Inspection on 23/06/05 for The Firs Nursing Home

This inspection was carried out on 23rd June 2005.

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

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

Other inspections for this house

The Firs Nursing Home 04/12/08

The Firs Nursing Home 26/11/07

The Firs Nursing Home 19/04/07

The Firs Nursing Home 11/01/07

The Firs Nursing Home 23/05/06

The Firs Nursing Home 15/02/06

The Firs Nursing Home 27/01/05

The Firs Nursing Home 01/09/04

The Firs Nursing Home 22/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 The Firs Nursing Home Kings Hill Great Cornard Sudbury, Suffolk CO10 0EH Lead Inspector Mary Jeffries Unannounced 23 June 2005 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 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 Stationary 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 I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Firs Nursing Home Address Kings Hill Great Cornard Sudbury Suffolk CO10 0EH 01787 371301 01787 880603 The.firs@craegmoor.co.uk Craegmoor Healthcare Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Judy Herring Care Home 23 Category(ies) of LD, Learning disability (23) registration, with number of places The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27/01/2005 Brief Description of the Service: The Firs is a care home with nursing for adults with a learning disability. Some of the service users are older adults who originally came from the closure of a long stay hospital. More recently the home has admitted a number of younger adults to the home. The Firs is a purpose built care home. The home is on two floors with a shaft lift connecting the two. The home has two interconnecting lounges and a separate dining room. The home has a mixture of single and double rooms. The premises are set on a compact site that allows for parking of several cars to the front and a garden that is used by the service users in summer. Daytime activities tend to be provided by the home and are based at the home. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during one late afternoon and early evening in June. It was approximately four hours in length. Two inspectors conducted the inspection, and were assisted by the home’s manager. A carer and a bank nurse working in the home on that occasion contributed to the inspection. Individual time was spent with four service users with varying levels of verbal communication, and their records were inspected. Time was also spent in the communal areas of the home, observing service users and their interactions with care staff. Two complaints, received prior to the inspection were investigated on this occasion, and were upheld. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 The general findings of this inspection indicated that the needs of the service users were being appropriately met at the home. Prospective service users and their relatives do not have all the information that they should have to make an informed choice about where to live . EVIDENCE: The home provides care for service users with a range of learning disabilities, including a number who are now over 65, and some with early onset dementia. A requirement was made at the last inspection that the Statement of Purpose be updated to include all up to date information as required in Schedule 1 of The Care Homes Regulations 2001 (including the sizes of all of the rooms), and that the document be is kept consistently up to date and under review. It was noted then that the Statement of Purpose had not been correct at the last three inspections. On this occasion the manager advised that a copy had been sent to the previous inspector. Records show that no revised Statement of Purpose had been received by the CSCI following the last inspection. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,9,10 Service user’s can expect to have a care plan that is detailed, comprehensive and is regularly reviewed. They can expect to have risk assessments undertaken. EVIDENCE: The care plans were stored in an office near the front door of the home in a lockable filing cabinet accessible to the staff containing service user’s files was found to be unlocked at the time of the inspection, with the key in the lock. A calm atmosphere was evident on the day of inspection, with staff interacting proactively and appropriately with the service users. One service user was heard to be vocalising above the others through out the day, this did not appear to disturb other service users on this occasion. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 9 Four service users files were inspected. All had care plans which were informative and well completed by staff. These documents evidenced that appropriate levels of thought had gone into many areas of care practice with regard to meeting the needs of service users. They included life histories, social plans, communication strategies, family involvement, eating and drinking preferences, healthcare records, risk assessments and daily entries by both nursing and care staff. Each service user had a named nurse whose responsibility it was to ensure the care plans remained up to date and reviewed. Care plans seen had been regularly reviewed on a monthly basis. Well documented risk assessments were present in all care records examined. Subjects covered included service users’ ability to use the nurse call systems, and healthcare matters. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 Service users who require assistance eating, or who need to receive peg feeding can expect to receive a good level of care. Service users can expect to enjoy privacy. EVIDENCE: A review a month prior to the inspection of one service user, whose record identifies can be increasingly vocal and is difficult to pacify, recorded that they had spent a lot of time in their room due to shouting increasing when they were downstairs. The manager advised that the service user is routinely brought down to the communal areas each day, however, the daily notes for this service user did not routinely detail how much time the service user was spending alone in their room. The notes of this service user’s most recent review were not on file. Another service user tracked was said by the manager as often settled in their room. During individual time spent with these service users and they appeared to be relaxed and comfortable. Their ability to interact with other service users was limited by their communication. One articulate service user spoke of choosing to spend some time in their room, but also enjoying special social The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 11 events organised by the home, and some time with other service users. This service user said that they thought their privacy was respected, and that staff would not just come into their room without knocking. Records showed that four service users have peg feeds. The procedure for this was discussed with a the manager. Care staff had been trained to peg fed. Procedures were good. The manager advised that the home was in close liaison with the district nurse. The evening meal was observed, and staff were seen to be very focused and interacting well with Service Users. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Service users can expect to be referred appropriately to medical services as and when required, and that their needs will have been clearly identified. While personal support and staffs ability to relate to service users appeared to be generally good, the absence of some service user’s prescribed medication in the home at the time of the inspection, and the recent shortages of staff mean that service users physical and emotional needs had not been consistently met. EVIDENCE: All interactions witnessed between staff and service users were appropriate and friendly. Staff interacted well with the service users during the inspection visit. Service users spoken with by the inspectors were appropriately dressed (for what was a very hot day), they were happy, and they appeared relaxed. Two service users with very limited verbal communication were observed talking with staff on a one to one basis. Both appeared comfortable and relaxed, and responded with clear recognition of the staff member. Healthcare and nursing risk assessments had been appropriately undertaken and regularly reviewed indicating that nursing care practices were sound. Four service users records inspected showed appropriate referrals to other health care professionals. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 13 Two of these service users were noted or described as spending significant periods of time in their own rooms, but daily records gave no routine indication of how much time they spent in their own rooms. For one, records of activities they joined in were recorded. The bank nurse was responsible for medication administration on the day of the inspection. The refrigerator for medication was found to be running at 8 degrees Celsius and was frosted up. The Drug room was not locked. The drug cupboard was not tidy. 4 tubes of medicinal creams had not been dated when opened. These normally have to be used within 28 days of opening, and this cannot be easily judged if tubes are not dated. Medication records for four Service Users were inspected. One service user had gaps in the signatures for the administration of Canesten cream. This was not a PRN medication, that is a medication to be used as required. Another service user had a prescription for Diazepam, to be taken twice a day. This was marked on the Medical Administration Record Sheet as unavailable from 6th June to 23rd June. The manager had advised that this medication was PRN, and that the home tries to use PRN medication at a minimum level. This service users care plan review described this medication as PRN. This medication was not described as PRN on the medical administration records. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home’s lack of a suitable whilstle blowing policy means that service users are not as well protected from unsuitable care practices as they should be. EVIDENCE: A copy of the home’s whistle blowing policy, which is a Craegmore Healthcare Policy, dated February 2005, was provided. It does not address the shortfalls identified at the last inspection as a requirement. The Registered Manager advised that they have no input into the policy design. Two complaints, one anonymous, had been received prior to the inspection. One of these was about staffing levels. The other complaint was about noise from a service user being heard outside of the home. It was found that the home had fallen bellow its own planned minimum staffing levels on a number of occasions, and also that medication for a service user (thought to be the source of the sounds coming from the home over the days prior to the inspection) had not been available. The complaints were therefore upheld. One service user who was able to communicate well, said that if there was anything that they did not like they would be able to tell the staff, and that they sometimes did. The only example of something they didn’t like that they could think of was a type of food. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,29.30 The environment requires some redecoration and repair, and some greater care is required in daily practices so that paper towels are available in communal bathrooms and soap in table form is not left out. Service users rooms were seen to be personalised and attractive. EVIDENCE: The environment was clean and well presented on the day of inspection. It was a very hot day, and fans were in use and windows open to maintain a cool environment and reasonably cool service users, however a number of fire doors were found to be propped open. The home had a well maintained and attractive garden. One fence panel that was close to a tree had been displaced. The manager advised the home were in discussion with the neighbours regarding sharing the costs of a wall. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 16 The manager advised that one of the double bedrooms was used as double, the others had single occupancy. Four service user’s rooms were seen and were found to be in good decorative order, and personalised to the service users choice. The rooms were found to be tailored very well to individual service users needs and lifestyle. One service user had a wide screen TV in their room that they were very pleased with. They had lived in other places, and said that this was the best room they had ever had. They had various DVDs, momento’s and special sports clothes that reflected their interests, and said that they had everything they had asked for. Another service user who had no verbal communication skills had soft toys and twinkling lights in their room. This room, however, had a vinyl floor covering. The home had a schedule of decoration which was in progress. A number of carpets were seen to be badly marked. The manager advised that the home was awaiting new carpets. A number of the doors were badly scuffed and required some renovation. The kitchen, which is old and lacks certain basic facilities had not yet been replaced. The manager advised that temperature control valves had been put onto all hot water outlets, and temperature charts were in place. A number of outlets were checked and this was found to be the case. In one communal bathroom there was a bar of soap, this is a potential hazard in terms of spreading infection. Individual service users’ own soap should be returned to their rooms, and liquid soap available in communal bathrooms. In another shared bathroom there were no paper towels. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,36 Staffing numbers have at times been less than the homes planned levels. Staff are not receiving the proper management support they require. EVIDENCE: An anonymous complaint had been passed to The CSCI prior to the inspection to the effect that on two weekend days recently, the staffing levels had fallen below this minimum, and on one of these occasions there had only been 2 carers and 1 nurse. A further complaint was received on 21/6/05 from a complainant who had been concerned about the noise a service user had been heard making the previous day, on account to the disturbance to them self and also that the service user sounded distressed. They were concerned that this service user may not have been properly attended to. The manager advised that the home had recently had a large number of staff having babies, and also that they had been concerned about staffing levels. They advised that the home had been on a recruitment drive, and had started two new care staff. The manager advised that the minimum staffing level used was 4 care staff and 1 nurse in the morning, 3 care staff and 1 nurse in the afternoons, and 2 care staff and 1 nurse at night. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 18 The staffing rota was difficult to read, as tipex had been used to adjust planned to actual staffing levels. The rota was discussed with the manager. Levels on the homes rota were similar to those identified at previous inspections, but actual staffing had occasionally had fallen below the level that the manager described as minimum, including on the afternoon of the inspection. Five staff and one registered nurse were on the rota for on duty during the morning shift on the day of inspection and four care staff and one registered nurse to be on duty during the afternoon shift. The manager advised that 1 of the carers on the rota for the morning shift was off due to sickness, and two of the carers on the afternoon shift were off due to sickness. Additionally the manager, who is a nurse, was taking on some care duties on the afternoon of the inspection, as the nurse on duty had been sent home due to illness. A bank nurse was providing 3 hours cover. The manager advised that this is exceptional. Even so, between 5.30 and 8.30 pm. The staffing level was therefore below the minimum. Staff at work on the occasion of the inspection did appear very busy, and the manager was involved in providing care. The rota for five days prior to the inspection showed that staffing levels were down on four of the ten shifts, and on three of these occasions, by two carers. The repeat requirements around supervision, and failure to achieve prescribed medication support a finding that staffing has been insufficient at times. It was also noted that some of the same staff nurse was on duty during the morning and the afternoon shifts, and that two of the cares were working double shifts. This was discussed with the manager, who advised that providing the staff took the proper breaks they did not consider this to be a problem. Four staff files were inspected and were found to have all of the required documentation. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,41,42 The failure to implement formal staff supervision is not acceptable. Whilst the home has chosen not to use agency staff, and the staff group appeared to relate well to service users, the home has not had satisfactory contingency arrangements to achieve constant acceptable staffing levels during staff sickness. EVIDENCE: The homes Registration Certificate was seen to be incorrect. The certificate in the home was dated December 2003, and stated RM post vacant, number of service users 22. The Manager advised that the home accommodates 20 service Users, and that it is planned that this will eventually be 19, all in single rooms. Two service users currently share one double room. The rest were accommodated in single rooms. The home awaits a corrected certificate from the CSCI: this matter is being dealt with separately. A valid employers liability insurance certificate was on display. Fire extinguishers had been checked in July 2004. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 20 It was a very hot day, and the door to two service user’s rooms were found to be wedged open. A member of staff spoken with confirmed that staff meetings were held. They said that everyone can voice their opinion, and that both the manager and the deputy were approachable. Notes of a recent qualified Nurse Meeting were seen to have been signed by staff present. Of the four staff files inspected, three were carers and there was no record of formal supervision on file. One had only been employed for a month, however the other two had been employed since the previous autumn. One of these was spoken with. They confirmed that they had not yet received formal supervision, but that managers do come to them if they are doing something wrong. The manager advised that supervision was not up and running properly. A requirement to provide supervision has been identified in 6 previous reports. The last inspection report noted that there was evidence of an intention to start this process, that documentation had been designed and steps had been taken to decide who the supervisors were going to be. That report stated that formal supervision must now begin in earnest. The medicines cupboard, a sluice room and a small office with service users plans in it were all found to be unlocked. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x 3 x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 3 x 3 2 Standard No 11 12 13 14 15 16 17 x x x x x 3 3 Standard No 31 32 33 34 35 36 Score x x 2 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Firs Nursing Home Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 1 2 x I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 22 YES 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 1 Regulation 4&6 Requirement Timescale for action 31/08/05 2. 10 3. 4. 5. 6. 20 20 20 23 17(1)(b) & Data Protection Act. 13(2), 12(1)(a) 13(1)(b) 13(3) 12(5), 13(6) & 21 The registered persons must update the Statement of Purpose to include all up to date information as required in Schedule 1 of The Care Homes Regulations 2001 (including the sizes of all of the rooms) and ensure the document is kept consistently up to date and under review. The statement of purpose must also reflect the unique and specific services on offer at The Firs. This requirement is repeated from the last four inspections. Service user files must be kept in Immediate a secure place. Medicine supplies must be available as prescribed. Any medicine that is PRN must be clearly marked as PRN on medicine administarion records. Prescribed medicinal creams should be dated when opened. The registered persons must update the whistle blowing policy to ensure staff are aware of their Immediate and ongoing Immediate Immediate and ongoing 30/09/05 The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 23 7. 8. 9. 10. 11. 24 24 24 30 25 23(2)(o) 22(3)(b) 23(2) (b,d) 13(4)(b) 16(1) 16(2)(c) 23(1)(a) responsibility to report bad practice or suspicions of abuse. The policy must also explain to staff their right to employment protection under the Public Interest Disclosure Act 1998 when highlighting these matters in good faith. This is a repeat requirement. A gap in the garden fencing must be made good. Badly scuffed doors within the home must be renovated Badly marked carpets in communal areas must be cleaned or replaced. Bars of soap must not be left in communal bathrooms. One service users bedrooms had vinyl fllooring rather than carpeting. Private ccommodation should be both homely and domestic in nature. The Registered Persons must demonstate how this flooring meets the assessed needs of service users in these rooms. Paper towels must be available in all communal bathrooms. The home should meet the staffing levels it has determined to be minimum levels at all times. The registered persons must ensure that all staff receive appropriate supervision . A requirement for ppropriate supervision has been repeated 6 times. Fire doors must not be propped open 31/08/05 31/11/05 30/09/05 Immediate and ongoing 31/08/05 12. 13. 30 33 13(4)(b) 18(1)(a) Immediate and ongoing 30/06/05 14. 36 18(2) 30/09/05 15. 16. 42 13(4) (a,b,c) 23(4)(a) Immediate and ongoing The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 24 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. 2. 3. 4. Refer to Standard 24 37 19, 43 33, 37 Good Practice Recommendations The registered persons should replace the kitchen, which is old and lacks certain basic facilities. Records should not be altered in typex. Where the staff who actually worked are different to those planned to work this should be shown clearly. Daily care notes and nursing notes should be developed and routinely include time serviceusers spend in their own room. Continegency arrangements for maintaining adequate staffing levels should be in place. The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection St Vincents House Cutler Street Ipswich IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Firs Nursing Home I54-I04 S31547 Firs V235240 050623 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!