that new floor covering had been purchased and was due to be fitted soon. Peoples bedrooms are located on all three floors of the home, they are not ensuite however all rooms are close to toilets, bathrooms and shower rooms, which are available on all floors. All toilets and bathrooms have good hand washing facilities and are hygienically maintained. The home also benefits from having an assisted bathing facility on the ground floor for use by people with mobility difficulties. There is large amount of shared space in the home including, two lounges, a large dining area, smoking room and a well-used pretty rear garden with patios and a lawn. Since the last inspection new ‘wood effect’ flooring has been fitted in the main lounge making this room look nicer. The home was clean and free from offensive odours making it a pleasant place to live in. The laundry area is small yet is adequate to provide a safe system of laundry. People have their own colour coded baskets to reduce the risk of clothes getting mixed up. Good infection control procedures were seen to be in place throughout the home to reduce the risk of the spread of infection. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are usually supported by well trained staff that they know well. Recruitment practice needs to improve so that people are protected from the risk of having unsuitable staff working with them. EVIDENCE: The AQAA stated that care staff have either achieved a National Vocational Qualification (NVQ) or are working towards an NVQ, with four care staff achieving an NVQ level 3. This ensures that staff have the skills and knowledge to meet the needs of the people living there. Many staff were observed talking with people at the home, they were seen to be supportive. The expert by experience said ‘there is a ‘family’ atmosphere; this seems to be generated by the interactions between residents and staff, as I observed many friendly exchanges between staff and residents’. The staffing support includes trained nurses who are registered mental health nurses and care staff. There are usually four to five staff on duty each day and three staff at night. A cook and domestic staff are also employed. Discussion with the manager indicates that the home is working towards having a minimum of five staff on duty during the day due to an increase in the number The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 24 of people living at the home. The manager said they were recruiting two extra care staff and response to a recent recruitment advertisement had been good. Staff spoken with and staff surveys we received show that staff feel there are usually enough staff on duty to meet peoples needs. It is good that the home rarely has to use agency staff and that most staff have worked at the home for some time. This means that people who live at the home are usually supported by staff they know well. The recruitment records of three staff were looked at. These included the required recruitment records including evidence that a Criminal Record Bureau (CRB) check and written references had been obtained. However some improvement is needed to ensure the recruitment procedure is robust. For one member of staff although there were two written references available one was not from their last employer. The manager was also advised to amend the homes reference request forms to make clear the designation of the person completing the reference. Improvement is also needed to make sure that where staff have convictions evidence is available that a robust assessment has been made of their suitability to work at the home. A matrix of training for the staff team was available, this showed that the training programme includes first aid, moving and handling, fire safety, adult protection, health and safety, infection control and food hygiene. As required at the last inspection staff have now received training in managing violence and aggression. One member of staff told the expert by experience that the home will pay for and support staff to undertake more specialist training, e.g. end-of-life care. Records of new staff sampled showed they had received an induction to the home. The annual quality assurance assessment records that in the next twelve months the home plans to ask staff to complete a training feedback form to enable the home to evaluate the training they have received. Staff spoken with and staff surveys we received indicate that staff feel they get the training they need to meet peoples needs. Staff meeting minutes sampled indicated that meetings are held regularly so that staff know how to meet the needs of the people living there and what is happening in the home. Records sampled and staff surveys received showed that staff had regular, formal supervision with their manager to ensure they were supported in their role and their training and development needs were identified. The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management practices and arrangements for health and safety were sufficient to protect the people living in the home from the risk of injury. Quality assurance arrangements have improved to provide evidence of improvements of the services delivered to the people living there. EVIDENCE: The home has a registered manager who is a qualified nurse. The annual quality assurance assessment states that the manager has over 30 years experience as a nurse, with over 15 years as a manager. The Manager was on duty at the time of the inspection visit. One person who lives at the home said ‘manager is very kind, you can’t get a better manager, you get everything you want’. Staff commented ‘manager is very approachable, can speak to her’, and ‘she’s okay, any concerns and she The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 26 will respond, would feel confident in raising concerns’. The owner visits the home monthly and writes a report on her findings, to make sure the home is being well managed. Reports show that people who live at the home and staff are spoken with during these visits. The manager also completes a weekly management report to send to the owner to update her on any issues at the home. The manager said that other quality assurance systems in place include the ex manager of the home completing audits every 3-4 months, the last one was a medication audit. Questionnaires are completed by people who live at the home and manager has completed a report of their responses, this indicates 60 of people completed the survey. The report indicates what action the home has taken as a result of what people said. Fire records showed that an engineer regularly services the fire equipment so it is well maintained. A fire risk assessment was in place that stated what action was needed to minimise the risks of there being a fire. Regular fire drills are held so that staff and the people living there would know what to do of there was a fire. Staff test the fire equipment regularly to make sure it is working. Staff test the water temperatures weekly to make sure these are not too hot or cold. Records showed that these were within the safe limits so that people are not at risk of being scalded. Certificates were available to show that the lift, adapted bath, gas and electrical installations in the home were safe for people to use. Where one member of staff had an accident on the stairs records showed this had been appropriately reported to the Health and Safety Executive and action taken to reduce the risk of future accidents to people using the stairs. The Firs Nursing Home DS0000024840.V371291.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 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 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 3 3 X X 3 X The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 28 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 YA6 Regulation 15 Requirement Where people have an assessed need, there must be a plan of care in place so that staff have information on how to meet the persons needs. Systems for assessing risk to people need to improve so that staff know about any risks to people and can take action to keep them safe. Where people have an identified health condition a care plan must be in place so that staff have information on how to support people to stay healthy. The system of checking medication into the home needs to improve to ensure any errors are spotted by staff so that people get the medication they are prescribed. Recruitment procedures need to be improved to ensure that procedures are robust and people are protected from having unsuitable staff working with them. Timescale for action 02/11/08 2 YA9 13(4) 02/11/08 3 YA19 12(1) 02/11/08 4 YA20 13(2) 02/11/08 5 YA34 19 02/11/08 The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 29 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 YA1 Good Practice Recommendations The service user guide should be updated so that people have more information about the home, to include how much it costs to live there. This will help people decide if they would like to live at the home. Care plans would benefit from further detail so that staff know exactly what type of ‘assistance’ people need. The format for assessing people’s mobility needs should be extended to include more areas, for example people’s ability to access the home’s bathing facilities. Review the use of security cameras in the home so that they do not invade people’s privacy. Where people do not attend annual health checks such as the dentist the reason for this should be recorded in their care plan. Nutritional screening should be undertaken where peoples weight has fluctuated to ensure they receive the support they need to stay healthy. Additional training for care staff should be arranged about health conditions such as epilepsy and diabetes so that staff have more knowledge to meet peoples needs. Where people are prescribed medication ‘as required’ guidance needs to be available so that staff know when the medication should be given to ensure that people get the medication they need. Consider, with consultation of people who live at the home, how people’s bedrooms can be improved so that they are more homely in style. 2 3 4 5 6 7 8 YA6 YA6 YA16 YA19 YA19 YA19 YA20 9 YA26 The Firs Nursing Home DS0000024840.V371291.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000024840.V371291.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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