Inspection on 21/09/09 for The Firs Nursing Home

This inspection was carried out on 21st September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 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 02/09/08

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 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 The Firs Nursing Home 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY Lead Inspector Kerry Coulter Key Unannounced Inspection 21st September 2009 09:00 The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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 Doreen Blake Care Home 25 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (25) of places The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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. 2nd September 2008 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. Copies of previous inspection reports are available in the home for people 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 hair-dressing. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over one day. The home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake 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 provision 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 the Annual Quality Assurance Assessment (AQAA).The AQAA provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by four people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there, the manager, a relative and staff were spoken with. Surveys were sent to some of the people living there, care professionals and staff. Their views stated in the surveys are reflected in this report. What the service does well: Staff interactions with people were good and people got the support they needed. There is a choice of healthy food so that people are supported in their diet to keep well. There is an open visitor’s policy. One relative told us “The staff always make us feel 100 welcome’’. Staff take notice when people seem unwell so that they get the help they need to be well. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 6 The home has good infection control procedures in place to help reduce the risk of people becoming ill. Regular checks are made of equipment in the home to ensure it is safe to use and people are not at risk of being hurt. People who live at the home are happy living there. They told us: ‘’I like living here”. “It’s a good place”. “The food’s good, I like it a lot”. “It’s very nice”. “I am happy in here”, I like it”. What has improved since the last inspection? What they could do better: 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 there. Risk assessments need to be developed further so that the risks to the safety and well being of people can be reduced as much as possible. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 7 Staff should have more detailed information in care plans so they know how to support people to meet their individual needs. The use of security cameras in the home needs to be reviewed so that they do not invade people’s privacy. Staff need to help people to develop their skills and experience new things so improving their quality of life. Develop the activities on offer to people and review the systems in place for recording the activities that people participate in, to help ensure people are doing the things they enjoy. Review the arrangements in place to help make sure people know how to make a complaint. Where there are suspicions of abuse or an allegation of abuse is made this must be notified to the Local Authority and the Commission under safeguarding procedures. This will help protect people from abuse. The home must make sure all the required recruitment records are available to demonstrate a robust recruitment procedure has been followed. Develop the quality assurance systems in place so that the home is improved for the benefit of people living there. The home’s fire risk assessment should be reviewed to make sure fire precautions are satisfactory. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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.V377712.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 4 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements usually ensure that people can be confident their needs will be met on admission but people do not always receive the information they need about the home. EVIDENCE: People who live at the home have a copy of the service user guide that tells them about the home. We looked at the guide at our last visit and found it did not tell people everything they needed to know about the home. At this visit we found that the guide had not been updated. It was quite brief in content and much of the information could have been about any home. There was very little information about how much it costs to live here and house rules. There were no photographs of the home so people thinking of moving there would not know what it looked like. The majority of people who completed a survey told us that they had not received enough information about the home. Discussion with the manager indicates that it is planned to update the guide. We looked at the admission procedure followed for one person who had moved into the home since we last visited. The home had obtained a copy of their care plan from their previous home and had also obtained assessment The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 10 information from care professionals. The manager and a nurse told us that the previous manager of the home had completed an assessment of the persons needs. A copy of the assessment could not be located during our visit. An initial assessment was available for one person who had not yet moved into the home. The manager told us that any potential new person would have an assessment of their needs and would have the opportunity to visit before moving in. Surveys from people did not indicate that they had all received a contract with the home. Contracts were available in all of the four care files sampled. However some contracts had not been signed by the person and some did not actually record the fees. The manager was unsure about the fees that were being paid and what should be charged. A fee structure needs to be implemented based on the needs of the person and the care offered. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not always have the information they need to support people to meet their individual needs and keep them safe. EVIDENCE: The records of four of the people who live there were looked at. These included individual care plans to give staff information about how to support the person to meet their needs. The care plans in place were in a new format that had been introduced by the new manager. They covered areas such as health, personal care, nutrition, mobility, social and mental health needs. We found that some information in the care plans was very good and gave staff clear information about how to meet people’s needs, for example what to do if the person had a seizure. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 12 Care plans included good detail as to how staff are to look for signs of their change in mood, which could indicate that their mental health is deteriorating. However, some plans about other support people needed were not very detailed. For example, one person identified at being of risk of pressure sores did not have a plan in place that informed staff what support was needed to prevent sores occurring. Plans also needed further details in regard to people’s lifestyles. For example, support needed to participate in activities and to maintain and develop contact with friends and family. It is good that people have their own copy of their care plan. Where able, people are given the opportunity to sign their plan to say they agree to it. People also have the opportunity to attend review meetings regarding their care needs. People told us they receive the care and support they need. One member of staff told us that care planning had improved as information in them was now up to date. Staff were observed during the day talking to individuals and monitoring their well being and mood. Records and discussions with staff indicate that people are encouraged to make choices and decisions about their lives. We observed people being given choices, for example about what to eat and drink at meal times. Meetings are usually held monthly with people who live at the home. Areas for discussion include the activities people would like to do, satisfaction with meals, good hygiene practice, trips out and rules on smoking. Minutes of the last meeting showed there was a good level of attendance with sixteen people at the meeting. The minutes of meetings are quite brief and would benefit from more detail so that people know what was discussed and what is being done about agreed actions. A new risk assessment format had recently been introduced that identifies where a person may be at risk due to their mental health and behaviour. For example it identifies if the person is a suicide risk, is at risk of neglecting themselves or if their behaviour poses a risk to other people. The document was concise in identifying if there was a risk but needed further development. Where a risk is identified there needs to be a risk management plan in place that informs staff of the action needed to reduce the risk. Other risk assessments sampled included pressure care, self medication, mobility and smoking. People had been involved in some of their risk assessments and it is an area of good practice that their comments are included in the assessment. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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): This is what people staying in this care home experience: 11, 12, 13, 15, 16 and 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements may not always ensure that the people living there experience a meaningful lifestyle. EVIDENCE: Care plans sampled contained little information about people’s opportunities for personal development. Records showed that one person at the home was able to make themselves a hot drink before moving to the home but this information was not included in their care plan. The manager told us this was not included as the home did not have any facilities for the person to continue doing this. The home should consider how people can be supported to maintain and develop new skills so that they can feel good about themselves and are as independent as possible. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 14 Surveys from people in regard to activities at the home were very varied, some people were happy but some were not. Some staff commented in their surveys that more activities were needed. The Annual Quality Assurance Assessment identified that the home was working towards improving the activities on offer to people. It told us that since we last visited the home has purchased a games console for people to use and has applied for bus passes so that people can go out more. Records sampled during the visit did not indicate that there were many activities on offer to people. However discussion with staff and the manager indicates that more activities are on offer but that they are not always recorded. Staff spoken with said that there had been trips out to the local park, to Stourport and to the pub. During our visit several people were seen to be taking part in a quiz and were enjoying this. There was a board outside the dining room which said that bingo was to take place that afternoon, this didn’t take place. The garden is very well kept and the manager commented that two people are very keen on gardening, and are out in all weathers tending the garden, particularly the vegetable plot. Some of the vegetables grown have been used in the homes kitchen and enjoyed by all. The home has an open visiting policy. One relative told us “The staff always make us feel 100 welcome. They are very helpful to all the family”. ‘’He is extremely well looked after. We are 100 confident he is in the right place”. At our last visit we saw that the home had some internal security cameras, pictures from these are relayed to a monitor in the office. The cameras were still in use at this visit. As at our last visit 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 people’s privacy and the use of the camera in this area should be reviewed. The home has a new chef in place and discussions with people and staff indicate that menus have been improved. People had brought up at one of their meetings that they had sandwiches too often at tea time. People have been listened to and there are now other alternatives available. The menus have been changed to cater for people’s preferred tastes, including curries, roast dinners and a cooked brunch on a Sunday. The menu is changed on a four weekly cycle and information on the daily menu is available in the dining room. All bakery and pastry items are home made and it was good to see cakes, custards and puddings are available to people that meet their diabetic dietary needs. Lunch time practice was observed. The dining room appeared clinical and uninviting. Tables were laid but the table cloths were quite threadbare. Improvement to the dining room would help to make the dining experience more pleasurable for people. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 15 Staff interactions with people during the meal were generally good and people got the support they needed. One member of staff was serving the meal and some people were getting quite anxious whilst waiting for their food. One person had to be escorted from the dining room, they became very upset because they had to wait for their lunch. Staff assured them that they would bring them their meal. People who live at the home told us “I like living here”, “It’s a good place”, “The food is okay”, “The food’s good, I like it a lot”, “It’s nice food, I like it’’. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements usually ensure that the personal and health care needs of the people living there are met EVIDENCE: Care plans sampled had information about the support people need with their personal care. Some of the plans were good in the detail included but others would benefit from further development. The people living there were dressed in individual styles that were appropriate to their age, gender, the weather and the activities they were doing. The healthcare provided to four people was case tracked. People had some good information in their care plans about their health needs, for example regarding diabetes or epilepsy. Since we last visited care staff have received training in epilepsy and the manager is arranging diabetes training. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 17 Care plans sampled included the frequency that people need to attend health check ups, for example with the dentist and optician. Detailed records are kept of health appointments attended. Records showed that staff supported people to go to the GP when they are unwell and to have annual health checks. Nutritional screening had been undertaken for people but the assessments had not been dated. This should be done so it is clear these are up to date. Regular monitoring of peoples weight is undertaken. One person had lost weight when last weighed and there was no indication in their records that this was planned. A review of the person’s nutritional assessment is needed to establish if they need input from the dietician. Two health professionals told us that the home usually meets people’s healthcare needs and seek and act on advice. One relative spoken with felt that their relatives mental health had improved since moving to the home, they told us “The treatment is brilliant. He’s more responsive now than twelve months ago, you can have a good conversation with him now” and ‘’We as a family are very confident with the treatment he gets here”. Medication is stored securely in the home and administered by qualified nurses. Previously people had to queue outside the room where medication was stored to get their medication. This practice was a little institutionalised and this has now been changed. A medication trolley has been purchased and people’s medication is now taken to them. A new fridge has also been purchased specifically for the storage of medication. This will help to ensure that medication is stored at safe temperatures. 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. Some people at the home are prescribed medication to be taken ‘as required’. Guidance was available in people’s care plan so that staff would know when this medication should be given. It would be beneficial if a copy of the guidance was kept with people’s MARs for ease of reference. Records show that people at the home have regular medication reviews to make sure the medication they are prescribed is still suitable for them. A pharmacist from the Primary Care Trust (PCT) has visited the home and completed audits of the medication system. These indicate that generally the medication system in the home is safe and where recommendations have been made the home has met these or is working towards this. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements may not always ensure that the views of the people living there are listened to and they are protected from abuse and harm which could impact on their well being. EVIDENCE: The home has a complaints procedure that is on display in the home. However only one person who returned a survey to us said they knew how to make a complaint. We raised this with the manager during our visit and were told that the complaints procedure would be explained to people at their next meeting. One relative told us “We are able to talk to any of the staff if we had any concerns”. The Annual Quality Assurance Assessment completed last year by the home’s previous manager told us that it was intended to develop a comment file for people who live at the home. This would be a useful tool for people to raise any ‘grumbles’ they may have about the home but had not yet been done. We have not received any complaints about the home in the last twelve months. The home’s complaint log shows that the home has received two complaints. Records indicated that these had been investigated and people made aware of the outcome of their complaint. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 19 Since the last inspection one person at the home had made a complaint that should have been notified to the Local Authority and ourselves under safeguarding procedures. The correct procedures were not followed and the home conducted their own investigations before notifying the appropriate authorities. Following this, the manager has taken steps to help make sure the correct procedures would be followed in future. Staff at the home have received training in safeguarding people from abuse and further training is arranged. Staff spoken with during our visit were aware of the need to report any suspicions of abuse to make sure people are protected. 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. The times had been changed when people can get access to their money. People spoken with seemed happy with the new system. One person told us “Its like a bank, I know when I can get my money”. The manager has provided staff with information on the Mental Capacity Act and Deprivation of Liberty Safeguards and is arranging more formal training on this. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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: The home is clean, odour free and well maintained. There is an ongoing programme of maintenance. Communal areas have been repainted, and the manager has tried to make both of the lounges more homely by buying new pictures and coffee tables. Both of the lounge areas are popular with people and were well used throughout the day. People told us “It’s very nice”, “I am happy in here”, “I like it”. People who smoke have a designated smoking room and there is a covered area in the garden with seating which some people prefer. The communal areas seen were light, comfortably furnished and one of the lounge areas The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 21 opened onto the garden. Corridor areas are dark, dimly lit and there are a confusing number of doors opening off the corridors. A member of staff commented “It’s like a maze but you do get used to it” and “The corridors are quite dark, the lights are not very bright”. The home should look to brightening the corridors and ensuring they are well lit so that people can find their way around the home more easily and safely. The dining room is very uninviting, cold and seems quite clinical. The home should look to making the room more homely by changing the décor and furnishings. The tables could be better laid to make dining a more pleasurable experience for people. The kitchen and laundry areas were very clean and orderly, and well maintained with all the relevant equipment in place. Since the last inspection the home has completely refurbished the bath and shower facilities. The main bathroom now has an adapted bath and allows staff to assist people using the bathroom more easily. Staff said: “The new bathroom is much better, people whose mobility is poor are able to use the bath, and we have more room to help them”. The shower rooms on each floor have been completely renovated, the baths have been removed and large walk-in shower facilities with seats, and non-slip flooring have been installed. One person told us “I like going in the shower, I can do it by myself”. Staff confirmed that having the new showers has made life easier for people. “We have seen that some residents have become more independent, before we had to help them but now they can manage on their own, with us waiting outside just in case they need us”. Six bedrooms were seen, of these three were shared rooms. There was a marked difference in the personalisation of the bedrooms, some were very welcoming and had photos, pictures and ornaments on display. Some people had brought their own favourite pieces of furniture into the rooms and had decorated their bedroom in their own style. Other bedrooms were sparsely decorated, had the basic furniture provided by the home and had no personal items on display. Staff said: “We do encourage them to make the bedrooms their own, as you can see some have done this but others are not interested and don’t want to spend their money on their bedrooms” “We have tried to make the rooms nicer with matching curtains, quilt covers and valances”. One person who shares a room said “I like sharing, its good company” and “I have all my things here, I like listening to the radio and reading”. Other people spoken to said “I like my room”, “I got my photos to look at” and “My bed is comfy, I like it”. Staff said: “There has never been an issue with people sharing rooms. When a single room has become vacant, they don’t want to move as they like the company”. Infection control is well managed within the home. A recent audit of infection control by an external healthcare professional saw the home achieve 98 compliance. Hand wash, antibacterial hand gel, paper towels and hand dryers The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 22 were present in all relevant areas. Gloves and aprons were in numerous supply for the staff, and yellow bags for disposal of waste were in all the waste bins seen. The cleaning products cupboard was locked, and no cleaning agents had been left unattended in the home which could have posed a risk to people. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of 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 Annual Quality Assurance Assessment told us that over half of the care staff have a National Vocational Qualification in Care. Staff who do not have this have been enrolled to do this. This should ensure that staff have the qualifications and skills to meet the needs of the people living there. Observed staff interactions with people were good and discussions with people indicate staff are well liked. One person told us ‘’They are nice’’. Staff spoken with had a good understanding of people’s needs. 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. Staff had The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 24 variable views in their surveys with regards to the staffing levels in the home. However surveys from people who live there told us that staff were available when they need them. Discussion with the manager and staff rotas indicate there are now usually five staff on duty at weekends. The manager said this helps to make sure people who need to can go out with staff support, for example to the pub. We looked at the recruitment records for four members of staff, these had most of the required information. For three staff there were Criminal Record Bureau (CRB) checks available. For one staff the home was still awaiting their full CRB to be returned and the manager said that this staff was therefore working under supervision. We looked at the homes procedure regarding recruitment and found that it did not include the arrangements for staff working in the home before the full check had been received. One member of staff had declared they had committed offences. The manager said these were discussed at interview and that due to the nature of the offences and when they occurred that the staff was safe to work with people. A written risk assessment regarding this should be available in the staff file. In some files there was not satisfactory evidence of staff’s identity. The manager told us that she had seen staffs proof of identity and was not sure why the evidence was not in their file. Surveys and discussions with staff indicate that training arrangements have improved. One staff told us ‘’ The manager is good at putting people on training’’ and ‘’We are getting more training’’. 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 stated earlier in this report staff have had more training regarding people’s health needs. One of the nurses told us they were booked to go on pressure care training. The manager told us that arrangements were also being made for care staff to have specific training regarding mental health. Induction records were available in three of the staff files sampled. For one member of staff there was not a record of induction. The manager told us that an induction had been completed but she was unsure where the record was. 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. Discussion with the manager and staff surveys indicate that the system for staff supervision has improved. Due to the previous manager leaving there had been a gap in some staff having this but the new manager has made sure that staff are now having supervision. One staff told us ‘’ Supervision is the best I have had for a long time’’. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements may not always ensure that the people living there benefit from a well run home, which could impact on their health, safety and welfare. EVIDENCE: The home has a new manager who has successfully completed registration with us. The manager is a qualified nurse who has many years experience of working with people who have mental health needs. The manager is currently undertaking a National Vocational Qualification in management. Throughout the inspection the manager demonstrated a commitment to wanting to improve things for the people who live there. The manager completed and sent us the home’s Annual Quality Assurance Assessment when we asked for it. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 26 Staff spoken with were positive about the manager. Their comments included“New manager is very good, has made a lot of changes for the better.’’ ‘’It’s a lot better run now. More activities sorted out. At the end of the day it’s a lot better. The manager is very approachable. She listens to the staff, she’s brilliant’’. Discussion with the manager indicates that there is no deputy manager and the manager is expected to be on call most of the time when not on duty. Having a deputy in post would give the manager the support she needs to make more improvements at the home. 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. However the detail in the report is very brief and does not indicate what was discussed and if people are happy. There should also be an action plan completed to address any issues identified. People who live at the home have the opportunity to complete surveys to say what they like and don’t like about the home. Sampled surveys were generally positive about the home. It would be good if the outcome of the surveys could be produced into a short report that is made available to read. The manager said the home has blank copies of surveys for relatives and professionals but that these had not been sent out recently. The manager said she intends to improve on quality assurance systems to include the content and format of the surveys in place. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. We looked at a selection of maintenance and servicing records, all were up to date and demonstrate that systems are in place to ensure the equipment is safe. The environmental health officer conducted an audit of the home’s food hygiene arrangements in December 2008 and found that these were good. Fire and smoke alarms were present throughout the home, and the fire alarm was tested during the inspection. The fire procedure is on display in the home and staff spoken to understood what they had to do in the event of a fire. The home had previously notified us of a small fire that occurred in one of the bins in a bathroom. Since then metal bins have been provided. The home’s fire risk assessment had been reviewed in January 2009. This needs to be reviewed in light of the recent fire that occurred in the home to make sure fire precautions are satisfactory. The home has risk assessed that the gate leading out of the garden onto the road needs to be locked to ensure peoples safety. However during our visit we The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 27 saw this gate was unlocked and staff were told twice about this but it remained open. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 28 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 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 2 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 2 X Version 5.3 Page 29 The Firs Nursing Home DS0000024840.V377712.R01.S.doc 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 YA9 Regulation 13(4) Requirement Improvements are needed to the home’s risk assessment procedures. So that people can take risks in their lives but be as safe as possible. Where there are suspicions of abuse or an allegation of abuse is made this must be notified to the Local Authority and the Commission under safeguarding procedures. Timescale for action 21/11/09 2 YA23 13(6) 21/10/09 3 YA34 19 This will help protect people from abuse. The required recruitment 21/11/09 records must be available in the home. So that the home can demonstrate that a robust recruitment procedure has been followed. The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 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 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. People should be provided with a contract that details how much it costs to live at the home. They should also have the opportunity to sign it. This will help to ensure people are aware of the terms and conditions of their stay at the home. Care plans need to be further developed so that staff have all the information they need to enable them to support people in the way they require and prefer. The home should consider how people can be supported to maintain and develop new skills so that they can feel good about themselves and are as independent as possible. Develop the activities on offer to people and review the systems in place for recording the activities that people participate in, to help ensure people are doing the things they enjoy. Review the use of security cameras in the home so that they do not invade people’s privacy. Review the appearance of the dining room and the arrangements for serving meals to help make the dining experience more pleasurable for people. Nutritional screening should be reviewed where people’s weight has fluctuated to ensure they receive the support they need to stay healthy. Take action to help ensure people are aware of how to make a complaint so that their views are listened to. The home should look to brightening the corridors and DS0000024840.V377712.R01.S.doc Version 5.3 Page 31 2 YA5 3 YA6 4 YA11 5 YA12 6 7 YA16 YA17 8 YA19 9 10 YA22 YA24 The Firs Nursing Home ensuring they are well lit so that people can find their way around the home more easily and safely. 11 YA34 Undertake a review of the recruitment policy and procedure. To make sure it includes the arrangements for staff working in the home before their full CRB check is received and risk assessment for staff who have committed offences. This will help to protect people of having unsuitable staff working with them. Develop the quality assurance systems in place so that the home is improved for the benefit of people living there. The home’s fire risk assessment should be reviewed to make sure fire precautions are satisfactory. A review of procedures should be undertaken to make sure that the home’s own risk assessments regarding the safety of the side gate are followed. 12 13 14 YA39 YA42 YA42 The Firs Nursing Home DS0000024840.V377712.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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